Supplemental Insurance vs. Secondary Insurance

Medicare providers and beneficiaries often confuse supplemental insurance payments with Medicare secondary insurance payments. The policies are not related to each other and are applied independently of one another to a Medicare claim.

Supplemental Insurance

Medicare Supplemental insurance is an insurance plan that provides additional payments for Medicare covered services after Medicare has issued payment. Medicare will pay the claim as the primary insurance and then the supplemental insurance will make payment on the remaining balance according to the benefits offered by that insurance.

Once a claim has processed through the Medicare system and paid according to the Medicare allowed amount, the Medicare claim will then "cross over" to the supplemental insurance company through the Benefits Coordination & Recovery Center (BCRC) for the supplemental insurance payer to process the remaining balance for possible payment.

The supplemental insurance company is responsible to set up the beneficiary information for their subscribers to their supplemental policies at the BCRC.

Medicare as Secondary Payer on a Claim

Medicare Secondary Payer (MSP) insurance occurs when Medicare is the next payer to another insurance company paying first or "primary." Claims must process through the beneficiary's primary insurance and then the claim may be submitted to Medicare, usually by the primary payer (or on rare occasions, by the beneficiary) for possible secondary payment.

Part A and Part B providers must submit the claim using UB-04 or CMS-1500 claim form (or electronic equivalent) coding to report the information from the primary payer's Explanation of Benefits (EOB). Medicare will then process the claim and will pay according to the Medicare calculations for secondary payment on the remaining balance of the claim.

Beneficiary's Responsibility

The beneficiary is responsible for supplying insurance information for updating their primary and secondary insurances with the BCRC. The beneficiary (and sometimes the provider) may update the information by contacting the BCRC at 1-855-798-2627 (TTY/TDD: 1-855-797-2627 for the hearing and speech impaired).

Last Updated Thu, 17 May 2018 13:30:27 +0000