When you have Medicare and another type of health coverage, the order in which they pay depends on your situation. The primary payer processes the claim first. A secondary payer may pay some remaining covered costs, but having two policies does not guarantee that every bill is paid in full.
Common situations at a glance
| Your situation | Who generally pays first? |
|---|---|
| Age 65 or older; coverage through your or your spouse’s current employment; employer has 20 or more employees | The employer group health plan |
| Age 65 or older; current-employment coverage; employer has fewer than 20 employees | Medicare |
| Under 65 with Medicare due to disability; current-employment group coverage; employer has 100 or more employees | The large group health plan |
| Retiree coverage | Medicare generally pays before the retiree plan |
| Medicare and Medicaid | Medicare generally pays first for services both programs cover |
Multi-employer plans and special arrangements can change the answer. Ask the benefits administrator how the rules apply to your coverage. The employee thresholds include exactly 20 or 100 employees; they do not mean “more than” those numbers.
Situations that need a separate check
COBRA is continuation coverage, not coverage based on current employment for the usual Part B enrollment rules. Medicare generally pays before COBRA for someone eligible because of age or disability. Different coordination rules can apply with End-Stage Renal Disease, including a 30-month coordination period. Confirm the dates with Medicare and the plan.
For an accident or work-related injury, liability, no-fault or workers’ compensation coverage may be responsible first. Veterans’ benefits and Medicare generally do not pay for the same service. These cases should not be treated as an ordinary employer-plan combination.
Before your next appointment
- Give the billing office all current insurance cards and explain which coverage is based on active employment.
- Ask your benefits administrator to confirm the primary payer and whether both Medicare Parts A and B are required.
- Tell Medicare about changes to your other coverage. For coordination questions, contact the Benefits Coordination & Recovery Center at 1-855-798-2627; TTY 1-855-797-2627.
- Compare the claim explanation from each payer with the bill before assuming the unpaid balance is correct.
Does payment order decide when I should enroll?
Not by itself. Enrollment deadlines are a separate issue. Before delaying Part B, confirm whether your present coverage qualifies for a Special Enrollment Period. Do not cancel an existing policy until you understand the replacement start date and the effect on anyone else covered.
Will the secondary policy pay everything left over?
Not necessarily. Each payer applies its own coverage rules, network requirements and limits. Ask about the particular service and provider instead of relying on the word “secondary.”
Related questions
- COBRA and Medicare enrollment deadlines
- Medicare while you are still working
- How Medicare and Medicaid work together