Medicare secondary payer — Cambridge, MA

The primary Medicare calling number for assistance with your coverage, enrollment, or general inquiries is 1-800-MEDICARE (1-800-633-4227). If you have questions regarding your Social Security benefits, which are linked to Medicare eligibility, you should contact the Social Security Administration. Your specific Medicare Advantage or Part D plan provider will also have a dedicated customer service number listed on your insurance card.

For seniors, Medicare provides coverage through several parts. Part A typically covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Part B covers outpatient medical services, including doctor visits, preventive services, and durable medical equipment. Many seniors opt for Medicare Advantage plans (Part C), which combine Part A, B, and often Part D prescription drug coverage, potentially including additional benefits like dental and vision. Supplemental policies (Medigap) can also help cover out-of-pocket costs.

Medicare Part B covers medically necessary outpatient services, including doctor visits, preventive services, lab tests, X-rays, and durable medical equipment. It also covers ambulance services and mental health services. You generally pay a monthly premium for Part B, and there's an annual deductible and coinsurance for most services. It's crucial to understand that Part B does not cover prescription drugs, routine dental or vision care, or hearing aids, which are typically covered by other plans or policies.

Medicare Part A, often referred to as hospital insurance, primarily covers inpatient hospital stays, including meals, room, and general nursing care. It also covers care in a skilled nursing facility (not custodial or long-term care), hospice care for terminal illnesses, and some home health care services. While Part A generally has no monthly premium for those who have paid Medicare taxes during their working years, there are deductibles and copayments for covered services, depending on the length of your stay.

Supplemental Medicare insurance, commonly known as Medigap, is designed to help pay for healthcare costs that Original Medicare (Part A and Part B) doesn't cover. These policies can help with deductibles, copayments, and coinsurance. Medigap plans are sold by private insurance companies and are standardized, meaning plans with the same letter offer the same basic benefits regardless of the insurer. They require you to have both Medicare Part A and Part B to enroll.

NGS Medicare, or National Government Services, is a Medicare Administrative Contractor (MAC) responsible for processing Medicare Part A and Part B claims for healthcare providers in specific jurisdictions. They handle the administrative aspects of Medicare for providers, ensuring claims are submitted and paid correctly. For beneficiaries, NGS Medicare is generally not the primary point of contact for individual coverage questions; those inquiries are typically directed to 1-800-MEDICARE or directly to the specific Medicare plan provider.