Medicare Supplement Insurance Options
Medicare Supplement Insurance (Medigap) and Medicare Advantage plans differ in coverage and costs. Medigap policies fill coverage gaps in Original Medicare, while MA plans replace Parts A and B. Learn about the distinctions and costs of these insurance options to make informed decisions for your healthcare coverage.
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2017 National Training Program Medigap Helpline Services. Medicare Supplement Insurance Policies; Medicare Advantage Plans; Other Insurance Coverages. August 16, 2017
Medicare Coverage Choices Part B Medical Insurance Part A Hospital Insurance Part A Hospital Insurance Part B Medical Insurance and/ or and OR Medicare Advantage Plan Part C Combines Part A and Part B and usually Part D Original Medicare You can add one or both Sometimes may add a Separate Part D Plan Prescription Drug Coverage (Most Part C plans cover prescription drugs. You may be able to add drug coverage to some plan types if not already included.) Medicare Supplement Insurance (Medigap) Policy. Must have Part A and B Part D Prescription Drug Coverage. Can have Part A and/or Part B June 2017 Medicare Supplement Insurance (Medigap) Policies 2
Medicare Supplement Insurance Often called Medigap Private health insurance Supplements Original Medicare Helps pay some health care costs that Original Medicare doesn t cover (coverage gaps ) Medicare will pay its share of the Medicare- approved amounts for covered health care costs Then the Medigap policy pays its share A Medigap policy covers one person June 2017 Medicare Supplement Insurance (Medigap) Policies 3
How Are Medigap Policies and Medicare Advantage (MA) Plans Different? Medicare Supplement (Medigap) Insurance Medicare Advantage Plans (Part C) Offered by Private companies Private companies Government oversight State, but must also follow federal laws Federal (plans must be approved by Medicare) Works with Original Medicare (Replaces Medicare A&B) Covers Gaps in Original Medicare coverage, like deductibles, coinsurance, and copayments for Medicare-covered services. All Part A and Part B covered services and supplies. (Will have copays/ coinsurance on services) May offer coverage for things not covered by Original Medicare, like vision and dental coverage. Most MA Plans include Medicare prescription drug coverage. (Depending on Riders, may have copay/coinsurance on some services) Part A and Part B Yes. You pay a premium for the policy and you pay the Part B premium. You must have Do you pay a premium Part A and Part B Yes. In most cases you pay a premium for the plan and you pay the Part B premium. June 2017 Medicare Supplement Insurance (Medigap) Policies 4
Original Medicare Costs in 2017Part A Medicare Cost Amount You Pay Part A deductible $1,316 for each benefit period Inpatient hospital stay No coinsurance for days 1 60 $329 per day for days 61 90 $658 per day for days 91 150 (60 lifetime reserve days) All costs for days after 150 Skilled nursing facility care No coinsurance for days 1 20 $164.50 per day for days 21 100 All cost for days after 100 Hospice care 5% of the Medicare-approved amount for inpatient respite care (coinsurance). A copayment of up to $5 per prescription for outpatient prescription drugs for pain and symptom management. June 2017 Medicare Supplement Insurance (Medigap) Policies 5
Original Medicare Costs in 2017Part B Medicare Cost Amount You Pay Annual Part B deductible $183 Coinsurance and copayment for Part B services 20% coinsurance for most covered services, like doctor s services and some preventive services, if provider accepts assignment $0 for some preventive services 20% coinsurance for outpatient mental health services, and copayments for hospital outpatient services Part B premium $134 per month is the standard premium Higher for those with higher incomes $109 is the average premium if you get Social Security benefits June 2017 Medicare Supplement Insurance (Medigap) Policies 6
Medigap Plans Standardized plans identified by a letter Plans A, B, C, D, F, G, K, L, M, and N are currently sold All plans offer the same basic benefits Companies don t have to sell all plans Plans E, H, I, and J exist but are no longer sold Plans with the same letter must offer all the same benefits Only the policy cost will vary between companies Waiver states (Massachusetts, Minnesota, and Wisconsin) standardize plans in a different way June 2017 Medicare Supplement Insurance (Medigap) Policies 7
Medigap Plan Types Medicare Supplement Insurance (Medigap) Plans Benefits A B C D F* G K L M N Medicare Part A coinsurance and hospital costs (up to an additional 365 days after Medicare benefits are used) 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% Medicare Part B coinsurance or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100%*** Blood (first 3 pints) 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% Part A hospice care coinsurance or copayment 100% 100% 100% 100% 100% 100% 50% 75% 100% 100% Skilled nursing facility care coinsurance 100% 100% 100% 100% 50% 75% 50% 100% Part A deductible 100% 100% 100% 100% 100% 50% 75% 100% 100% Part B deductible 100% 100% Part B excess charges 100% 100% Foreign travel emergency (up to plan limits) 80% 80% 80% 80% 80% 80% Out-of-Pocket Limit in 2017** $5,120 $2,560 *Plan F is also offered as a high-deductible plan by some insurance companies in some states. If you choose this option, this means you must pay for Medicare- covered costs (coinsurance, copayments, deductibles) up to the deductible amount of $2,200 in 2017 before your policy pays anything. **For Plans K and L, after you meet your out-of-pocket yearly limit and your yearly Part B deductible ($183 in 2017), the Medigap plan pays 100% of covered services for the rest of the calendar year. ***Plan N pays 100% of the Part B coinsurance, except for a copayment of up to $20 for some office visits and up to a $50 copayment for emergency room visits that don t result in an inpatient admission. June 2017 Medicare Supplement Insurance (Medigap) Policies 8
Waiver States Massachusetts, Minnesota, Wisconsin Different kinds of Medigap policies NOT labeled with letters Benefits comparable to standardized policies Basic and optional benefits For information Call your State Health Insurance Assistance Program or State Insurance Department June 2017 Medicare Supplement Insurance (Medigap) Policies 9
Medicare SELECT Policies A type of Medigap policy with a network To get full benefits (except in emergency) Must use specific hospitals, and May have to see specific doctors Can be any of the standardized policies Generally cost less than non-network policies Can switch to plan with equal or lesser value at any time Not available in all states June 2017 Medicare Supplement Insurance (Medigap) Policies 10
Medigap Costs Cost (monthly premium) depends on Age (in some states) Residence (e.g., urban, rural, or ZIP Code) Company selling the policy Discounts (women, non-smokers, married couples) Medical underwriting Process insurance companies use to decide, based on medical history, whether to accept the application for insurance, whether to add a waiting period for pre-existing conditions, and how much to charge Premiums may vary greatly for same Medigap plan Medicare SELECT policies generally have lower premiums June 2017 Medicare Supplement Insurance (Medigap) Policies 11
Medigap Pricing Based on Age Type of Rating Description No-age-rated (community-rated) Everyone pays same regardless of age if 65 or older Generally least expensive over lifetime Issue-age-rated Based on age when purchased Doesn t go up automatically as get older Attained-age-rated Premium based on current age Costs less when age 65 Cost goes up each year as get older Premiums may go up due to inflation and other factors. Not all states allow all 3 types of ratings. June 2017 Medicare Supplement Insurance (Medigap) Policies 12
The Best Time to Buy a Medigap Policy Medigap Open Enrollment Period (OEP) 6 months when insurance company must sell a policy Guaranteed issue period without medical underwriting OEP begins when aged 65 or older and enrolled in Part B (get only ONE OEP) Can t be changed or repeated Some states have more generous rules (ie. An OEP if start Medicare based on Disability and again at age 65) May be able to buy a Medigap policy any time an insurance company will sell one pass health underwriting. June 2017 Medicare Supplement Insurance (Medigap) Policies 13
Medicare Supplement Insurance (Medigap) Policies for People With Disabilities If under 65 and have a disability Federal law doesn t require insurance companies to sell a Medigap policy If available, choice of plans may be limited and may be charged more based on health status May have to wait until you turn 65 Wisconsin requires Medigap insurance companies to sell Medigap policies if under age 65 starting Medicare. Will also get a 2nd 6 month OEP starting the month turning 65. July 2017 Medicare and Other Programs for People With Disabilities 14
Delayed Medigap Open Enrollment Period (OEP) If enrolling in Medicare Part B is delayed: Because beneficiary or spouse is still working, and are covered by group health coverage Medigap OEP is delayed Until you re 65 and enrolled in Part B No Part B late enrollment penalty Notify Social Security to delay Part B June 2017 Medicare Supplement Insurance (Medigap) Policies 15
Pre-existing Conditions and Medigap Health problem had before the new insurance policy starts Treated or diagnosed 6 months before coverage start date Pre-existing Condition Waiting Period Insurance companies can refuse to cover out-of-pocket costs for excluded condition for up to 6 months ( look- back period ) Unless had 6 months of prior creditable coverage with no break in coverage more than 63 days The Affordable Care Act doesn t impact the pre-existing condition waiting period for Medigap coverage. June 2017 Medicare Supplement Insurance (Medigap) Policies 16
Medigap for People With a Disability or End-Stage Renal Disease (ESRD) In Wisconsin, people with a disability or ESRD are able to buy a policy when starting Medicare A&B and again when turning 65. In other states, companies may voluntarily sell Medigap policies May cost more than policies sold to people over 65 Can use medical underwriting Get a Medigap Open Enrollment Period at 65 June 2017 Medicare Supplement Insurance (Medigap) Policies 17
Steps to Buy a Medigap Policy STEP 1: Decide which benefits/riders are wanted, then decide which of the Medigap policies meets those needs. Get a listing of the insurance companies selling Medigap policies in the state. Compare costs of the Medigap Policies sold by those insurance companies Buy the Medigap policy STEP 2: STEP 3: STEP 4: June 2017 Medicare Supplement Insurance (Medigap) Policies 18
Switching Medigap Policies Might switch policies if: Want to change insurance companies Find a cheaper policy May pay more for the new policy There will be medical underwriting Could have a delay in coverage for a pre-existing condition When you buy a new Medigap policy You ll have a 30-day free-look period You ll need to pay both Medigap policy premiums June 2017 Medicare Supplement Insurance (Medigap) Policies 19
Medigap Guaranteed Issue Rights Federal protections in certain situations Companies must sell a Medigap policy All pre-existing conditions must be covered Can t be charged a higher premium Must apply within 63 days of date other coverage ends Wisconsin has added Consumer Protections Loss of Medicaid (Full Medicaid, QMB, MAPP) Wisconsin gives Guarantee Issue. June 2017 Medicare Supplement Insurance (Medigap) Policies 20
Examples of Guaranteed Issue Rights John is in a Medicare Advantage (MA) Plan. He ll have a Medigap guaranteed issue right if He joined when first eligible for Part A at 65, and in the first year wants to change to Original Medicare (Trial Right) He moves out of the plan s service area His plan leaves Medicare His plan stops giving care in his area or or or If Leave employer coverage for a Medicare Advantage plan and leave that plan within 12 months using Federal Enrollment June 2017 Periods, Wisconsin gives GI rights into a supplement. Medicare Supplement Insurance (Medigap) Policies 21
Examples of Guaranteed Issue Rights (continued) Mary has Original Medicare. She ll have a Medigap guaranteed issue right if She has a Medicare SELECT policy and moves out of her Medicare SELECT policy s service area Her employer group health plan or union coverage that pays after Medicare pays is ending or Wisconsin also gives GI protection: if Employer Coverage increases premium 25% or more over 12 month period Hospital leaves Select network and no other hospital available within 30 miles June 2017 Medicare Supplement Insurance (Medigap) Policies 22
Guaranteed Renewable Policies Medigap policies purchased after 1992 are guaranteed renewable Can t be dropped unless: Stop paying the premium Weren t truthful on the policy application The insurance company goes bankrupt or insolvent June 2017 Medicare Supplement Insurance (Medigap) Policies 23
Right to Suspend Medigap for People With Medicaid If have both Medicare and Medicaid Generally can t buy a Medigap policy Can suspend Medigap policy Within 90 days of getting T19 for up to 2 years Can start it up again No new medical underwriting or waiting periods If suspend a Medigap policy Don't pay Medigap premiums Benefits are not paid May not want to suspend policy to see doctors who don t accept Medicaid June 2017 Medicare Supplement Insurance (Medigap) Policies 24
Right to Suspend Medigap for People Under 65 Can suspend Medigap policy if under 65 While enrolled in own or spouse s employer group health plan Get Medigap policy back at any time Must notify insurer within 90 days of losing employer plan No waiting period June 2017 Medicare Supplement Insurance (Medigap) Policies 25
Medicare Advantage Plans Health plans run by private companies that provide Part A and Part B benefits Part of the Medicare Program Approved by Medicare Most plans include prescription drug coverage Part D May provide vision and dental services (other non- Medicare services) Sometimes called Part C Available across the country May 2017 Medicare Advantage and Other Health Plans 26
Medicare Advantage Plans Medicare pays the plan every month to provide coverage (on average over $800 a month unless on dialysis) Provides Medicare-covered benefits Have Medicare rights and protections May have to use in-network doctors/ hospitals May differ from Original Medicare cost sharing (copays/coinsurance) If the plan leaves Medicare, will have Consumer protections: Join another MA Plan, or Return to Original Medicare (GI for a Medigap) May 2017 Medicare Advantage and Other Health Plans 27
Medicare Advantage Plan Costs Need to pay the monthly Part B premium A few plans may pay all or part of Part B premium State assistance is available for some May pay an additional monthly premium to the plan Plan deductibles, coinsurance, and copayments Different from Original Medicare Vary from plan to plan May have higher costs if out-of-network May 2017 Medicare Advantage and Other Health Plans 28
Joining a Medicare Advantage Plan To be eligible, the beneficiary must Be enrolled in Medicare Part A (Hospital Insurance) Be enrolled in Medicare Part B (Medical Insurance) Live in the plan s service area Be a United States (U.S.) citizen or lawfully present in the U.S. Not be incarcerated To join must also Provide necessary information to the plan Follow the plan s rules Only belong to one plan at a time May 2017 Medicare Advantage and Other Health Plans 29
Medicare Advantage (MA) Plans and End-Stage Renal Disease (ESRD) Usually can t enroll if the beneficiary has ESRD There are limited exceptions Transition from one plan to another within the same parent organization (within same state) No break between coverage Must meet all other enrollment requirements If joined the plan without ESRD, but developed ESRD while in the plan, may stay in the plan If had a successful kidney transplant or no longer require a regular course of dialysis Beneficiary isn t considered to have ESRD for MA eligibility purposes May 2017 Medicare Advantage and Other Health Plans 30
Enrollment into Medicare Advantage (MA) Plans 7-month period begins 3 months before the month turning 65 Includes the month turning 65 Ends 3 months after the month turned 65 Important: If delay Part B enrollment (for example, due to active employer group coverage), the time to enroll in an MA Plan may be more restricted. For more information, visit CMS.gov/Medicare/Eligibility-and- Enrollment/MedicareMangCareEligEnrol/Downloads/CY_2017_ MA_Enrollment_and_Disenrollment_Guidance_8-25-2016.pdf Initial Enrollment Period (IEP/ICEP) CMS.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/CY_2017_MA_Enrollment_and_Disenrollment_Guidance_8-25-2016.pdf CMS.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/CY_2017_MA_Enrollment_and_Disenrollment_Guidance_8-25-2016.pdf CMS.gov/Medicare/Eligibility-and-Enrollment/MedicareMangCareEligEnrol/Downloads/CY_2017_MA_Enrollment_and_Disenrollment_Guidance_8-25-2016.pdf 7-month period begins 3 months before the 25th month of disability benefits Ends 3 months after the 25th month of disability benefits Medicare due to a disability May 2017 Medicare Advantage and Other Health Plans 31
Joining or Switching Medicare Advantage (MA) Plans October 15 December 7 Coverage begins January 1 Medicare Open Enrollment Period open enrollment (AEP) *Can only join one MA Plan at a time, and enrollment is generally for a calendar year. *Plans must be allowing new members to join May 2017 Medicare Advantage and Other Health Plans 32
Joining or Switching Medicare Advantage (MA) Plans (continued) Move out of plan s service area Have Medicaid with Medicare The plan leaves the Medicare Program or reduces its service area Lose employer or union coverage Enter, live at, or leave a long-term care facility (like a nursing home) Continuous (SEP) if you qualify for Extra Help Lose Extra Help status Receive a retroactive notice of Medicare entitlement Enroll into 5 Star plan (caution about Part D coverage) Low Performance plan Other exceptional circumstances Special Enrollment Period (SEP) May 2017 Medicare Advantage and Other Health Plans 33
Leave or Disenroll from Medicare Advantage (MA) Plans May leave an MA Plan May switch to Original Medicare Coverage begins first day of month after switch May join Part D Plan January 1 February 14 (ADP) Drug coverage begins first day of month after plan gets enrollment May not join another MA Plan during this period May be able to buy a Medicare Supplement Insurance (Medigap) policy (underwriting unless in GI or Open window) May 2017 34 Medicare Advantage and Other Health Plans
Medicare Advantage (MA) Trial Rights and Medigap Special Medigap rights for people who join an MA Plan for the first time When first eligible at 65, or Drop a Medigap policy Can disenroll during the first 12 months Return to Original Medicare Have guaranteed issue rights for Medigap Wisconsin GI for a Medigap if enrolled into MA Plan for first time when leaving employer sponsored coverage. Within 12 months using Federal enrollment periods to disenroll. May 2017 Medicare Advantage and Other Health Plans 35
Types of Medicare Advantage Plans Health Maintenance Organization (HMO) HMO Point-of-Service Preferred Provider Organization Special Needs Plan Private Fee-for-Service Medicare Medical Savings Account May 2017 Medicare Advantage and Other Health Plans 36
HMO Plan PPO Plan PPFS Plan MSA Plan No. Unless use POS for out of network. YES, but may pay more if non- network provider. YES, can see any provider who accepts plan s terms. YES, can see any provider who accepts plan s terms. Can you get your health care from any doctor or hospital? Most cases, yes. If want Part D, must select the HMO plan which includes Part D. Most cases, yes. If want Part D, must select the PPO plan which includes Part D. Sometimes; If plan has NO RX, can select standalone PDP. NO, will need a stand alone PDP. Are prescription drugs covered? In most cases, yes. NO NO NO Do you need to choose a primary care doctor? In most cases, yes. Some don t require a referral. Usually NO NO NO Do you need a referral to see a specialist? May pay full cost if services outside of network May offer extra services but may pay extra for those benefits Some PFFS have networks so pay more OON Connected to Medicare Savings Account. What else do you need to know about this type of plan? May 2017 Medicare Advantage and Other Health Plans 37
Medicare Special Needs Plans (SNPs) Can you get your health care from any doctor or hospital? Generally must get care and services from doctors, other health care providers, or hospitals in the plan s network (except emergency care, out-of-area urgent care, or out-of-area dialysis). Are prescription drugs covered? Yes. All SNPs must provide Medicare prescription drug coverage (Part D). Do you need to choose a primary care doctor? Generally, yes. Do you need a referral to see a specialist? In most cases, yes. Certain services, like yearly screening mammograms, don t require a referral. Institutional SNP (I-SNP): Those living in certain institutions (like a nursing home), or who require nursing facility-level of care at home What else do you need to know about this type of plan? Dual Eligible SNP (D-SNP): Those eligible for both Medicare and Medicaid Chronic Condition SNP (C-SNP): Those with specific chronic or disabling conditions Medicare Advantage and Other Health Plans May 2017 38
Medicare Cost Plans Available in limited areas Must have Medicare Part B to join Can see a non-network provider Services covered under Original Medicare With Part A and Part B cost sharing Join anytime new members are being accepted Leave anytime and return to Original Medicare Get Medicare prescription drug coverage From the plan (if offered) OR Join a separate Medicare Prescription Drug Plan (Part D) May 2017 Medicare Advantage and Other Health Plans 39
Medicare and the Marketplace Medicare isn t part of the Health Insurance Marketplace Medicare Part A is considered minimum essential coverage (MEC) No matter which Medicare, contact the Marketplace to end any subsidies, such as Advanced Premium Tax Credits or Cost- Sharing Reductions, which are being paid Having Medicare, it s illegal for someone to knowingly sell a Marketplace plan Can keep a Qualified Health Plan (QHP) through the Marketplace and Medicare at the same time only if were signed up for the QHP before starting Medicare May 2017 Coordination of Benefits 40
Medicare and Marketplace Coordination Generally, there s no coordination of benefits between Marketplace Qualified Health Plans (QHPs) and Medicare Unless enrolled in an employer-sponsored Small Business Health Options Program (SHOP) plan QHPs aren t secondary insurance to Medicare May cause a lifetime Part B penalty if don t enroll in Part B during the Medicare Initial Enrollment Period Unless enrolled in an employer-sponsored SHOP plan If needing to pay a premium for Medicare Part A Can drop Medicare and enroll in Marketplace QHP (with subsidies if otherwise eligible) May 2017 Coordination of Benefits 41
Consumers Who Have Premium-Free Medicare Part A, But Not Part B Consumers who receive a PDM (Periodic Data Matching) notice may have a special opportunity to sign up for Medicare Part B Must visit their local Social Security office by September 30, 2017, to request enrollment in Medicare Part B o Must show their Medicare PDM notice Note: This opportunity will expire September 30, 2017 July 2017 Medicare and the Marketplace 42
Medicare Periodic Data Matching (PDM): Notices to Dually-Enrolled Consumers The Marketplace is mailing paper Medicare PDM notices to consumers who may be dually-enrolled in minimum essential coverage (MEC) Medicare (Part A) anda Marketplace plan Medicare PDM Notices will Include: Names of consumers who were found to be dually- enrolled A recommendation that individuals who are found to be enrolled in MEC Medicare (Part A) and a Marketplace plan should end their Marketplace coverage Instruction on how to end Marketplace coverage or Marketplace financial help (for consumers enrolled in MEC Medicare (Part A) Where to find contact information to confirm if they are enrolled or if they have any questions about Medicare July 2017 Medicare and the Marketplace 43
Premium-Free Medicare Part A and Part BLate Enrollment Penalty Reduction/Removal (Limited) Consumers who received a PDM notice may be eligible to request that their late enrollment penalty be reduced or removed Must be currently or previously dually enrolled in Marketplace coverage (with or without APTC) and Medicare Part A and Part B Must visit their local Social Security office by September 30, 2017, to request removal or reduction of their Medicare Part B penalty o Must show their Medicare PDM notice Note: This opportunity expires September 30, 2017 July 2017 Medicare and the Marketplace 44
Important Retiree Coverage Considerations Most retiree plans offer generous medical and prescription drug coverage for the entire family Employer/union must disclose how its plan works with Medicare drug coverage Talk to your benefits administrator for more information If you lose your creditable prescription drug coverage, you have 63 days to enroll in a Part D plan without penalty People who drop retiree drug coverage may Lose other health coverage Not be able to get it back Cause family members to lose their coverage May 2017 Coordination of Benefits 45
Employer Group Health Plans Coverage offered by many employers and unions To current employees, spouse, and family members To retirees, spouse, and family members Retiree coverage may be employer-based Medicare Part C or Part D plans Includes Federal Employee Health Benefits Program May be fee-for-service plan or managed care plan Employees usually can choose to keep or reject Businesses with 50 or fewer employees can offer Small Business Health Options Program plans May 2017 Coordination of Benefits 46
Employer Group Health Plans (EGHP) Continued If You Are Medicare Pays First 65 or older and have retiree coverage Yes (as long as you don t have excluding conditions such as black lung, or others specified on next page) If the employer has less than 20 employees 65 or older with employer group health plans (EGHP) coverage through current employment (yours or your spouse s) Under 65 with a disability and have EGHP coverage through current employment (yours or a family member s) Eligible for Medicare due to End- Stage Renal Disease (ERSD) and you have EGHP coverage If the employer has less than 100 employees When the 30-month coordination period ends, or if you had Medicare primary before you had ESRD May 2017 Coordination of Benefits 47
Non-Group Health Plans Medicare doesn t usually pay for services when diagnosis indicates that other insurers may provide coverage, including: Auto accidents Illness related to mining (Federal Black Lung Benefits Program) Third-party liability Work injury or illness (workers compensation) May 2017 Coordination of Benefits 48
No-Fault Insurance Includes automobile insurance, homeowners insurance, and commercial insurance plans Pays regardless of who s at fault Medicare is secondary payer Medicare may make conditional payment If claim not paid within 120 days You won t have to use your own money to pay bill Must be repaid when claim is resolved by the primary payer May 2017 Coordination of Benefits 49
Liability Insurance Protects against certain claims Negligence, inappropriate action, or inaction Medicare is secondary payer Providers must attempt to collect before billing Medicare Medicare may make conditional payment If the liability insurer won t pay promptly (within 120 days) Must be repaid when claim is resolved by the primary payer May 2017 Coordination of Benefits 50
