What is Medicare carve out coordination?

Answer 1

Medicare carve out coordination is a concept which requires an explanation. Under Coordination of benefits, Medicare Carve-Out plans--normally associated with Fortune 1000 companies incorporated in the United States-- are a method of coordinating medical payment pay outs once a retiree becomes eligible for medicare(the 1st day of the month of their 65th birthday) at a money savings to a corporation with limited financial impact to both the corporation and insured. Medicare coordination of benefits by "carve-out" is best explained by an example. In order for a company to be eligible for "carve-put" coordination of benefits, a company must (in laymen's terms) self insure their employees with monthly collection of premium from their employees to pay for their own health insurance claims. Claim pay outs for "carve out" plans are paid by the Employer's funds, not a Health Insurance Company's funds. (For instance, Toys R Us employees fund their health insurance claims, Blue Cross Blue Shield doesn't pay, Toys R US's health fund collected from employee's monthly health insurance premium pays.) "Carve-Out" plans pay after Medicare ONLY after a patient/insured reaches their "Out of Pocket Maximum" or otherwise known as "Stop Loss." "Stop Loss" is any provision within an insurance policy designed to end the insurance company's losses for a claim at a given point. In an example, say for instance a Toys R Us retiree experiences a $100,000 hospital claim (ei: 2 weeks inpatient hospital claim including 1 week in ICU.) Let's assume this hospital recognizes Medicare with a contract. Medicare may have a contract with a hospital to pay $61,000 (with a $39,000 write off, non-collectable) & will pay 80% of expenses as the primary insurance carrier(since a patient is retired.) 80% of $61,000=$48,800 paid. The remaining $12,200 ($61,000 Medicare Acceptable minus $48,800 Medicare Paid) is the remaining balance to be paid by the 2nd insurance in line. Under "carve out" plans, the 2nd insurance company to pay (Blue Cross Blue Shield funded by Toys R Us's own fund in this example) will pay AFTER an insured has paid their "Out of Pocket" or "Stop Loss" for the year. If an insured has a $1000 deductible, a "carve out" plan eliminates a deductible's importance and the "out of pocket/stop loss" is the amount that holds importance. Most "Out of Pockets" are approximately $10,000. Let's assume that Toys R Us retiree hasn't had a previous claim during the year. $10,000 will be the insured's responsibility to the hospital & Toys R Us's fund through Blue Cross Blue Shield will pay the remaining $2,200. Any future claims for the year will be financially picked up by Toy R Us's funded Blue Cross Blue Shield plan at 100%.

Answer 2

Medicare carve-out coordination refers to the process of coordinating healthcare benefits and services between Medicare and other insurance plans. In a carve-out arrangement, certain specific benefits or services are excluded from the primary insurance plan and instead covered by Medicare. The coordination involves ensuring that claims, payments, and coverage for these carve-out services are properly managed and coordinated between Medicare and the primary insurance plan.