Medicare secondary coverage of high-deductible, employer health plans

in /Ask Phil by

Alan – Calif.: I have a question about Medicare as secondary payer. I am over 65 and a part-time county government employee. As an active employee, I must be enrolled in a county health plan and can’t opt out. As a part-time employee, I can get a $500 deductible PPO [preferred provider organization] plan for a premium of around $4,500 a year or get a $5,000 deductible PPO plan for zero premium, which is what I have chosen. I am enrolled in Medicare Part A and Part D (my high deductible plan is considered non-creditable drug coverage). If I get Medicare Part B and my primary insurance has a $5,000 deductible, will Medicare Part B pay as secondary payer on a claim if the $5,000 deductible has not yet been met? I have asked this question to seven Medicare phone customer service people! Three said no, and that Medicare Part B wouldn’t pay until the entire $5,000 deductible has been met. Three said yes, and that Part B would pay on the claim. The seventh time I asked for a supervisor, who said Medicare Part B might pay on the claim! Very frustrating.

Phil Moeller: Kudos to Alan for continuing to search for an answer to this question. I am not sure I would have been so diligent. I only hope I’m up to the pressure of casting the tie-breaking vote. Fortunately, the public-information folks at Medicare (actually at the Centers for Medicare & Medicaid Services, which oversees Medicare) were unequivocal in their response. The answer is yes. Where Medicare is a secondary payer, it will pay even though the primary payer’s deductible has not yet been reached. Here is the spokesman’s precise explanation:

As long as Medicare’s deductible is met, Medicare will make the appropriate payment, including a secondary payment, for Medicare covered and otherwise reimbursable items and services. This includes secondary payments, where the primary payer’s deductible has not been met.