FAQ

When Is Medicare Primary Insurance and When is it Secondary? – MedicareGuide.com

While Medicare is the only insurance for some beneficiaries, it’s also common to have Medicare along with other insurance to reduce out-of-pocket costs. When that happens, there is a predetermined coordination of benefits, where one policy is “primary insurance” and the other is “secondary insurance.” Primary insurance pays first and secondary insurance may make additional payments before the policyholder owes money. that may include a portion of your deductibles or copays, but may not.

when is the primary medicare insurance?

If you have no other insurance, Medicare will always be your primary insurance. In most cases, when you have multiple forms of insurance, Medicare will continue to be your primary insurance. here are several common cases where medicare will be the primary insurer.

Reading: Medicare is primary to which insurance plan

if you have job-based insurance from a company with fewer than 20 employees

Your group insurance plan is the secondary insurer, so you must enroll in medicare part b before your group plan will pay its share of the claim.1

if you have retiree insurance through a previous company

Some retiree insurance plans don’t pay for medical costs if you’re eligible for Medicare and don’t sign up. For the details of how Medicare will work with your retirement health benefits, get a copy of your plan’s benefit materials.2

if you have insurance you get paid after leaving a company where you had health insurance

You can decide to stay with Medicare only and not pay for additional coverage through Cobra.

if you have a disability

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If you have a disability, are under 65, and your employer’s health plan has fewer than 100 employees, Medicare will pay first.3

if you have end-stage renal disease (esrd)

Even if you have a group health plan, Medicare is the primary insurer as long as you’ve been eligible for Medicare for 30 months or more. 4

if you have tricare

if you are on inactive duty, medicare is the primary insurer, but tricare will pay the bills if you receive services from a military hospital or other federal health care provider.5

if you have medicaid

Medicaid is always secondary insurance if you have Medicare.6

when is medicare secondary insurance

While Medicare is often the primary insurance, there are some cases where Medicare is secondary. Two common instances are:

if you have job-based insurance from an employer with 20 or more employees

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This is the case whether you get insurance through your company or your spouse’s employer. employers must offer workers age 65 and older the same health benefits they offer to all other employees.7

if you receive workers’ compensation

Your workers’ compensation insurance will be primary for any services or items related to your workers’ compensation claim. Medicare will serve as your primary service for all covered medical expenses not related to that claim.8

when is medicare primary and secondary?

when can you delay your enrollment in medicare?

If you have health insurance through your or your spouse’s employer, and that employer has more than 20 employees, you may be able to delay enrolling in Medicare without paying a penalty. In that case, even if you signed up for Medicare at age 65, it would be secondary insurance and would only kick in after your primary insurance had paid its share of your claims. To avoid penalties after you (or your spouse) leave your job, you’ll need to sign up for Medicare within eight months. 9

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If your employer has fewer than 20 employees, Medicare would be your primary insurance and you should sign up during your initial enrollment period. If you miss this opportunity to enroll in Medicare Part B, you may face a late enrollment penalty. Every year you delay enrolling in Medicare Part B, your premiums will go up 10%, unless you or your spouse has insurance through work.10

next steps

While having multiple forms of health insurance is a fortunate situation, it can also be confusing to determine which is primary and which is secondary, or whether it makes sense to continue paying for both policies. however, finding out what your primary insurance is will make it easier for you to manage your insurance in the future.

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