How does Medicare work with my employer health plan?

It is very important to understand how your two health insurances work together to cover your health care.

If you’re eligible for Medicare because you have a disability and you also have health insurance through a current employer, who pays first depends on how many people work for that employer. The employer coverage may be through your job, your spouse’s job or another family member’s job.

The insurance that pays first on health care claims is called your primary insurance. The secondary insurance pays after the primary insurance. The secondary insurance may cover all or some of the costs the primary insurance does not cover.

If there are fewer than 100 employees at the company where you, your spouse or other family member currently work, then Medicare is your primary coverage and your employer group health plan pays second.

If the company where you, your spouse, or other family member currently work has 100 or more employees, your employer group health plan pays first and Medicare pays second.

If you have Medicare due to disability and are no longer working, but are receiving COBRA or retiree insurance from a former employer, Medicare is your primary insurance. This would then make COBRA or your retiree plan secondary.

The above is only true if you have Medicare because of a disability. The rules are different if you are eligible for Medicare because of End Stage Renal Disease (ESRD) or age. Please contact us at 1-800-247-9889 for more information.