Is Medicare primary or secondary to employer insurance?
Your primary insurance pays out first when receiving medical services. This insurance is referred to as the primary payer. Your secondary insurance pays out for anything that your primary insurance does not cover. This insurance is referred to as the secondary payer. The primary purpose of the secondary layer is to cover some or all of the remaining costs.
This is how to know who the primary and secondary payer is in any situation:
- Medicare is the primary payer when the company you work for has less than 20 workers. However, Medicare becomes the secondary payer if your employer is part of a group health plan with other employers who employ more than 20 workers.
- Medicare is the secondary payer when the company you work for at least 20 workers. Your group health plan will be the primary payer and Medicare will only pay out if your employer’s plan has paid their portion.
The rules stated above are for general situations and may vary based on your own situation. You can contact someone at the Centers of Medicare and Medicaid Services Benefits Coordination and Recovery Center if you don’t know if Medicare will be the primary or secondary payer.