Medicare - Which Insurance Is Primary? (Medicare Or Employer Coverage?)

There are many factors that determine whether Medicare is primary (pays first) or secondary (pays second) and it will depend on your specific situation.

If you have Medicare and other health insurance or coverage, each type of coverage is called a "payer." When there's more than one payer, "coordination of benefits" rules decide which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" to pay. In some cases, there may also be a third payer.

Medicare can either be primary or secondary to your employer coverage. This coverage usually depends on the size of the employer and whether or not you or your spouse are currently working.

Primary insurance pays first for health care claims. Secondary insurance pays after the primary insurance for some or all of what the primary insurance did not cover. Knowing which is your primary insurance is important to understand because secondary insurance often refuses to pay anything if the primary insurance has not paid first.

You should consult with to your employer to find out how your employer insurance will work with Medicare.

Generally if you are 65 or over and still have insurance through your (or your spouse’s) current employer that has 20 or more employees, then your employer coverage is primary. However with that said, if you have insurance coverage through your (or your spouse’s) current employer that has fewer than 20 employees, then Medicare is primary.

For other situations, please click on the web link below

How Medicare coordinates with other coverage

Note: Medicare Insurance information can be overwhelming and confusing to many people. As an independent licensed agent I can explain things to you in simple terms so you feel comfortable making a decision. Then I can help you choose and enroll in a plan that you feel fits your needs.

By the way, it doesn’t cost you any more if you enroll in a Medicare Insurance plan through me as an independent agent versus directly with an insurance company either over the phone or via the Internet, since I get paid by the insurance companies for your enrollment. Plus you will have personalized service by a local agent. If you would like my assistance, please call me at 941-404-5334.

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