Coordination of Benefits 101

Coordination of Benefits (COB) ensures that when you have multiple health insurance plans, they work together to pay your claims. The primary plan pays first, and the secondary plan covers any remaining eligible expenses.

COB comes into play when you are enrolled in Original Medicare—that is, Medicare Parts A and B—and in the HOP Medical Plan or HOP Value Medical Plan. In your case, Medicare pays first. Your HOP Medical Plan or HOP Value Medical Plan pays secondary.

Steps To Ensure Proper Coordination

• Make sure you provide both your Medicare card and your HOP insurance information when you visit a doctor, provider, or hospital.
• Review your Explanation of Benefits (EOB) and provider bills to make sure they have properly billed all your insurance plans.
• Keep records of all communications and documents related to your insurance coverage.

Medicare Advantage Coverage

If you enroll in a Medicare Advantage plan, it essentially replaces your Original Medicare coverage. This means that you cannot be enrolled in both Original Medicare and a Medicare Advantage plan at the same time. The Medicare Advantage plan becomes your primary insurance, and you receive all your health care services through that plan.

School District Insurance Coverage

If you had medical insurance through your school district, it’s important that you get a letter of termination to confirm you are no longer covered by the district and submit it to the HOP Administration Unit. School districts sometimes forget to terminate coverage when you retire. This can affect your Medicare and Health Options Program coverage. However, if you are covered by your school district due to binding arbitration that mandates continued coverage, that is a separate matter. Questions? Contact the HOP Administration Unit toll-free at 1-800-773-7725.