How To Register a Medicare Beneficiary  

At the end of every year, Medicare beneficiaries pick the insurance they want for the next year at open enrollment. It is important that patients be asked what their insurance plan is currently. Make a copy of the insurance card(s). Run the Real-Time Eligibility (RTE) and confirm registration is correct, including the order of the insurance plans. 

These registration steps should be done at every visit. 

Because Medicare only covers 80 per cent of the allowable after the deductible, the majority of Medicare patients will have two insurances. 

Below are the common selections and how to handle in the office. 

Traditional Medicare 

Medicare Plus a Supplemental Insurance Plan 

A supplement, often called “medi-gap”, pays the co-insurance left over after Medicare processes the claim. This plan may or may not cover the deductible. 

Medicare is the primary insurance; the supplement is the secondary insurance. 

Nothing should be collected from the patient at the time of service. Any remaining balances (e.g., the deductible) will be billed to the patient according to the explanation of benefits (EOB).  

Medicare Plus a Commercial Insurance Plan 

Some patients may have another commercial insurance plan. This plan may be from a former employer, or it may be a spouse’s insurance. Commercial insurance plans follow their own benefit guidelines and may or may not cover the co-insurance. In some instances, this may be more than the co-insurance. 

Depending on the circumstances, this insurance may be the primary plan, or it may be the secondary plan. As life circumstances change, the order that these plans are billed in may change.  

Nothing should be collected from the patient at the time of service. Any remaining balances will be billed to the patient according to the explanation of benefits (EOB). 

Medicare Plus Medicaid 

Medicaid is always secondary to Medicare.  

Nothing should be collected from the patient at the time of service. Medicaid may process claims in three ways: 

1. Medicaid pay the deductible and co-insurance or a portion of this if Medicaid’s allowable is less than Medicare’s. The patient will not pay anything. 
2. Medicaid pays nothing until the patient’s spend down is met. A Medicaid spend down is the amount of medical expenses a person is responsible for before Medicaid pays a portion of the allowable. This is like an insurance deductible. If any balance is due, the patient will get a statement based on the amount they are responsible to pay according to the EOB. 
3. Medicaid pays nothing because the patient is a Qualified Medicare Beneficiary (QMB). QMB recipients have income that is less than 100 per cent of the federal poverty level. There may be an amount adjudicated as patient responsibility by Medicaid, but the practice is required to adjust these balances. 

Part C Medicare 

Medicare Part C, also known as Medicare Advantage, is a health plan that provides Medicare Part A and Part B coverage through a private company. 

This may be the only plan or there may be a secondary plan like above with traditional Medicare insurance. 

The copay listed on the insurance card is usually the only amount the patient will owe. It should be collected at the time of service with two exceptions: 

1. Patient has Medicare Part C and Medicaid as two separate plans. They will have two insurance cards and should be registered with two health plans. Nothing should be collected at the time of service. Any balance due will be billed to the patient. 
2. Patient has both Medicare and Medicaid and selected a dual insurance benefit plan. A Dual Eligible Special Needs Plan (D-SNP) is a managed care plan for people who qualify for both Medicare and Medicaid. Only one insurance plan should be registered. Nothing should be collected at the time of service. Any balance due will be billed to the patient. 

In both circumstances, the patient may also be a QMB. As above, in that event any remaining balances will be adjusted for the practice. QMB status is found in the RTE results.