Unlock the Mystery: Medicare Supplements vs. Secondary Insurance Explained

Supplemental vs Secondary insurance has been a hot topic recently, so let’s discuss the differences.

Don’t forget, my Medicare billing course goes in-depth into everything you need to know to bill Medicare, and you get lifetime access with unlimited replays. You can grab it here.

Medicare Supplemental Plans 

Medicare Supplemental insurance is an insurance plan that provides additional payments for Medicare-covered services after Medicare has issued payment. Medicare will pay the claim as the primary insurance and then the supplemental insurance will make payment on the remaining balance according to the benefits offered by that insurance. Not all supplemental plans cover the 20$ co-insurance that Medicare doesn’t pay, to know for sure you’ll need to check with the supplemental payor. 

Once a claim has been processed through the Medicare system and paid according to the Medicare allowed amount, the Medicare claim will then "cross over" to the supplemental insurance company and in most cases, you do NOT need to be in network with that payor.

Insurance Secondary to Medicare

Just like with “regular” insurance plans, Medicare beneficiaries can have a commercial insurer that is secondary. This is different from a supplemental plan. Supplements are specific to Medicare to cover the costs that Medicare doesn’t cover. Secondary insurance can have its own copays, coinsurance, and deductibles. These are not automatically crossed over and you’d need to be in network with the secondary plan (unless it has out-of-network benefits). 

Supplemental insurance is most common, but some folks do have a secondary plan (typically an employer plan) so always, always check your client’s insurance cards! 

I cover this extensively (with card examples!) in the Medicare Billing course.

If you want more 1:1 help, you can schedule a free discovery call with me here and check out my Etsy for my progress note template, discharge summary, and other templates to help you streamline your practice.