Monday, January 27, 2014

IBM Medicare Extend Health - Medicare and medigap (aka supplemental) claims crossover

If you are using Original Medicare and have a secondary medigap supplemental insurance policy the medigap usually will have a crossover agreement with Medicare to get your claims from Medicare. How the crossover agreement works will depend on the secondary insurance company that issued your policy. Automatic crossover claims processing is really easy.  After I set it up,  I never had to file any claims with Aetna.  Medicare automatically sent claims to Aetna.  Do not assume your new medigap insurance company will do the same.
I have a user account on so I can see claims filed by doctors and also see my insurance profile without having to call Medicare or wait for a Medicare Summary Notice (aka MSN) which is mailed out once a quarter.  I looked at my secondary insurance profile on  today and it still showed Aetna as my secondary insurance.  There is no capability for a Medicare recipient to change that field.  Only insurance companies are authorized to notify Medicare of changes and it takes approximately 6 weeks for a change to be implemented.
If you have a medigap policy, your secondary insurance company may be willing to work with both the old IBM plan and Medicare to make the change. Call your insurance company and ask if they will do it or if they have already done it. When I first used Aetna Integration, it took one call to them and they worked with both Medicare and United Heath Care to make the change. 
This time, my insurance company would not do changes because of how they do crossover. It is not automatic.  I am paying a really low premium for a medigap F high deductible insurance plan so  I had low expectations. Also, Aetna did not notify Medicare that my 2013 policy terminated which is sort of crazy because it means Medicare would keep sending claims until Aetna told them to stop.  Aetna would have to keep denying those claims -- all of which has to have some administrative cost. Anyway, I called Aetna to have them notify Medicare my plan terminated.  Then I called my new insurance company to find out how their crossover works. 
By way of example, this is how my company does it - which is not great but worth the low premium:
  • I ask the doctor's office to put the insurance company code on the Medicare claim form (in position 9D).  That code tells Medicare to fax or mail a copy of the claim to the insurance company. If there are Medicare employees involved in the process, I bet it doesn't work very well but it's worth trying.
  • If the doctor's office cannot, I could ask if them to fax or mail a copy of the Medicare insurance claim directly to the insurance company. Since that does require human action, I won't ask.
  • If the doctor's office cannot put the code on the claim,  then I will fax or mail a copy of the MSN to the insurance company when I get it. That is the official copy.  Print out of a claim from the website is not an "official" copy.
Even if there were automatic crossover, an F high deductible plan doesn't start paying until your out-of-pocket is $2110 for Medicare deductibles and copays. I will keep track of my Medicare deductibles and copays because I will submit them to Extend Health for HRA reimbursement. I'll also track it to be sure my insurance company starts paying if I hit the $2110 (and I sure hope that doesn't happen).  Even the IBM medical supplemental insurer United Heath Care was not good about keeping track of my out-of-pocket amounts (it was $4000 last time I used that plan) and made mistakes.


  1. PLATO, This is the first year for me to have Medicare and a medigap secondary policy (previously I had a Medicare Advantage plan). I see my medigap policy listed as my secondary insurance at Does this mean Medicare will automatically send my claims to them after Medicare processes them? I too have a HD type F medigap,so thanks for the tip in regard to keeping close tabs on the out-of-pocket expenses which go toward my deductable. I hope my medigap company will send me an EOB for each Medicare claim even if I haven't reached my copay yet. Speaking of copays,I think I read the Type F HD copay went up $40 for 2014. I hope the government doesn't begin to increase this more drastically in the future.

    1. I am not sure if Medicare will automatically send claims to your medigap even though it is listed in your profile because it's up to the medigap what process they use. I suggest you call the medigap insurance plan to ask them what their cross over process is. I was surprised by the low tech way my policy handles it. Ditto for sending statements to you. The medigap insurance process for sending EOBs varies from company to company so ask them how they do it. Regarding the deductible .... it seems to go up by $20 or $30 from year to year. When I first started looking at them in 2009 the deductible was something like $2090. It is regulated by the government and if an insurer does not like the deductible amount they do not have to sell the plan. AARP United Healthcare doesn't sell it in NY. It is likely it will gradually keep going up between $20 and $40 a year.