Primary insurance: the insurance that pays first is your “primary” insurance, and this plan will pay up to coverage limits. You may owe cost sharing. Secondary insurance: once your primary insurance has paid its share, the remaining bill goes to your “secondary” insurance, if you have more than one health plan.

What is a secondary payer in insurance?

Secondary Payer — under federal law, Medicare is only secondarily responsible for paying medical expenses for individuals covered by Medicare who are also covered by any type of private insurance. An example of how this concept applies is in the context of workers compensation claims.

Who is the primary payer for Medicare when it is secondary?

When Medicare is secondary, your current insurance will pay the majority of the cost for covered services. You can also confirm how Medicare works with your current insurance by contacting the Social Security Administration (SSA) or Medicare.

Can a second insurance pay more than primary insurance?

If $200 is allowed, the first pays $100, but the second will only pay $50 because their contracted rate is $150., or nothing at all if the primary allowed amount exceeds their fee schedule. Our policy is if we are contracted with both insurances we follow the latest payer.

Is the second payer allowed more than the first?

Our policy is if we are contracted with both insurances we follow the latest payer. Personally I have been balance billed by a hospital because the second payer allowed less than the first, despite both payers being in network, so it seems to me that there is no hard rule regarding this. If anyone knows of one, please share!

When did Medicare become a secondary payer to WC?

Under the Medicare law, as enacted in 1965, Medicare was the primary payer for services except those covered by workers’ compensation (WC). In 1980, Congress enacted the first of a series of provisions that made Medicare the secondary payer to certain additional primary plans.