All FEHB plans have benefit adjustment or dual coverage provisions. The purpose of this provision is to ensure that participants and covered family members can recover as much of their medical expenses as their total coverage allows, without exceeding their actual medical expenses. Under this provision, one plan typically pays the full amount of benefits as a primary payer, and the other plan pays reduced benefits as a secondary payer.
Generally, if you are enrolled in Medicare and (1) are 65 years of age or older and (2) are not a federal employee, Medicare is your primary payer for your health benefits and your FEHB plan is your secondary payer. Masu.
Additionally, if you are age 65 or older and have only Medicare Part B health insurance, regardless of your employment status, Medicare will be your primary payer. If you are a federal retiree with self- and family insurance coverage and your eligible spouse is age 65 or older and has Medicare coverage, if you or your spouse is employed in the federal government. Medicare is the primary payer for your spouse’s health benefits, unless you have a spouse. I have Medicare Part A hospital insurance.
If you or a covered family member is under age 65 and eligible for Medicare benefits based on a disability:
• If you are employed by a federal agency, your FEHB plan is your primary payer for your medical benefits and Medicare is your secondary payer.
• Medicare is your primary payer and FEHB is your secondary payer if you are not employed in the federal service.
If you have questions about whether a FEHB plan or Medicare is the primary payer for your or a covered family member’s medical benefits, please contact your local Social Security Administration.
All FEHB plans adjust the benefits paid to complement, rather than duplicate, Medicare benefits. When Medicare is the primary payer, it typically pays the full allowable benefit and the FEHB plan pays the reduced benefit as a secondary payer. Typically, the total amount paid by both equals 100 percent of the covered or allowable expenses. Although you may be paid 100% of your covered or allowable costs, you may incur remaining medical costs that are not covered by either Medicare or your health benefits plan.
Any costs not covered by compensation shall be borne by the customer.
If Medicare is your primary payer, you must first submit your claim to Medicare for payment consideration. This is because your health insurance cannot process your claim until you pay the Medicare-covered costs. Be sure to submit an explanation of the benefits you received from Medicare to his FEHB plan along with your bill.
