Medicare: Primary or Secondary Insurance?

Can Medicare be secondary insurance? It’s an interesting question that, like so many aspects of Medicare, has a complicated answer.

Today, we’re going to explore possible scenarios and when Medicare becomes secondary insurance.

What Do Primary and Secondary Insurance Mean?

Primary and secondary insurance refers to having more than one insurance plan providing coverage. Many people have health care coverage through a primary insurance and a secondary insurance plan.

Primary insurance is an insurance plan that covers you and is typically offered through an employer or purchased as private insurance. Primary insurance is billed first when you receive health care.

Secondary insurance is a health insurance plan that covers you in addition to your primary insurance plan. Typically, secondary insurance is billed when your primary insurance plan is exhausted and may help cover additional health care costs.

For example, if you already have insurance through your employer and choose to enroll with your spouse’s health insurance plan (if allowed), that coverage would become your secondary insurance.

So, what does that have to do with Medicare? Medicare enrollment happens at 65 and many either do not retire immediately, have a spouse still in the workforce, or choose to purchase coverage that goes beyond traditional Medicare.

Is Medicare Secondary to Medicare Advantage?

Enrolling in Medicare Advantage takes the place of Original Medicare. Although you have to pay any applicable Medicare premiums in order to enroll in a Medicare Advantage plan, you don’t actually have coverage through both Medicare Advantage and Original Medicare.

When you are enrolled in a Medicare Advantage plan, your health care services are administered by your plan provider and not by the government agency, CMS.

Is My Medicare Supplement Primary or Secondary Coverage?

Unlike Medicare Advantage, which becomes your primary coverage, Medicare Supplement plans are exactly what they sound like: supplemental coverage. Your Medicare Supplement is secondary coverage to your Original Medicare plan.

A Medicare Supplement is a great example of the purpose of secondary insurance coverage, because it fills the coverage gaps in Medicare and helps give you a more complete plan.

With a Medicare Supplement, Medicare is billed first and whatever is left over goes to your supplemental company. Your plan will then take care of the remaining balance, minus any deductibles or other out-of-pocket expenses you may have that are plan-specific.

When Is Medicare Primary Coverage?

If you don’t have any other insurance, Medicare will always be your primary insurance. In most cases, when you have multiple forms of insurance, Medicare will still be your primary insurance.  

Here’s a few instances where Medicare is your primary insurer:

• If you have workplace insurance from a company with fewer than 20 employees
• If you have retiree insurance through a former company
• If you have COBRA insurance after leaving a company where you had health insurance
• If you have a disability and work at a company of less than 100 people
• If you have end-stage renal disease (ESRD)
• If you have TRICARE For Life
• If you have Medicaid

When Is Medicare Secondary Coverage?

There are a few scenarios where Medicare becomes secondary coverage. Let’s look at the most popular ones:

• You Still Have Group Coverage Through Larger Employer

If you or your spouse receives group insurance through their employment at a company that employs more than 20 people, Medicare will serve as secondary coverage to that insurance plan. Some Medicare beneficiaries will choose to delay their Part B enrollment if their group coverage is cheaper.

• You’re Under 65 and Disabled With Larger Employer Group Coverage

If you’re under 65, eligible for Medicare due to a disability and have group employer coverage through an employer with more than 100 employees, Medicare will be your secondary payer. 

• You Are on Active Military Duty  

If you’re on active duty, TRICARE pays first for Medicare-approved services at civilian facilities. And Medicare doesn’t cover treatment provided by a military hospital or federal health care provider; that will all go through TRICARE or your VA benefits.

Conclusion

Medicare can be both primary and secondary coverage depending on what other coverage types you have.

Those with Medicare Advantage, however, do not have secondary Medicare coverage because they don’t receive their care from the government. Medicare Supplement plans are a prime example of secondary coverage working alongside Medicare.  

If you have questions about your current Medicare coverage or are looking to make changes, we are here to help! Contact us at 833-801-7999 to speak with a licensed insurance agent and find the right Medicare coverage plan for you.