A 65-year old insured individual has suffered from kidney failure for the last 18 months. They are a member of the health insurance plan provided by their spouse's large-group employer. Medicare will
Medicare will act as a secondary insurer and pay claims not completely covered by the group health insurance.
In this scenario, Medicare will function as a secondary insurer, stepping in to cover costs that are not fully paid by the primary group health insurance plan. This arrangement is common for individuals who have both group insurance and Medicare coverage, ensuring comprehensive financial assistance for medical expenses.
This statement is incorrect. Medicare does not withhold coverage to prevent overinsurance. Instead, it coordinates benefits with other insurance plans to ensure appropriate coverage without duplication.
This choice is inaccurate. In cases where an individual has group health insurance through an employer, that plan typically serves as the primary insurer, with Medicare acting as a secondary payer to cover remaining costs.
This option is not applicable in this context. Individuals with group health insurance from a large-group employer do not need to cancel their coverage to enroll in Medicare. Medicare can complement existing group insurance without necessitating its cancellation.
This is the correct answer. Medicare serves as a secondary insurer in situations where an individual has group health insurance through a large-group employer. It covers expenses that remain after the primary insurance plan has paid its share, providing additional financial support for healthcare needs.
For the 65-year-old individual with kidney failure under a large-group employer's health insurance plan, Medicare will function as a secondary insurer. This means that Medicare will step in to cover medical expenses that are not fully paid by the primary group health insurance, ensuring comprehensive coverage and financial support for the insured individual.
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