To put it briefly, when you are covered by both Medicare and additional health insurance (for instance, from an employer-sponsored health plan, post-employment benefits, or Medicaid), each form of coverage is labeled a “payer.” If multiple payers are involved, “coordination of benefits” regulations determine the order in which they pay. The “primary payer” covers its share of your expenses initially and forwards any remaining amount to the “secondary payer” (also known as supplemental payer) for payment. Occasionally, there might even be a third payer involved.
Should the insurer fail to settle the claim (typically taking up to 120 days), your healthcare provider or facility might send the bill to Medicare. In such instances, Medicare might execute a temporary payment to settle the bill and subsequently reclaim any costs that the primary payer was responsible for.
