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Medicare Or Medicaid Primary

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June 25, 2022

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Medicare Secondary Payer

Medicare Secondary Payer (MBP) refers generally when Medicare programs do not have primary pay obligations, e.g. when a different entity is responsible. payments before Medicare. Initially, Medicare was the first payer for any claim that was excluded from those under workers' compensation, federal lung benefits and VA Benefits.

In 1980 Congress introduced legislation to make Medicare secondary payee for certain primary programs as he sought a way to move costs from Medicare to suitable private payments.

Is Medicare Primary or Secondary?

Medicare is a primary insurance policy. When a policy is added there is a predetermined coordinating effect for benefit. A coordinated benefit program determines what forms of coverage are primary and which forms of protection are secondary.

Primary coverage is billed first and secondary coverage is paid second. Below you can find some Medicare secondary scenarios. Find affordable health insurance plans in your region.

When is Medicare Primary?

In many situations, Medicare is primary. Several examples include group coverage through smaller employers COBRA or in active service with the government. Secondary insurance usually pays only if primary insurance pays its share. Watch the Podcast Now!

Group Coverage Through Small Employers

If your employer employs more than 30 people, Medicare would be your main coverage and employers' coverage would be your secondary coverage. If the Part B is not enrolled your health insurer won't cover your medical bills for your claim. It is therefore extremely important to sign up for Medicare when you qualify.

Employer coverage isn't even considered creditable. In addition, if you have not enrolled at Part B before your eligibility date the enrollment fee will increase and a penalty will be imposed. This applies equally for couples on group plans. Also, look at what the employer insurance cost is. The cost of Medicare is often much lower than monthly rates.


In some cases, Medicare and COBRA are in one place. Medicare is most often primary in nature while COBRA is secondary. Except for group coverages, special provisions that determine primary payer coverage apply.

COBRA is not often considered an alternative for an individual who has Medicare benefits. It was caused by the fact that COBRA is much cheaper than Medicare. When a person enrolls in Medicare the COBRA insurance may be reduced.

One of the most important things we must know regarding COBRA is the lack of credit. When an individual doesn't enroll in Medicare, they incur late fees because COBRA doesn't offer the same benefits as Medicare.

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TRICARE for life

Upon receiving Medicare, a retired serviceman's surviving spouse can also be covered through Medicare. Medicare pays your healthcare in the military setting. This means you have to apply for Part A or Part B if you qualify. TFL also offers an excellent coverage for medical drugs. It is no longer necessary if a part D student enrolls in the program.

Many TFLs opt out of the Medicare Advantage plan because of additional benefits it offers. Additions to these benefits include dental coverage as well as vision coverage. The TFL program also pays for certain expenses incurred by Medicare Advantage plans.


Medicaid is one government-funded program helping low-income Americans. Those with Medicaid are also dual-eligible. When you are dual-admitted to Medicare or Medicaid, Medicare will be your primary payment. Medicare pays first whereas Medicaid pays first.

Applicants for the Medicare Savings Program should consider applying. Always ensure that whoever you choose is receiving Medicare and Medicaid. Get a quote, Find an affordable Medicare program near me.

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End-Stage Renal Disease

Individuals diagnosed with ESRD receive 30-month employer coverage. After thirty months, they will immediately move to Medicare as the primary cover. It is the same as the COBRA & retiree policy.

Upon successful transplantation your eligibility for Medicare will expire after 36 months. If the kidney transplant is successful, the patient will remain in a Medicare program even with a kidney transplant.

Retiree Coverage

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When retiring from group employers insurance you still have coverage for retirement. In this case Medicare will be primary, and retirees should have secondary responsibilities. Most retirement plans include drugs insurance. This will make it unlikely that you will need any Part D drug insurance.

Under 65 and disabled with employer group coverage

If you are under the age of 65 and qualify for health care through Medicare because of a disability, then you can obtain group employer insurance at your local employer with less than 100 employees. Medicare is your primary insurer while your health insurance from your employers is second.

When is Medicare Secondary?

Secondary policy covers out-of-pocket expenses left after your insurance covers its part. In many cases Medicare is secondary. An example of group coverage in the presence of larger employers is for over 200 workers.

Group Coverage Through Larger Employers

Medicare is your primary coverage when your employer employs 20 employees. Some people in Medicare will delay enrolling for part B because of the higher group insurance costs. Generally, though, the insurance providers are able to provide higher quality coverage by utilizing Medicare.

Receiving Workers Compensation

Workers' compensation is paid out of your workers compensation for injuries and illnesses. Medicaid pays first. If Medicare is provided with a non-worker compensation claim for medical treatment, Medicare first pays the claim amount.


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In active-duty military situations, Medicare will pay for first-time services. Medicare cannot cover medical services that are provided by a military hospital. TRICARE pays first for Medicare-approved services at a civilian facility if you're on active duty, Medicare will pay second. Medicare doesn't cover treatment provided by a military hospital or federal health care provider.

Under 65 and disabled with larger employer group coverage

If you have Medicare under 60 and an employer that employs at least 100 people, Medicare will be your primary provider.

Federal Black Lung Program

Those who receive Medicare's Black Lung Program will pay first and Medicare will pay second.

What it means to pay primary/secondary education?

If insurance companies don't get the money quickly, the physician can charge Medicare. Medicare can make a conditionally billed payment and recover the payment that the primary payer should have paid.

No coordination of benefits

If benefits aren't coordinated they cannot be integrated. You might be covered by a Medicare Advantage or Marketplace plan or veterans benefit. Medicare does not support such health plans. Employers must offer workers age 65 or older the same health benefits that they offer to the rest of employees.

Is Veterans Benefits Primary or Secondary to Medicare?

Medicare and Veterans are two separate programs. When you visit a veteran home, you will get veteran's health insurance as their only coverage. Medicare will be the primary and only healthcare coverage for a patient whose medical conditions are not covered by the insurance plan. By receiving Veterans' Benefits or Medicare benefits the Veteran will also receive the services of a civilian doctor or health center.

Is Marketplace Coverage Primary or Secondary to Medicare?

Medicare Marketplace coverage is not available. Once Medicare is available your benefit will be redirected to the Marketplace. The exception only applies if you have no premium-free Part A. You are not permitted to enroll in any Medicare Marketplace program.

Is Medicare Advantage Primary or Secondary?

When you join Medicare Advantage, it pays your medical bills rather than Medicare. Medicare will not reimburse the patient. Your Medicare Advantage plan is your sole insurance.

Is Medicare primary insurance or secondary?

Although Medicare is one insurance plan for many beneficiaries is common and helps reduce the out-of-pocket expenditure. During this stage benefits are coordinated with each other, and one policy is primary and one is secondary.

Primary insurance is paid first and secondary insurance may then take payments until a policyholder owes a payment to it. Usually these are deductibles and payments and some are copays.

How Medicare works with other insurance plans?

Depending on what health care you use, you're called a payer. In situations where a payer can pay multiple bills, a coordination of benefits procedures determines which pay first. The first payee pays all your payments first and sends the remainder to the second payer. Sometimes a third payer is available.

I have Medicare and Medicaid

Tell a doctor if you have additional Medicare coverage. It helps the company send your bill in to the right payer and reduces any delays. Our mission is to provide information that will help everyday people make better decisions about buying and keeping their health coverage.

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