Did You Know: How Medicare works with other insurance

When you have other insurance and Medicare, who pays first and when?

If your client is 65 or older and has group health plan coverage based on their or their spouse's current employment status:

If the employer has 20 or more employees, then the group health plan pays first, and Medicare pays second. If the group health plan didn't pay all of your bill, the doctor or health care provider should send the bill to Medicare for secondary payment. You may have to pay any costs Medicare or the group health plan doesn't cover.
Employers 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. 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.
If the employer has less than 20 employees and isn't part of a multi-employer or multiple employer group health plan, then Medicare pays first, and the group health plan pays second.
If the employer has less than 20 employees, the group health plan pays first, and Medicare pays second if both of these conditions apply:
- The employer is part of a multi-employer or multiple employer group health plan
- At least one of the other employers has 20 or more employees

Check with their plan first and ask if it will pay first or second. If your group health plan or retiree coverage is the secondary payer, you'll likely need to enroll in Medicare Part B before they'll pay.

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