If the employer has less than 20 employees, the group health plan pays first, and Medicare pays second if both of these conditions apply:. , then Medicare pays first, and the group health plan pays second. If the employer has less than 20 employees and isn't part of a multi-employer or.If the employer offers coverage to spouses, it must offer the same coverage to spouses 65 and older that they offer to spouses under 65. You may have to pay any costs Medicare or the group health plan doesn't cover.Įmployers with 20 or more employees must offer current employees 65 and older the same health benefits under the same conditions that they offer employees under 65. Should send the bill to Medicare for secondary payment. If the employer has 20 or more employees, then the group health plan pays first, and Medicare pays second.ĭidn't pay all of your bill, the doctor or health care provider.I have Medicare and: I'm 65 or older and have group health plan coverage based on my or my spouse's current employment status. Tell your doctor and other health care providerĪbout any changes in your insurance or coverage when you get care. If you have questions about who pays first, or if your coverage changes, call the Benefits Coordination & Recovery Center at 1-85 (TTY: 1-85). How Medicare coordinates with other coverage Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should've made. Promptly (usually within 120 days), your doctor or other provider may bill Medicare. If the insurance company doesn't pay the claim If your group health plan or retiree coverage is the secondary payer, you may need to enroll in Medicare Part B before they'll pay.The secondary payer (which may be Medicare) may not pay all the remaining costs.The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover.The insurance that pays first (primary payer) pays up to the limits of its coverage.In some rare cases, there may also be a third payer. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" (supplemental payer) to pay. And other health insurance (like from a group health plan, retiree coverage, or Medicaid), each type of coverage is called a "payer." When there's more than one payer, "coordination of benefits" rules decide who pays first.
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