Many beneficiaries wonder if Medicare is primary insurance. But, the answer depends on several factors. While there are times when Medicare becomes secondary insurance, for the most part, it’s primary.
Let’s go into further detail about what “primary” means, and when it applies.
Is Medicare Primary or Secondary?
Mostly, Medicare is primary. The primary insurer is the one that pays the claim first, whereas the secondary insurer pays second.
But, depending on the other policy, you have Medicare could be a secondary payer.
Is Medicare Advantage Primary or Secondary
When you enroll in an Advantage plan, the company you select will pay all your claims. Since the Advantage company pays the claims, that plan is primary.
Please note that Medicare WON’T pay your claims when you have an Advantage plan. Medicare doesn’t become secondary to an Advantage plan.
So, you’ll rely on the Advantage plan for claim approvals.
When is Medicare Primary to Group Insurance?
Those with small employer health insurance will have Medicare as the primary insurer. A small employer means less than 20 employees in the company.
When you have small employer coverage, Medicare will pay first, and the plan pays second. If your employer is small, you must have both Part A and Part B.
Having small employer insurance without Medicare could mean the employer’s plan won’t cover anything. It’s in your best interest to enroll in Medicare as soon as possible.
Can Medicare be Primary if Still Working?
As long as you work for a small employer, Medicare is primary. If the company has over 20 employees, Medicare is secondary.
If you’re not sure, talk to the benefits administrator in the office where you work.
Between Veterans Association Benefits and Medicare, Who is Primary?
Medicare and Veterans benefits don’t work together; both are primary. When you go to a VA hospital, Veteran benefits are primary.
Then, if you go to a civilian doctor or hospital, Medicare is primary. But, you CAN’T use Veterans benefits at a civilian doctor.
Also, you can’t use Medicare benefits at the VA. These two options don’t go together.
Many Veterans find an Advantage plan gives them extra coverage outside the VA, without breaking the bank.
Tip: It’s always worth checking the plan options in your area.
Does Medicare Pay First or TRICARE?
Medicare is primary to TRICARE. If you have Part A, you need Part B to remain eligible for TRICARE. But, Part D isn’t a requirement.
Also, TRICARE covers your prescriptions. Your TRICARE will be similar to a Medigap plan; it covers deductibles and coinsurances.
You have 90 days from your Medicare eligibility date to change your TRICARE plan.
No-Fault or Liability Insurance with Medicare
If you’re in an accident that results in an injury requiring care, liability insurance is primary. Medicare will pay as if it were the only payer.
How to Learn More About Your Medicare Options
Primary insurance isn't too hard to understand; it's just knowing which insurance pays the claim first. Medical billing personnel can always help you figure it out if you're having trouble.
While it's not hard to understand primary insurance, Medicare is its own beast. If you're sick of being alone in trying to figure out the difference in plan options, give us a call at the number above.
Our agents can answer your questions and help you identify quality coverage. It's better to have coverage before you need it than after it's too late.
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