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But Medicare doesn't pay 100% of the costs, so most people have 2nd insurance. For example, my mom's 2nd was Blue Cross which was a federal employee program through my dad's work and her premium was paid by being taken out from her retirement annuity every month automatically. Now my late MIL was on a Humana secondary payor that she had to write a check for every month and before that was on another one that was limited to health services within a specific health care group in order for them to pay for anything.
The doctors office, hospital, etc. need to know to whom else they are to send the bill to for whatever Medicare doesn't pay for. If you don't have a secondary policy, then you may be asked to pay in full, up front for the anticipated co-pay. This could be quite a bit of $. Some doc's will not take patients who only have Medicare - this is what was the case for my mom's ophthalmologist and orthopedic doc's - because she had fed BCBS then she could continue as a patient. Medicare reimbursement is super low and not worth the paperwork and other logistics for many practices unless payment is balance by another insurer.
So "they" always have to ask exactly what the insurance situation is, even for people on Medicare.
(And, by the way, this chaotic hodge podge of seemingly unlimited possibilities is one of the costs in our healthcare system. "They" have to have administrative people to deal with all this.)