Medicare question

[barbgris]

I have a client who has a Blue Shield Empire PPO plan for Major Medical, but now that he is on permanent disability so now Medicare has become his primary.  He talked with Blue Shield Empire (and he says they told him that once he got Medicare, his PPO insurance policy downgraded from a Major Medical PPO policy  to a Medicare Supplement according to the his employer's contract. He wonders "How is it that my policy is "worth less" than  the same policy than what the other employees have?"  Also, can you help me understand the difference between a medicare supplement and a secondary policy?  I would think this policy is now secondary, not a supplement, but they are saying it is supplemental.

Barb Griswold,, LMFT
Author, Navigating the Insurance Maze: The Therapist's Complete Guide to Working with Insurance -- And Whether You Should
www.theinsurancemaze.com
barbgris@aol.com

[Michele]

The difference between a MCR supplemental and secondary is that MCR supplemental plans simply "supplement" MCR, meaning that they do not cover things not covered by Medicare, they pick up the balance after Medicare.  Secondary plans follow their own policy, so if there is a service not covered by Medicare it may still be covered by the secondary. 

The client you are referring too has an employer sponsored plan that writes their own rules.  Apparently they have specified that if an employee (or retiree) becomes eligible for MCR then they become a supplemental plan.  I bet if your client looks in him employee handbook it will state that.  It's something that people don't pay attention to until it affects them.

Hope that helps!