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Medicare Can Also Be A Secondary Payer

primary insurer , federal government, veterans benefits
June 7, 2022

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When is Medicare Primary?

Typically, if there are multiple kinds of insurance coverage, Medicare is primarily primary. Some example include group insurance through smaller employers, COBRA, and inactivity under TRICARE. Secondary insurance typically only pays the premium unless primary insurance pays the full premium first. Listen now on Podcasts.


In some cases, Medicare and COBRA can be combined simultaneously. Medicare is most times the primary, while COBRA will be the second. There are exceptions when your group insurance has special rules determining who will pay the first payment of the premium. COBRA isn't commonly considered a better option for an individual with Medicare eligibility.

COBRA has a high cost and Medicare is cheaper. After joining Medicare, if you haven't already got coverage, you may be denied coverage by Medicare. The COBRA program does not provide creditability coverage. You have ESRD, are covered by COBRA on top of Medicare, and are in the first 30 months of being eligible for Medicare. You have Medicare and are in an accident where no-fault or liability insurance is involved.

Group Coverage Through Small Employers

For an employer with less than twenty employees Medicare is the most basic insurance and the employee coverage is your secondary insurance. Unless you enroll in Part B, employers cannot reimburse your health insurance premiums.

This is an important reason to enroll into Medicare as soon as possible. Employability insurance can't be claimed by the company. You will therefore incur late enrollment penalties if the enrollment period is not fully filled. It also applies to spouses in group plans. Also, take into consideration the cost of the employer's coverage. Medicare usually charges fewer monthly premiums.

TRICARE for life

TRICARE is available to military veterans and their families after retirement. Medicare first covers medical services in non-military facilities that have received military support from military personnel. This is the main reason that you must apply for Part A and Part B once you qualify. However, TFL covers the drugs well.

Consequently, you won't get Part D. Many TFL recipients opt for the Medicare Advantage plan because it offers additional protection for their health. Besides dental and eye insurance, there are many benefits available. TFL will provide some of these benefits through Medicare Advantage.


Medicaid is a federally funded federal program that provides help to poor citizens. During Medicare and Medicaid, a patient is dual-eligible. If you are enrolled on Medicare or Medicaid as an employee, the government will pay you first. Medicaid will not be paying for the first Medicare payment. If your Part B and Part D costs are covered by Medicare Savings Programs, you might qualify. Always ensure that providers accept both Medicare and Medicaid before seeking treatment. Get an accurate estimate Find a Medicare Plan that fits your budget and needs.

End-Stage Renal Disease

Individuals diagnosed with ESR will continue to receive employer insurance during the initial 30 months. After 30 months a user becomes enrolled in Medicare. These regulations apply equally to the insurance policies for retirement and workers. ESRD patients are eligible for Medicare after 36 months after obtaining a successful transplant. If you are eligible under Medicare for Medicare due to age or disability your eligibility remains valid until you have completed an MRI.

Retiree Coverage

If you are enrolled into your employer's health care program as part of a pension, you receive retirement protection. Medicare coverage in that case is primary, whereas retirement coverage is second. Many pensioners are able to purchase prescription medications for their health care. If it happens then it'd probably not require you to take part in Part D.

Under 65 and disabled with employer group coverage

You are under 65, have disability coverage, and have coverage from a small/midsize company with less than 100 employees. Medicare will serve as the primary payer, whereas employer insurance remains secondary.

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When is Medicare Secondary?

Second, insurance can cover the extra costs owed if the policy has paid for its part. Medicare can be a secondary to many different scenarios in many cases. Examples may be the group coverage offered by larger employers that have 20 workers. Medicare secondary payer (MSP) means that another insurer pays for healthcare services first, making them the primary payer.

Group Coverage Through Larger Employers

When an employee employs a maximum of 20 people, Medicare provides secondary protection to the employer. Medicare patients are hesitant about enrolling in Part B because they want a better group insurance policy. In many cases, though, Medicare is cheaper and provides better protection if a customer lets Medicare remain their primary coverage.


TRICARE pays first Medicare-approved service in the civil facility when the active duty officer is active. Medicare is paid second-mostly. Medicare is not available to patients in military and federal hospitals.

Receiving Workers Compensation

Your workers' compensation benefits cover your first injury. Medicare pays second. Medicare pays for all treatment services which have little relation to an injury claim.

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Federal Black Lung Program

In cases of Black Lung Program Coverage, the federal program would pay first and Medicare would pay the second.

Under 65 and disabled with larger employer group coverage

Medicare may be an additional payer for those under 65 with disability who qualify for Medicare. Medicare statute and regulations require that all entities that bill Medicare for items or services rendered to Medicare beneficiaries must determine whether Medicare is the primary payer for those items or services. Register When you have Medicare and another type of insurance, Medicare will either pay primary or secondary for your medical costs.

What are Medicare secondary payers

Medicare beneficiaries don't need a single Medicare benefit. People can use other coverage programs to gain better health coverage. Generally speaking, the primary and secondary payers are responsible for the majority of costs and they then take over the rest.

In the Medicare plan, a third party payer contributes the copayment and coinsurance amount. Medicare - generally - serves as a primary provider, sometimes acting as a secondary provider. This article discusses the primary payers of Medicare.

Medicare secondary payers (MSP), also known as secondary payers, are commonly used for Medicare when it has no primary payments responsibility. In 1966, when Medicare was introduced, it was the primary payer on all health insurance claims. In 1980 Congress approved a new bill making Medicare the primary payer in a bid to reduce the cost of Medicare to a private payment method.

Common Situations of Primary vs. Secondary Payer Responsibility The following list identifies some common situations when Medicare and other health insurance or coverage may be present, and which entity will be the primary or secondary payer.

Is Medicare Primary or Secondary?

Medicare is the main plan if that's what you need the most. With other forms of coverage there can be coordinated benefits. A good plan of action is to determine what type of coverage is primary and what type of coverage is secondary. Healthline Media does not transact the business of insurance in any manner and is not licensed as an insurance company or producer in any U.S. jurisdiction.

Primary insurance pays first, secondary insurance is paid 2nd. Let's look at scenarios where Medicare's primary or secondary status is secondary. Get a Quote Free. Find the cheapest Medicare plan for your region. The primary payer may not cover some things that Medicare does, and vice versa, so it's especially nice to have both sources to cover healthcare costs.

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