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When is Medicare Primary

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.

With a Medigap policy, the supplement is secondary. Medicare pays claims first, and then Medigap pays.

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.

If you can't call an agent now, fill out an online rate form, and see your options now!

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Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

10 thoughts on “When is Medicare Primary

  1. If a patient has Medicare as primary and BCBS as secondary and the provider is not contracted with Medicare, do we still have to submit to Medicare first and then BCBS or can we submit to BCBS directly? Assuming Medicare will just deny the claim correct?

    1. Hi Janine. If the doctor does not accept Medicare, the secondary insurance will not cover the service either. The client is 100% responsible for the costs.

  2. I have a BCBS blue advantage hmo through the market place and was enrolled in medicare after choosing that. Currently we have tax credit, but when I report change I will become responsible for premium and they state I can keep that policy if I do so. Can my marketplace plan be the primary as it covers all the TBI injury I have and Medicare does not? If so how do I make it primary?

    1. Hi Cheryl! As soon as you become eligible for Medicare, you’ll no longer be eligible for premium subsidies through the Marketplace. Marketplace coverage and Medicare do not coordinate with one another. Your Marketplace coverage will not cover your health costs if you have Medicare. In addition, once you have Medicare and leave the Marketplace plan, you cannot get it again. So I think the information you received is incorrect. I would recommend giving us a call to figure out what you actually have and what Medicare plan will cover your TBI injury.

  3. If My last day of physically working was on 08/14/2020 and I’ve had Medicare since 08/01/2020, would Medicare become primary on 08/15/2020?

    1. Hi Kathy! I would contact your benefits administrator to confirm when Medicare becomes primary. It’s not the same for everyone.

  4. I have FEHB (federal employees health benefits)….I am a retired federal plan I am thinking of switching to is thru aetna medicare advantage plan..with that being said would medicare be primary as it is with most FEHB plans?..thanks..

    1. Hi Joe! If you enroll in Part B and keep your FEHB, then your FEHB will be primary. If you choose to enroll in a Medicare Advantage plan, you still have to pay your Part B premium, just keep that in mind. Usually, most on FEHB will go with Part A and Part B since there is not much advantage to enrolling in a Medicare Advantage plan. Medicare Advantage plans and FEHB are very alike. There isn’t much need to have both. I hope this helps!

  5. “Please note that Medicare WON’T pay your claims when you have an Advantage plan”. So then why am I paying for medicare if they don’t pay anything?

    1. Hi Samantha. That is a great question! This is because Medicare Advantage replaces your Original Medicare benefits. Medicare is no longer responsible for your medical costs, the Advantage plan is. Medicare pays the Advantage carrier to take on your risk. That’s how the carriers are able to offer zero-premium plans.


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