Do Medicare supplements always cover the remaining 20%?

One question I have is for the patients that have Medicare and a Secondary insurance, how do you figure what they owe in cash? Medicare generally pays 80% of the CMS fee schedule, right? The other 20% then goes to the secondary, correct? How do I know how much of the last 20% the secondary will cover? Will the secondary cover the Medicare deductible? Do I have to been in network with the secondary?

There are secondaries, supplements and Medicaid plans that pick up what Medicare doesn’t. As a reminder, for Medicaid patients, they only pay up to the Medicaid allowed amount (which may be significantly less than 80% of Medicare depending on your state) and you can’t balance bill the patient. Know your state’s Medicaid rates, which you can use google to search for.

Generally speaking, 99% of the time you don’t need to credential with secondaries to get them to pay secondary to Medicare.

And you definitely don’t have to for supplements. But you do need to train your staff to check to make sure that the secondary or supplement pays the remaining 20% Medicare coinsurance or Medicare deductible.

This is another reason why practice owner must pay attention and collect at the time of service, which is much more efficient than hiring a billing company that will just write off these amounts, or hiring a in house biller that doesn’t know about this.

There are some supplements that don’t pay the 20%. For UHC/ AARP plans the list is below. 

Look at the card- plan K collect 10% of Medicare allowed amount; plan L 5% of allowed; and plan N $20 copay. I wish someone had told me this when I first opened- was wondering why the insurance didn’t pay full 20%!

Also plan F typically covers Medicare deductible and full 20%. But there is a new high deductible plan F for Humana, M of O among others. So this high deductible F plan won’t cover the Medicare deductible (collect at time of service or hold claim) nor the 20%. On a lot of cards it appears as plan HF so be aware!

Some other secondaries or supplements have deductibles we don’t go to too much trouble to figure it out unless obvious from card or PM system, but when you get EOBs back make a alert in your PM system (your in house biller or billing company should do so) to get the correct amount at time of service. 

Leave a Reply