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How Your Bills Get Paid if You Have Other Health Insurance

 Sometimes your other insurance pays your health care bills first and the Original Medicare Plan pays second. Other insurance that usually pay first includes:
  • no-fault insurance (including automobile insurance),
  • liability insurance (including automobile insurance),
  • black lung benefits, and
  • workers’ compensation.

When you have other insurance (like employer group health coverage), there are rules that decide whether Medicare or your other insurance pays first. The insurance that pays first is called the "primary payer." The one that pays second is called the "secondary payer."

Use this chart to see who pays first.

If you have retiree insurance (insurance from former employment)… Medicare pays first.
If you’re 65 or older, have group health plan coverage based on your or your spouse’s current employment, and the employer has 20 or more employees… Your group health plan pays first.
If you’re 65 or older, have group health plan coverage based on your or your spouse’s current employment, and the employer has less than 20 employees… Medicare pays first.
If you’re under 65 and disabled, have group health plan coverage based on your or a family member’s current employment, and the employer has 100 or more employees… Your group health plan pays first.
If you’re under 65 and disabled, have group health plan coverage based on your or a family member’s current employment, and the employer has less than 100 employees… Medicare pays first.
If you have Medicare because of End-Stage Renal Disease (ESRD)… Your group health plan will pay first for the first 30 months after you become eligible to enroll in Medicare. Medicare will pay first after this 30-month period.




Medicare And You Important note
Note: In some cases, your employer may join with other employers or unions to form a multiple employer plan. If this happens, only one of the employers or unions in the multiple employer plan has to have the required number of employees for group health plan to pay first.


Here are some important facts to remember:
  • The insurance that pays first (primary payer) pays up to the limits of its coverage.
  • The one that pays second (secondary payer) only pays if there are costs the primary insurer didn’t cover.
  • The secondary payer (which may be Medicare) may not pay all of the uncovered costs.
  • If your employer insurance is the secondary payer, you may need to enroll in Part B before your insurance will pay.



Medicaid and TRICARE never pay first for services that are covered by Medicare.
They only pay after Medicare, employer group health plans, and/or Medicare Supplement Insurance have paid.


For more information, visit www.medicare.gov/publications to view the booklet "Medicare and Other Health Benefits: Your Guide to Who Pays First." You can also call 1-800-MEDICARE (1-800-633-4227) to find out if a copy can be mailed to you. TTY users should call 1-877-486-2048.

It’s important that you tell your doctor, hospital, and pharmacy that you have other insurance so they know how to handle your bills.

In some cases, if the insurance that is supposed to pay first doesn’t pay promptly, the Original Medicare Plan may make a "conditional" payment. This means it must be repaid to Medicare when a payment is made by the insurance that is supposed to pay first.

If you are in the Original Medicare Plan and you have questions about who pays first, or you need to update your other health insurance information, call the Coordination of Benefits Contractor at 1-800-999-1118. TTY users should call 1-800-318-8782. For more information, visit www.medicare.gov on the web and view the booklet "Medicare and Other Health Benefits: Your Guide to Who Pays First" or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Medicare And You Important note
If you join a Medicare Prescription Drug Plan (Part D), you must let your plan know if you have other prescription coverage.

(Primary Source: Centers for Medicare and Medicaid Services - Medicare and You Handbook. This content may have been enhanced by Q1Group LLC to include further examples, explanations, and links.)




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  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
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  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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