RE: Commercial/Medicare-Pt turns 65

[Guest guest]

If he or his spouse

is not working his Medicare is primary due to age.

Beverly Antoine, LPN

Transplant Financial Coordinator

LSU-UMC

Laffayette, LA

bantoi@...

From: TxFinancialCoordinators [mailto:TxFinancialCoordinators ] On Behalf Of cfegley

Sent: Monday, March 31, 2008 12:43

PM

To: TxFinancialCoordinators

Subject:

Commercial/Medicare-Pt turns 65

Ladies,

I have a patient who just turned 65. He has a BC BS plan as primary

w/Medicare as secondary. Does his turning 65 make Medicare primary or

does he need to finish out the coordination of benefits period first?

Thanks.

Fegley

Renal Tx Program

Saint Luke's Hospital

of Kansas City

[Guest guest]

From the MSP Guide:

20.1.3 - Dual Eligibility/Entitlement Situations

(Rev. 49, Issued: 04-07-06; Effective/Implementation: 05-08-06)

If an individual also becomes entitled to Medicare based on age 65 or disability after being entitled based on ESRD, the coordination period continues for the remainder of the 30-months if Medicare was properly the secondary payer at the time of the dual entitlement.

When an individual is eligible for, or entitled to Medicare based on ESRD and also entitled on the basis of age or disability, the coordination of benefits is described below.

Except as provided in subsection B, GHPs are subject to a 30-month coordination period for any plan enrollee eligible for, or entitled to Medicare based on ESRD, regardless of whether that individual also is entitled to Medicare on the basis of age or disability. The 30-month period coincides with the first 30 months of ESRD-based Part A Medicare eligibility or entitlement. (Under previous law, Medicare automatically became the

Becca Jerominski Financial Coordinator Transplant Program Christiana Health Care Services Phone (302)623-7088 Fax