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Primary payer, what can I do now?

Question: Eighteen months ago, my wife signed up for health insurance coverage for our entire family from her employer. I am also covered by Medicare and her employer told us Medicare would be my primary payer. Now Medicare is saying the employer's insurer should have been the primary payer all along! The problem is that she no longer has that insurance because she got a new job. What can I do now?

Al, Pennsylvania

Dear Al,

It appears there was some miscommunication between your wife's former health plan administrator and Medicare. The rule is: If the employer has fewer than 20 employees, Medicare is the primary payer for a dually enrolled plan member. If the employer has more than 20 employees, the group health plan is the primary payer for a dually enrolled plan member.

I'm assuming that you're upset because Medicare now wants to be reimbursed for 18 months of overpayments it made on your behalf. I suggest that you call Medicare's Coordinator of Benefits at (800) 999-1118 and ask for help in resubmitting the bills to your wife's former health plan. If you continue to have problems, call your state department of insurance and ask for help in resolving the issue. You can find the department's contact information by selecting the state in which you live from the "Insurance in your state" pull-down menu at the top of this page.

When your wife dropped her former employer-based health insurance, Medicare once again became your primary payer. If you should decide to enroll in your wife's new group health insurance plan, make sure the new plan administrator is aware of the rules governing Medicare's coordination of benefits to prevent this situation from occurring again.

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Disclaimer: We are journalists, not financial planners or insurance brokers. Nothing we say should be interpreted as a recommendation to buy or sell any insurance product, or to provide other financial or legal advice.

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