Coordination of Benefits: How Medicare Works with Other Insurance

When you have both Medicare and another health insurance plan, each type of coverage is considered a “payer.” The coordination of benefits rules determine who pays first.

These rules apply whether you have Original Medicare, Medicare Advantage (Part C), or Medicare drug coverage (Part D).

Primary Payer: The primary payer is the first to pay its share of your medical bills, up to the limits of its coverage. Afterward, any remaining balance is sent to the secondary payer (also known as the supplemental payer).

Secondary Payer: If the secondary payer covers the remaining balance, great! But if not, you may be responsible for the rest of the costs.

Types of Payers: Examples of payer types include:

Group health plans for workers or retirees

COBRA plans

Federal programs like Veterans benefits, TRICARE, Indian Health Service, Federal Black Lung Program, and Medicaid

Non-group health plans like liability insurance, no-fault insurance, and workers’ compensation. For more on benefits, see article here https://protect.com/insurance/auto

Remember to inform your healthcare providers if you have additional health coverage alongside Medicare. This ensures that your bills are sent to the correct payer and avoids delays. If your group health plan or retiree coverage is the secondary payer, consider signing up for Medicare Part B before they’ll pay.

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Coordination of Benefits: How Medicare Works with Other Insurance

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