How Do Medicare Supplements and Medicare Work Together?

Medicare Supplements and Medicare work together seamlessly. Many people are used to types of health insurance that require pre-approvals, have waiting periods and require you to file claims manually. Medicare Supplements, on the contrary, do not have any of those complicated features and are extremely easy to use.

Where Can You Use Medicare Supplements and Medicare?doctor looking at medicare patietn

The way it works is that Medicare is your primary coverage. It is accepted at nearly all doctors/hospitals nationwide. Anywhere that Medicare is accepted, the Medicare Supplement plans are also accepted. There are no networks for Medicare Supplement plans. If your plan has a network, it is not a traditional Medicare Supplement but is likely a Medicare Advantage plan (plan that replaces Medicare and has a network).

Many physician group and hospital publish annual lists showing which plans they will/will not accept for the following year. This can be confusing to Medicare beneficiaries, who assume that this also includes Medicare Supplement plans. However, if your doctor/hospital accepts Medicare, they are required to accept your Medicare Supplement plan. So the main question that you need to ask is whether your provider accepts traditional Medicare.

Do You Have to Have a Pre-Authorization to Use a Medicare Supplement Plan?

Medicare itself does not typically require pre-approvals or pre-authorizations for most medical tests or procedures. However, it is a good idea to check with your doctor to ensure that any recommended medical tests or procedures are Medicare-covered prior to having them done.

From the Medicare Supplement perspective, though, there are no pre-approvals or prior authorizations required. Any time that Medicare approves a claim, the Medicare Supplement provider will receive and pay their portion through the Medicare “Crossover” system.

what is the medicare crossoverWhat is the Medicare “Crossover” System?

So, how do Medicare Supplements and Medicare pay claims? It’s pretty straight-forward, really. They pay claims through the Medicare “crossover” system, which is Medicare’s automated system to ensure timely and correct claims payments. On Medicare Supplement plans, you should never have to manually file a claim or work individually with the insurance company to file, manage, or get a claim paid.

Let’s look at an example of how it works: You go to the doctor on February 15. You present your Medicare card and the card from your Medicare Supplement company. The doctor’s office files the claim with Medicare right away. Medicare pays its portion and coordinates payment from the supplement company electronically through the “Crossover” system. If you have a plan that does not pay the Medicare Part B deductible (i.e. Plan G) or a plan that requires a co-payment (i.e. Plan N), you’ll receive a bill a couple of weeks later from the doctor’s office for the amount you owe. If you have a plan that does NOT have a co-pay and DOES pay the deductible, you will simply receive two “Explanation of Benefits” (EOB) showing what Medicare and the supplement company paid.

What Types of Plans Do Not Work This Way?

Medicare Supplements and Medicare plans are often confused with other types of Medicare coverage, such as a Medicare Advantage plan, a Medicare SELECT plan, or a group plan. Those three plan types are NOT Medicare Supplements. All three of those plan types have networks – some are PPOs, some are HMOs. It is important not to confuse the two plan types, since they work completely differently.

The Bottom Line

There is a reason that Medicare Supplement plans have a 97% satisfaction rating. The bottom line with Medicare Supplements and Medicare is that the plans work together seamlessly. Medicare Supplements were designed to go with Medicare and “supplement” it. As such, they pay claims in an automated way, can be used anywhere that takes Medicare and are among easiest insurance products to understand (because they are standardized) and use.

Those same factors, however, can work against your pocketbook. If you have had a Medicare Supplement for a while, chances are you are happy with how it works. They all work – efficiently and easily. This can mean that you keep it at all costs, even if the rates have increased significantly. In reality, the plans are standardized, and if you’ve had a plan for 2+ years, it is likely you could reduce your costs for equivalent coverage.compare medicare supplement plans

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Medicare-Supplement-Comparison.com is a leading, independent Medicare insurance brokerage. We have worked with thousands of Medicare beneficiaries over the last 10+ years on comparing and choosing a plan that fits their needs. If you have questions about Medicare plans or anything else about Medicare, please do not hesitate to contact us online or by phone at 877.506.3378.

 

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