Because Supplemental Insurers are STATE REGULATED and thus the Federal agency of Medicare has to have an agreement with each one of them.
Supplemental policies are only GAP INSURANCE and many of these insurers are not only supplemental insurers within a specific state but they also service several markets within the same state.
They could be just a Medicare Supplemental policy provider for the general retirees going on Medicare.
They could be a Medicare Supplemental policy provider through an employer plan for their retirees
They could be a Medicare Supplemental policy provider through a union plan for their retirees
They could be a Medicare Supplemental policy provider through a civil or federal plan for their retirees
Ass you might know, most Medicare claims are submitted by the provider - CMS processes them, Medicare pays their amount and then it is sent on to the linked Supplemental insurer or supplemental coverage provider - automatically.
It gets complicated sometimes when there is coordination of benefits because sometimes, Medicare pays 1st and other times based on specific criteria of certain employers / unions, the other coverage pays 1st. All of these types also need a COB agreement too.
Why are you even concerned with such inter-workings???? Just curious?
In 2018 / 2019, The Centers for Medicare & Medicaid Services (CMS) developed a model national contract, called the Coordination of Benefits Agreement (COBA), which standardizes the way that eligibility and Medicare claims payment information within a claims crossover context is exchanged. COBAs permit other insurers and benefit programs (also known as trading partners) to send eligibility information to CMS and receive Medicare paid claims data for processing supplemental insurance benefits for Medicare beneficiaries from CMS’ national crossover contractor, the Benefits Coordination & Recovery Center (BCRC).
Purpose: The COBA program establishes a uniform national contract between CMS and other health insurers and benefit programs. The COBA program is a standard processing methodology used by the national Medicare community. The COBA allows greater efficiency and simplification via consolidation of the claims crossover process. The COBA allows other insurers and benefit programs to send eligibility information to CMS and receive Medicare paid claims data, along with other coordination of benefits data, from one source, the BCRC
"Why are you even concerned with such inter-workings???? Just curious?"
Because if I go to medicare.gov it lists United Health Group twice under Other Insurance. I only have one AARP supplemental plan.
I cannot get an answer from Medicare as to why I would have two entries for United Health Group. The only info I can get from Medicare is that the listings are for two different COBA numbers.
So Medicare has YOUR "coordination of benefits" messed up?? Is that right?
if you are looking at Medicare COBAs numbers, you are way outside of finding a solution to your problem or question - It is Medicare that will fix any problem you are having with YOUR "coordination of benefits", if that is where the problem lies.
UnitedHealthcare is the insurance arm of UnitedHealth Group
UnitedHealth Group also operates Optum, - OptumRx is a pharmacy benefit management services - which could be your Medicare Part D plan.
I only have an AARP United Health Part B Supplemental plan. My part D plan is with a different insurance company.
Since I only have ONE United Health plan, I don't understand why I would have two entries for United Health Group under OTHER INSURANCE on my medicare.gov account.
I have not had a coordination of benefits problem (yet), as I have not had any claims against my AARP United Health part B supplemental plan yet.
I just found it weird that United Health Group was listed twice on medicare.gov when I only have one United Health plan.
I don't know if it's a problem or not. I just want to make sure that if there is a problem, I get it corrected before I actually have a claim.
The only info I can get from the Medicare people at 1-800-Medicare is that the reason I have two entries is that the two different entries are for two different COBA numbers. That's the only info they can give me.
On your "My Plans & Coverage" page - it should say that you have Original Medicare
Under "Other Insurance" :
Are the plans that are showing indicating the SAME Name and SAME Address ?
Then Go up one notch from OTHER INSURANCE heading - on the right you will see the heading of:
Already picked a new plan?
under that heading you will see a click on choice that says
Get your plan confirmation
click on it and it should give you your past enrollment
Do this and see if it gives you any info on these (2) plans
I came back to edit to add:
Those plans shown under "Other Insurance" do they also have the same dates of coverage ?
Have you ever had a claim or are you new to Medicare? Never mind, I see from your response, you have had no claims. So we don't know if there is a problem or not. Do you have any outstanding claims that are being processed now?
I will also tell you that the website is a bit quirkie - I recently tried to change my authorized representative's address (she moved). I was never able to actually change the address so I just ended up adding an additional one with the same name; just a different address.
Let's see what your search of this info shows and then we hopefully can tell if there is a problem or just some Medicare website quirk
'On your "My Plans & Coverage" page - it should say that you have Original Medicare".
Yes, it says I have Original Medicare.
Under "Other Insurance", it lists two entries with the same name (UNITEDHEALTHGROUP), same address, and same dates of coverage. The entries are identical (but as my previous post indicated, the Medicare folks said the entries represent two different COBA numbers.) I got this info from calling 1-8000-MEDICARE, since the mymedicare.gov site does not list COBA numbers.
If I then click on Get your plan confirmation, it says "We couldn't find past enrollment information. If you recently enrolled in a plan, check the Plans & Coverage page after 10 days for your plan information." I am rather new to Medicare. My previous coverage was through an employer.
"Do you have any outstanding claims that are being processed now?"
I have only had one claim that went through and it shows that Medicare paid $0.00 (because I have not yet met my part B deductible.)
My concern is that once I have a Medicare claim that has to be coordinated with AARP UHC supplemental, I don't want there to be a problem because of the two COBA numbers.
I don't know if this is a problem--I am just trying to make sure everything is set up correctly before I actually have to use the coverage.
If it is a problem, I don't know if it's an AARP UHC problem or a Medicare problem. I can't get answer from anyone as to why I have two entries for UNITEDHEALTHGROUP with two different COBA numbers.
I am pretty sure that you are gonna be fine since they have the same address - and the same name.
I assume any other identifying info listed, if any, is also the same.
Sounds like just a duplicate entry.
What Supplemental plan do you have - the letter of the plan?
Since I assume that you are only paying for (1) supplemental plan then it isn't your fault. Those COBa numbers are for internal use by Medicare contractors - private insurers that contract to process claims - or those that try to recover money from other insurers (like if there is an auto insurance medical payment).
There is a "CHAT" function at the top of your medicare page - guess you could ask a question there but don't get too complicated - just ask why it is listed twice. If they can't help any more than who you have already talked to - don't push it - you don't want to get into the "weeds" of Medicare unless there is really a problem especially with people that know ONLY their particular job or answer questions about benefits.
Just follow your claims through when you have one - you will get an EOB from Medicare and your supplemental insurer. In fact, it might be listed on the Medicare claim that is processed already even if they didn't have to pay anything because of your deductible. Look at the bottom of the Medicare EOB (Medicare Summary Notice for Part B) - there is a list of alphabetical codes and what they mean. I think it is Code H - and it will say something to the effect that this info is being sent to your private insurer and state the name of the insurer.
"I assume any other identifying info listed, if any, is also the same."
Yes, the info in both entries is identical: UNITEDHEALTHGROUP, the address, and dates of coverage. That's all the info there is, but as I said previously, the Medicare customer service rep said there were two entries because they each represented a different COBA number.
I have plan G so I am responsible for the $198 part B deductible and the claim on the mymedicare website shows that Medicare paid $0.00 for this claim (since I have not met my deductible).
I have not received the MSN yet. The only info I have is the claim on the mymedicare.gov website.