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My parents are both on Medicare are they responsible for the addition 20% co-pay?

My parents are both elderly and covered by Medicare which only pays 80% of there Medical bills. There other insurance United healthcare refuses to pay the additions 20% Medicare leaves behind. Are they really responsible for this remaining 20% of the bills? I have heard somewhere that they did not have to pay for that amount is this true?

Public Comments

  1. Of course they are responsible for their co-pays!
  2. Medicare doesn't even pay ALL your medical bills. Yes, of course, they are responsible for the balance! Where ever you "heard" that from, it's wishful thinking.
  3. You heard wrong. If there's an issue with their other insurance (presumably a Medicare supplement), you need to take it up with that insurer. Medicare was never designed to cover 100% of all costs.
  4. The medical providers will expect that someone pays. The question is why doesn't United pay? If it is a Medicare Supplement there are 13 different standardized Medicare Supplement plans; maybe the plan that they have doesn't have that coverage and they need to switch to a plan that does. If it is a policy provided by a former employer it's also possible that it doesn't have that coverage.
  5. Your parents are responsible for the balance not covered by Medicare. If they have Medi-gap insurance with United Health care and that company won't cover the 20%, they should drop them and sign up with another company. The only way they would not have to pay is if they qualified for full Medicaid. For that they must apply with social services in their county. With any doctor, whatever insurance or Medicare won't cover the patient is always responsible.
  6. You need to find out if they are on United Health care as a supplement (which they would be paying an extra fee to every month) or if they are on United as a Medicare Advantage plan (which does not cost anything extra outside of the usual $96.40 monthly Medicare premium everyone has to pay). If they are under a Medicare Advantage plan then United does not have to pay more than 80% and your parents are responsible. The good news is that every year you can change to a different Advantage plan(ie insurance company) who may cover more than the 80%. Medicare's website has the list of plans in your area and what benefits they offer. IF they are under a supplement plan (and are paying an extra monthly amount), they are still responsible for some co-pays and the supplement pays other things. It really depends on the type of coverage they are paying for. They may only be paying for a catastrophic plan that only starts paying after their bills reach a certain limit. Review the plan documents to determine. IN short: It is common for people to pay the 20%. But you can fix it by changing to an Advantage plan or increasing the coverage under the Supplement plan.
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