When does Medicare pay first? When does Employer pay first?
The answer depends on the number of full-time employees the employer has. When a company has 20+ employees, the employer is primary, and Medicare is secondary. When the company has fewer than 20 employees, Medicare is primary, and the employer is secondary.
Scenario |
Primary Payer |
Secondary Payer |
Employer with 20+ employees |
Employer |
Medicare |
Employer with fewer than 20 employees |
Medicare |
Employer |
On spouse's insurance and employer has 20+ employees |
Employer |
Medicare |
On spouse's insurance and employer has fewer than 20 employees |
Medicare |
Employer |
Retiree from non-federal job with health insurance from former employer |
Medicare |
Employer |
Retired and spouse's employer's plan for business with fewer than 20 employees |
Medicare |
Employer |
Retired and spouse's employer's plan for business with 20+ employees |
Employer |
Medicare |
Retired federal employee |
Medicare |
Federal Employees and Health Benefits Program |
TRICARE* |
See below |
|
COBRA |
Medicare |
COBRA |
Medicaid |
Medicare |
Medicaid |
Under 65, disabled and have coverage through a family member's employment and employer has 100+ employees |
Employer |
Medicare |
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