Crossover Agreement Medicare

Crossover Agreement Medicare: What It Is and How It Works

Medicare is a federal health insurance program that provides coverage to people who are 65 years and older, as well as those under 65 with certain disabilities. However, Medicare does not cover all medical expenses, and beneficiaries are often left with gaps in coverage. To address this issue, Medicare has established a crossover agreement with other insurers to help cover these gaps.

What is a Crossover Agreement?

A crossover agreement is an arrangement between Medicare and another insurance company or healthcare provider that allows them to share the cost of medical services provided to Medicare beneficiaries. Medicare is the primary payer, while the other insurer is the secondary payer. This means that Medicare pays for the covered services first, and the secondary payer covers the remaining costs.

How Does the Crossover Agreement Work?

When a Medicare beneficiary receives medical services, their healthcare provider will submit a claim to Medicare. Medicare then processes the claim and pays for the covered services. If there are any remaining costs, Medicare will forward the claim to the secondary payer, who will then pay the remaining amount.

The crossover agreement is particularly important for beneficiaries who have additional health insurance coverage, such as employer-sponsored health plans, veterans’ benefits, or Medicaid. In these cases, the crossover agreement ensures that the beneficiary receives the maximum amount of coverage possible and that their out-of-pocket costs are minimized.

What Services are Covered Under the Crossover Agreement?

The services covered under the crossover agreement vary depending on the other insurer’s policies. However, the following services are typically covered:

• Co-payments, deductibles, and coinsurance for Medicare-covered services

• Costs for medical equipment and supplies

• Prescription drug costs

• Costs for Medicare-covered services that are not fully covered by Medicare, such as certain preventive services

It’s important to note that services not covered under Medicare, such as long-term care, are not covered under the crossover agreement.

How to Find Out if Your Plan has a Crossover Agreement

If you have additional health insurance coverage in addition to Medicare, you should contact your insurer to find out if they have a crossover agreement with Medicare. The insurer should be able to provide you with information on what services are covered and how the coordination of benefits works.

In conclusion, the crossover agreement between Medicare and other insurers is an important aspect of healthcare coverage for Medicare beneficiaries. It ensures that beneficiaries receive the maximum amount of coverage possible and that their out-of-pocket costs are minimized. If you have additional health insurance coverage, it’s important to check if your plan has a crossover agreement with Medicare to take advantage of this benefit.