Your Medicare Community - MedicareFAQ

Is Medicare Primary or Secondary?

October 15, 2021 Lindsay Malzone
Your Medicare Community - MedicareFAQ
Is Medicare Primary or Secondary?
Show Notes Transcript

When you become Medicare-eligible, you may be wondering whether your existing coverage coordinates with Medicare. Whether Medicare will pay primary or secondary depends on the other type of coverage you have.

First, it's common for Medicare beneficiaries to work past the age of 65. Most will have employer coverage. So, the major questions are whether you should keep your Medicare coverage while you have employer coverage and, if you do, which will pay first? This depends on how many employees are at the company.

When your employer has 20 or more employees, your coverage is creditable for Medicare. However, with fewer, than 20 employees, the coverage isn't creditable. In the latter scenario, you'll want to enroll in Medicare Part B to avoid penalties in the future.

With creditable employer coverage, Medicare is secondary and the group plan is primary. Whereas, with a group plan that is not creditable, Medicare is primary and the group plan is secondary.

In the circumstance where you're Medicare-eligible due to disability and have employer coverage, possibly through your spouse, the number of employees must be 100 or more for coverage to be creditable.

Medicare Advantage plans are considered primary coverage because they pay for your care instead of Medicare.

Other scenarios where Medicare is primary:
• You have Medicare and a Medicare Supplement (Medigap) plan
• You're dual-eligible for and have Medicare and Medicaid
• You also have coverage through FEHB, TRICARE, COBRA, retiree insurance, or tribal self-insurance

Situations when Medicare pays secondary:
• When you have a worker's compensation, liability, or no-fault insurance policy
• Active duty with TRICARE

As for Veterans benefits and Medicare, the two don't coordinate together. Veterans benefits work at veteran-approved facilities and Medicare works at civilian facilities.

Medicare also does not work with the Marketplace (a.k.a. "Obamacare"). If you have this coverage and receive subsidies, unfortunately, you will no longer qualify for them when you become eligible for Medicare. Additionally, it's illegal for an agent to try to sell you a Marketplace policy when you already have Medicare.e

All this information can seem overwhelming, but we are here to simplify it for you so you can make the best health care decisions. If you found this video helpful, please subscribe to our YouTube channel and join our Facebook Community Group!

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When you become Medicare eligible, you may be wondering if the options you're exploring or the coverage you already have is going to pay primary or secondary. Well the answer is, it depends on what coverage you currently have. In today's video, we're going to answer the big question on is your Medicare primary or secondary? Hi Medicare Community. My name is Lindsay Malzone and on the Medicare expert for Elite Insurance Partners and MedicareFAQ.com. It's Common for Medicare beneficiaries to work past the age of 65. Most of them have employer coverage. So one of the bigger questions is, should I enroll in Medicare if I have employer coverage and if so, when is it primary or secondary? Whether or not your group employer coverage is primary or secondary, depends on how many employees are at the company. When your employer has more than 20 employees then your coverage is considered creditable. However, if they have less than 20 employees, then the coverage is not considered creditable. In this case. You'll want to enroll in Part B to avoid being charged any late enrollment penalties. When your group employer coverage has more than 20 employees and is considered creditable under Medicare, Medicare will be your secondary coverage and your employer group coverage will be primary. In the scenario were are company has less than 20 employees and is not considered creditable, then Medicare will be your primary coverage and your group employer coverage will be secondary. In this scenario, your coverage is not considered creditable and you are going to incur a late enrollment penalties is under Part B. When you're on Medicare due to a disability and you have employer coverage through possibly your spouse, Medicare will be a primary if the employer has less than 100 employees and will be secondary if the employer has more than 100 employees. Now, let's go over how a Medicare Advantage plan will work with Medicare regards to being primary or secondary. To enroll in a Medicare Advantage plan, you still must be enrolled in Part A and Part B of Original Medicare. When you have Medicare Advantage, the plan is always going to be considered your primary coverage. This is because your Medicare Advantage plan is paying for your care instead of Medicare. Now, let's go over other scenarios when Medicare is your primary coverage. When you enrolled in both Medicare and Medigap, your Medicare will always be your primary coverage and your Medigap plan will be your secondary coverage. When your dual eligible for both Medicare and Medicaid, Medicare is your primary coverage. Other scenarios where Medicare is

your primary coverage include:

Federal Employee Health, Benefits, Tricare, Cobra, retiree insurance and Tribal Self insurance. Now let's go over some situations where Medicare pays secondary. When you have an active workers compensation, liability or no-fault insurance policy, your Medicare coverage will be secondary. This is because the Medicare secondary payer act protects Medicare from paying for illness and injury related cost when there is another party responsible for the beneficiaries condition. Another scenario where Medicare pays secondary is those who are active duty with TRICARE. One question we get a lot is how VA benefits or veterans benefits work with your Medicare coverage? In this scenario, there is no primary or secondary coverage, since each one is only eligible to be used at a specific set of facilities. You have your Medicare approved facilities and your veterans approved facilities. When you go to a medical facility, Medicare will pay. When you go to a VA facility, your veterans benefits will pay. Now, let's talk about how the marketplace coverage or Obamacare works with Medicare. Well, unfortunately, Medicare does not work with Marketplace health care at all. If you are receiving any subsidies through the HealthCare Marketplace, unfortunately, you'll no longer qualify for those subsidies once you're eligible for Medicare. You'll have to pay the full premium with no subsidies applied for your coverage if you choose to keep the coverage through the marketplace. Also, if you don't already have a plan through the marketplace, it is illegal for any Medicare agent to sell you a policy. It's important to be clear on how Medicare works or doesn't work with the current coverage you have. The information can sometimes be overwhelming, but that's why we're here. Once you understand its easier to make an important health care decision. Thank you so much for watching. I hope you found the video helpful. If you haven't already subscribe to our YouTube channel, make sure to do so. Don't forget to turn notifications on so youre notified each time we upload a new video. You also have a fantastic Medicare community on Facebook, well include a link in the description below so you can join. Until next time. Bye.