## Overview

 

 Health care providers, the Medicare program and insurance companies work together to make sure your Medicare claims are paid correctly.

Many situations affect how your Medicare claims get paid, such as workers’ compensation, Veterans’ benefits, COBRA, group health insurance or supplemental Medicare plans.

Learn how it works with this official government booklet.

[View Medicare guide](https://www.medicare.gov/publications/02179-how-medicare-works-with-other-insurance.pdf)



 

 

 

 

 ### Simple definitions

- **Medicare primary payer**: Pays for your health care costs up to the limits of your coverage.
- **Medicare secondary payer**: Pays the rest of your health care costs up to the limits of your coverage.



 

 

 

 

 

 

## Claim payments

 ## Medicare claim payments

How your Medicare claims get paid also depends on whether you have just Original Medicare or if you are enrolled in a supplemental Medicare plan. This chart provides a summary of who pays for Medicare Part A and Part B costs:

Medicare planWho pays\***ORIGINAL MEDICARE**  
*Coverage from the federal government***Medicare Part A:** Covers hospitalization- Medicare is primary payer for Part A services
- Member pays the rest

**Medicare Part B:** Covers doctor visits, outpatient care and tests- Medicare is primary payer for Part B services
- Member pays the rest

**PLANS THAT REPLACE ORIGINAL MEDICARE OR OFFER ADDITIONAL MEDICARE COVERAGE**  
*Optional coverage you can buy from a private insurer to help pay for what Original Medicare doesn’t cover***Medicare Supplement (Medigap) plan:**  
A private insurer pays for expenses Part A and Part B don’t cover- Medicare is primary payer for Part A and Part B
- Insurer is secondary payer for Part A and Part B expenses not covered by Medicare
- Member pays the rest, if anything

**Medicare Cost plan**  
A private insurer contracts with Medicare to provide Part B benefits (and sometimes Part D)- Medicare is primary payer for Part A services, and insurer is secondary payer
- Insurer is primary payer for Part B services and Part D prescriptions if part of plan benefits
- Member pays the rest, if anything

**Medicare Part D plan**  
A private insurer contracts with Medicare to cover prescription benefits. Medicare does not cover Part D prescription drugs.- Insurer is primary payer for covered prescriptions
- Member pays the rest, if anything

**Medicare Advantage (Part C) plan:**  
A private insurer contracts with Medicare to provide Part A, Part B and Part D benefits- Insurer is primary payer for Part A, Part B and Part D services
- Member pays the rest, if anything



\*For eligible services covered by Medicare or the health plan

If you're a Blue Cross Medicare member, [log in](https://identity.bluecrossmn.com/u/login?state=hKFo2SBxdThLYmNVQ3YwQWNlbGZmQkRKLXZmVkhiRk9CR0VORqFur3VuaXZlcnNhbC1sb2dpbqN0aWTZIF9Za0dDYXFWeHBCMlRDeFkwNlFLTm5VZ0dxTTNlb0xqo2NpZNkgcDZ2elJyNHBQRUFvWkM4d0NVQWNMU3VNSHU2OEJKMm4) or [create an account](https://members.bluecrossmn.com/) to check your claim status.







 

 

 

 

 

## Claim process

 ## Medicare claim process

Medicare and insurers work together to pay claims. But how it works depends on the type of plan you have.

Remember that if you use a provider in your plan network, the provider will submit claims for you. If you use an out-of-network provider, you will need to submit your own claim.



 

 

 

 ###  Original Medicare plan 

- You present your Medicare ID card to your health care provider
- Your provider sends your claim to Medicare
- Medicare pays first and sends payment directly to the provider
- Medicare sends you a statement saying what you owe
- You pay the balance to the provider directly



 

 

 



###  Medicare Supplement and Medicare Cost plans 

- You present your Medicare ID card and insurance ID card to your health care provider
- Your provider sends your claim to Medicare and your insurer
- Medicare is primary payer and sends payment directly to the provider
- The insurer is secondary payer and pays what they owe directly to the provider
- Then the insurer sends you an Explanation of Benefits (EOB) saying what you owe, if anything
- You pay the balance to the provider directly



 

 

 



###  Medicare Advantage plans 

- You present only your insurance ID card to your health care provider (store your Medicare ID card someplace safe)
- Your provider sends the claim to your insurer only
- The insurer is primary payer and pays what they owe directly to the provider
- Then the insurer sends you an Explanation of Benefits saying what you owe, if anything
- You pay the balance to the provider directly



 

 

 



 

 

 

 

 

SilverSneakers® is a registered trademark of Tivity Health, Inc., an independent company that provides health and fitness programs. Blue Cross Medicare Advantage, Platinum Blue, Senior Gold and other Medicare Supplement and SecureBlue plans are eligible.

TruHearing® is a registered trademark of TruHearing, Inc., an independent company who works with health plans to offer low out-of-pocket costs on hearing aids.

S5743\_090825\_G02\_M  
Y0138\_090825\_ G01\_M