You may only have Medicare coverage. If this is the case, Medicare is always your primary insurance. However, some individuals have another form of insurance to reduce out-of-pocket medical costs. Secondary coverage can leave you confused as to which insurance will pay. When you have two insurances, your primary one pays first before the second one. You may be asking yourself, “is Medicare secondary to private insurance?” The answer to whether Medicare is your primary or secondary insurance isn’t so clear: it depends.
At Senior Insurance Solutions, I am an independent Medicare insurance agent who can help you enroll in Medicare. I am your resource for all things about your Medicare plan. No matter if you have questions about your insurance program or want to go over your health benefits, I am here to help! When you work with Senior Insurance Solutions, you can have peace of mind that you have the best Medicare plan that is right for you and your healthcare needs.
Want to know if Medicare is secondary to private insurance? Keep reading to learn how Medicare and secondary insurances work!
When is Medicare Primary Insurance?
Medicare is your primary insurance when you have no other form of insurance. In most cases, Medicare is still your primary insurance when you have an additional form of coverage. For example, you may have Medicare and Medicaid or Medicare and group coverage through an employer. Normally, your secondary insurance will only pay if your primary insurance has paid first.
See some scenarios where Medicare is your primary insurance below.
Group Coverage Through a Small Employer
If you have insurance through an employer with fewer than 20 employees, Medicare will be your primary insurance, and your employer insurance will be your secondary coverage. However, keep in mind that you must be enrolled in Medicare Part B before your employer coverage will pay its portion of the claim.
Retiree Insurance Through an Employer
If you still have group employer insurance even though you have retired, you have retiree coverage. Medicare will be your primary coverage whereas your retiree insurance will be your secondary payer.
COBRA
There are cases where someone may have Medicare and COBRA coverage. Medicare will be your primary insurance and COBRA will be secondary unless your group coverage states otherwise.
Under 65 With a Disability and Group Coverage
If you are under 65, eligible for Medicare because you are disabled, and have a group health plan through an employer with fewer than 100 employees, Medicare pays first. Your secondary insurance will pay next.
End-Stage Renal Disease
Individuals diagnosed with end-stage renal disease will get to keep their group coverage as their primary payer for the first 30 months. Once the 30 months end, their primary type of insurance will be Medicare.
Your Medicare coverage eligibility will end 36 months after a successful kidney transplant. If you meet other eligibility criteria for Medicare, such as age or disability, you will continue to keep your coverage even after your transplant.
TRICARE
Medicare is the primary insurance if you are on inactive duty and receive care at a non-military medical office. If you receive medical services from a military hospital or another federal medical care provider, TRICARE will pay first instead.
Medicaid
If you have Medicare and Medicaid coverage, Medicare will always pay first before Medicaid.
When is Medicare Secondary Insurance?
In a majority of cases, Medicare is your primary insurance. However, there are two scenarios where Medicare is your secondary insurance.
Group Coverage Through a Large Employer
If you have group coverage through a company you work for or your spouse’s employer, Medicare is your secondary insurance if the employer has more than 20 employees.
Workers’ Compensation
Your workers’ compensation will pay before Medicare if you are injured while on the job. However, if you receive medical services not related to your workers’ compensation claim, Medicare will pay out first.
Federal Black Lung Program
If you have insurance coverage under the Federal Black Lung Program, Medicare will be your secondary insurance.
Coordination of Medicare Benefits
If you have two insurance policies that have no coordination of benefits, they are not compatible with one another. While Medicare coordinates with many plans, this coverage does not coordinate with Medicare Advantage plans, Marketplace plans, or veterans benefits.
For example, when you enroll in a Medicare Advantage plan, Medicare has no responsibility to pay for claims. Additionally, if you enroll in Medicare, you cannot also enroll in a Marketplace plan. For individuals with veterans benefits, both Medicare and veterans benefits are primary, which means Medicare will pay first only if you have received medical services at a non-military facility.
Enroll in Medicare With Senior Insurance Solutions
It is challenging to know what insurance will pay first when you have primary and secondary coverage. Most times, Medicare will pay first. However, there are a few instances where that is not the case, such as workers’ compensation. You should also understand how Medicare coordinates with other insurance programs. For example, Medicare and veterans benefits do not coordinate. Understanding how your insurance works, especially if you have primary and secondary insurance, is crucial in knowing what you will be responsible for paying out-of-pocket for your medical costs.
At Senior Insurance Solutions, I am your go-to Medicare expert. With my knowledge and experience, I am here to help you pick the right Medicare plan that is best for you. Medicare is confusing to understand, especially with secondary insurance. That is why as a licensed Medicare agent, I am a reliable resource for everything Medicare. If you have more questions about if Medicare is secondary to private insurance, or if you are ready to find the Medicare plan that is right for your healthcare needs, contact Senior Insurance Solutions!
