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When is Medicare Primary or Secondary?

Medicare Posted by Crystal L.

When Is Medicare Primary and Secondary?

  • If you have Medicare and Medicaid, your primary insurance is Medicare, and your secondary insurance is Medicaid
  • If you have Medicare and you are 65 or older with a group health plan through a company with at least 20 workers, your primary insurance is a group health plan, and your secondary insurance is Medicare
  • If you have Medicare and you are 65 or older with a group health plan via an employer with less than 20 employees, your primary insurance is Medicare, and your secondary insurance is Medicaid.
  • If you have Medicare and a retiree health plan via a former employer after you retire, your primary insurance is Medicare, and your secondary insurance is retiree coverage.
  • If you have Medicare and you are disabled with a group health plan via an employer with at least 100 workers, your primary insurance is a group health plan, and your secondary insurance is Medicare. If the employees are less than 100, the roles will be reversed.
  • If you have Medicare and veteran’s benefits. There is no secondary insurance in this instance. So, Medicare pays for Medicare-covered services and Veterans covers VA-authorized services.
  • If you have Medicare and COBRA coverage, Medicare will be your primary plan and COBRA will be your secondary plan.
  • If you have both Medicare and TRICARE (and inactive duty military), Medicare will be your primary plan and TRICARE will be your secondary plan. If you are an active duty military, the roles will be reversed.
  • If you have been in an accident and you have insurance, your primary insurance will be based on no liability or fault services associated with the accident claim and your secondary insurance is Medicare.
  • If you have Medicare and you are covered by workers’ compensation, workers’ compensation for services or items linked to the workers’ compensation claim will be the primary insurer. The secondary insurer does not apply here.
  • If you have Medicare and end stage renal disease, a group health plan and you’ve been qualified for 30 months, your primary insurance is a group health plan and your secondary insurance is Medicare. If you have been qualified for less than 30 months, the roles will be reversed.
  • If you have Medicare and end-stage renal disease, COBRA coverage and you’ve been qualified for less than 30 months, your primary plan will be COBRA [5] and your secondary plan will be Medicare. If you have been eligible for more than 30 months, the roles will be reversed
  • If you have Medicare and you are a beneficiary of the federal Black lung benefits program [6], the federal black lung benefits program will pay first for any services related to black lung, and Medicare will pay second.

Conclusion

Having more than one form of health insurance comes with numerous benefits. However, you may find it difficult to know which plan is your primary or secondary. Your primary plan always pays first for the related services, while your secondary plan pays for any additional cost.

References

[1] https://www.nerdwallet.com/article/insurance/medicare/what-is-medicare-part-b

[2] https://www.hopkinsmedicine.org/health/conditions-and-diseases/end-stage-renal-failure

[3] https://www.humanamilitary.com/

[4] https://www.healthcare.gov/medicaid-chip/getting-medicaid-chip/

[5] https://www.dol.gov/general/topic/health-plans/cobra

[6] https://www.gao.gov/products/gao-22-105546