Who pays first - Medicare or other Insurance?

If you are covered by a Group Health Plan

Primary Payer

Secondary Payer

Based on you or your spouse/family member working at a firm which has 20 or more employees

Group health plan

Medicare

Based on you or your spouse/family member working at a firm which has less than 20 employees

Medicare

Group health plan

You are disabled and coverage is based on you or your family member working at a firm with 100 or more employees

Group health plan

Medicare

You are disabled and coverage is based on you or your family member working at a firm with less than 100 employees

Medicare

Group health plan

You have End-Stage Renal Disease (ESRD) and group health plan coverage (including a retirement plan)

• During first 30 months of eligibility or entitlement to Medicare

• After 30 months

Group health plan

Medicare

Medicare

Group health plan

If you are covered by COBRA

Primary Payer

Secondary Payer

You are 65 or over or disabled, and are also covered by COBRA

Medicare

COBRA

You have ESRD and are covered under COBRA

• First 30 months of eligibility or entitlement to Medicare

• After 30 months

COBRA

Medicare

Medicare

COBRA

If you are covered by Medicaid

Primary Payer

Secondary Payer

You are enrolled in a Medicaid program

• Medicare
• Employer health plans
• Medicare Supplement

Medicaid

If you are covered by Federal Employee Health Benefits

Primary Payer

Secondary Payer

Active Federal Employee

FEHB

Medicare

If you are covered by TRICARE

Primary Payer

Secondary Payer

Active-duty military personnel

Inactive-duty military personnel

TRICARE

Medicare pays for Medicare-covered services

TRICARE pays for services provided by a military hospital or other federal providers

N/A

If you have coverage not mentioned above

Primary Payer

Secondary Payer

If you are in an accident where no-fault or liability insurance is involved

Insurance provider

Medicare

If you are getting workers’ compensation because of a job-related illness or injury

Workers’ compensation for services or items related to workers’ compensation claim

Does not apply, but Medicare may make a conditional payment

If you are affected by black lung disease and are covered under the Federal Black Lung Benefits Program

Federal Black Lung Benefits Program for services related to black lung

Medicare