How Do You Know When Medicare is Your Primary or Secondary Insurance?
Many people have Medicare and some form of additional coverage. Common additional coverage options include employer coverage, VA health care, TRICARE. Maintaining employer coverage, especially if you’ve delayed Part B enrollment, is common. In 2021, 32% of people on Original Medicare also had employer coverage.
If you do have another type of insurance in addition to Medicare, one insurance pays first and one pays second. These are called primary and secondary payers.
Medicare’s “coordination of benefits” rule determines when Medicare is the primary insurance and when your other health coverage is the secondary insurance. We’ll break it down by insurance type in this blog.
Key takeaways:
Medicare may be the primary or secondary insurance. It depends on the situation and what your other health insurance is.
The best way to check if Medicare is your primary or secondary payer for your medical bills is to check the policy details of both types of insurance. You can also contact the Benefits Coordination & Recovery Center at 1-855-798-2627 (TTY: 1-855-797-2627).
What is a primary and secondary payer?
When you have Medicare and another insurance, the two types of coverage can work together to pay your medical bills. One insurance is the “primary payer” and one is the “secondary payer.” The primary insurance pays your medical costs first, then the rest of the bill is sent to the secondary payer.
Having two types of health coverage can be advantageous when you don’t have to pay two different premiums. If your employer fully pays for your premiums, having Medicare can fill gaps in the coverage. For example, Medicare could cover a service or piece of equipment that your employer insurance doesn’t cover.
If you have any questions about when Medicare is the primary or secondary insurance, you can get in touch with your plan provider about your specific situation. You can also get in touch with the Benefits Coordination & Recovery Center at 1-855-798-2627 (TTY: 1-855-797-2627).
When is Medicare primary or secondary?
The coordination of benefits (COB) rules state which insurance is primary and which is secondary. Medicare’s designation as a primary or secondary payer depends on the situation.
Medicare and employer coverage
Medicare is the primary payer if the employer you work for has less than 20 employees. Your employer health insurance pays second.
Medicare is the secondary payer if your company has more than 20 employees. Your employer plan would pay first.
If you continue to work when you turn 65 and you work for a small company with fewer than 20 employees, make sure that you don’t miss your Initial Enrollment Period for Medicare. You won’t qualify for the Part B Special Enrollment Period, and you’ll face late penalties.
Medicare and TRICARE
TRICARE is a healthcare program for military members, retirees, and military families.
Medicare is the primary insurance when you’re not on active duty, and TRICARE is the secondary payer.
Medicare is the secondary payer when you’re on active duty, and TRICARE is the primary payer for medical bills.
Medicare and VA benefits
VA health care provides health insurance for eligible veterans of the military. Coordination of benefits rules don’t apply to beneficiaries with Medicare and VA benefits. You can only use VA benefits at a healthcare facility affiliated with the VA. Since non-VA facilities won’t take VA health care, you can use your Medicare benefits to broaden your coverage outside these health centers.
Medicare and COBRA
COBRA is a federal law that allows people to keep their employer health coverage for a limited period of time after their employment ends. With Medicare and COBRA coverage:
Medicare is the primary payer if you’re enrolled in Medicare. COBRA is the secondary payer.
COBRA is the primary payer if you’re eligible for Medicare due to End-Stage Renal Disease (ESRD), and Medicare pays second. This coordination period lasts for up to 30 days after you’re first eligible for Medicare. Once this period ends, Medicare pays first.
If you lose your employer coverage and you’re eligible for Medicare, you can enroll during a Special Enrollment Period in most cases. Understanding when to enroll in Medicare can ensure that you receive timely care.
Medicare and FEHB
Federal Employees Health Benefits (FEHB) covers health insurance for active and retired federal employees.
Medicare is the primary payer if you’re a retired federal employee. FEHB is the secondary payer in this case.
Medicare is the secondary payer if you’re an active federal employee. FEHB is the primary payer in this situation.
Medicare and Medicaid
Medicaid provides health insurance for low-income Americans. It’s jointly funded by federal and state governments, and each state operates its own Medicaid program. Once you turn 65, Medicaid coverage is paired with Medicare through Medicare Savings Programs. Depending on which Medicare Savings Program you’re eligible for, Medicaid may pay for:
Your Medicare Part A and Part B premiums
Your share of costs, including deductibles, coinsurance, and copayments
Any drugs and services that Medicare doesn’t cover
Because of how Medicare and Medicaid work together, neither is a primary or secondary payer.
Medicare and private insurance
The COB rules for Medicare and a private health insurer will depend on the provider and plan. Check your policy details to determine who pays first.
How Medicare works with other insurance
Keep in mind that these rules can change with specific situations. Checking with your Medicare plan or other insurance coverage is the best way to see who’s responsible for coverage. How another insurance works with Medicare can be confusing. Get in touch with a licensed Chapter Medicare Advisor to answer your questions about Medicare coverage. Talk to an Advisor at 855-900-2427 or schedule a time today.