More Than One Insurer?

Who Pays First?

If you have other health coverage along with Medicare, here’s some information to help you understand how you can expect your benefits to be paid.

While each insurer is a payer, your primary payer is the one with the responsibility to pay first for services you receive. Your secondary payer pays second, and your third payer, if you have one, pays after that.

Your primary payer is required to pay all costs to the limits of its coverage. Once the primary payer’s obligations are met, your secondary payer does likewise, and so on down the line. In order to know each payer’s obligations and limits, it’s important to read each policy carefully.

If you have dual health coverage including Medicare, the Medicare Coordination of Health Benefits Contractor can help you to determine whether Medicare is or isn’t your primary payer. For further information, call 800-999-1118 toll-free.

Generally Speaking:

If you are covered under both Medicare and a former employer’s group health plan, Medicare is your primary payer.

If you are covered under both Medicare and a current employer’s group health plan, your employer’s plan will pay first if your employer has more than 20 employees. If you work for a smaller company and are covered under both Medicare and your current employer’s group health plan, Medicare will normally be your primary payer.

If you have both Medicare and Medicaid coverage, Medicare is your primary payer because Medicaid never pays first for Medicare-covered services.

Even if Medicare is not your primary payer, your medical service provider may bill Medicare for a claim your primary provider does not pay promptly. This may take place after a period of about 120 days. In such a case, Medicare may make a conditional payment to your medical service provider. Be aware, however, that Medicare must be reimbursed for any such payment.

If you have other health insurance of any kind, it’s important to provide this information when enrolling in Medicare. Similarly, if you gain any other coverage after enrolling in Medicare, you need to inform the Medicare Coordination of Benefits Contractor of the change by calling 800-999-1118 toll-free. You should also keep your health care providers fully informed about all of your insurance coverage and any changes that occur.

For further information about dual coverage including Medicare, visit here. If you have any further questions about Medicare Part A, Part B, Medicare Advantage, Medigap, or any other aspect of health care, MedicareMall will be happy to answer them. Contact us now and we’ll lead you through the Medicare maze and help ensure that you have the knowledge and confidence you’ll need to make the best decisions about your health.