Primary insurance is the insurance policy that pays first if you have a claim. Medicare is always your primary insurance if it’s the only health insurance you have.
If eligible for Medicare but also have other insurance such as Medicaid, insurance from your job, or Tricare for Life; Medicare may be your primary insurance. But sometimes the other insurance is primary, and Medicare is secondary.
If Medicare is the primary insurance and you don’t sign up for Part B when you turn 65, you could be setting yourself up for big medical bills in the future. Your other insurance may not pay your claims, and you’ll pay a monthly penalty for enrolling late.
Medicare as Primary Insurance Status
If you have more than one kind of health insurance, then one policy is “primary.” This means it will be the first to pay any claims. Once the primary policy has paid, then your other insurance (known as secondary insurance) may pick up some or all the costs that the primary policy didn’t pay.
For example, suppose you have Original Medicare as your primary policy, and you have a procedure that costs $500. Medicare will pay 80 percent, leaving you to pay the remaining 20 percent, or $100.
If you have a secondary policy, it may pay some or all that amount, depending on the policy you have and whether you have any deductibles to meet.
Is Medicare Primary if I have Employer coverage
If you or your spouse is still working when you reach age 65, you may still be eligible for employer health insurance. You can choose to continue your employer coverage rather than enrolling in Part B. Before deciding, consider this:
If the employer has more than 20 employees, the employer coverage is considered primary and Medicare is secondary. In this case, you can keep your employer coverage and wait to sign up for Medicare without paying any penalty. Be sure to compare the cost and benefits of Medicare with the cost and benefits of your employer plan.
If the employer has 20 or fewer employees, Medicare is considered the primary insurance, and the employer coverage is secondary. If you don’t sign up for Part B, you can wind up paying the full cost of a medical procedure – if there’s no Medicare coverage, your secondary insurance may not pay either.
In addition, you may owe a monthly penalty when you do sign up for Medicare.
If you have both employer and Medicare coverage, you will maximize your benefits if you see providers who are in your employer’s network AND who accept Medicare assignment.
Does Medicare Pay First or TRICARE
Retired military and their dependents have health insurance through TRICARE for Life. However, once you become eligible for Medicare, Medicare becomes your primary insurance for all health care you receive from non-military providers. This means you should be sure to sign up for Part B when you are first eligible.
Is Medicare Primary if I Have retiree or COBRA coverage from a former employer
Some employees provide ongoing health insurance coverage to their retirees. Most employers give former employees a chance to buy continuing employer coverage (COBRA) for a limited time.
Medicare is primary to both retiree coverage and COBRA coverage. This means Medicare will pay first and your other insurance will only pick up costs that Medicare does not pay.
What if I have both Medicare and Medicaid
Medicaid is health insurance for people whose incomes are below a certain amount. Many Medicare recipients are also on Medicaid.
If you have both Medicare and Medicaid, Medicaid will always be secondary. Medicaid is also secondary to any employer-sponsored health insurance you may have.
Not all providers accept Medicaid, even if they accept Medicare. To get the most out of your coverage, always see providers who accept both Medicare and Medicaid.
Primary and secondary insurance can be confusing. To keep your costs down, it’s important to understand the rules and which policy is primary.
Learn More about When Medicare is Primary
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