What is the difference between primary and secondary coverage?

When you have Medicare and another type of insurance, Medicare will pay primary or secondary for your medical costs. Primary insurance pays first for your medical bills. Secondary insurance pays after. Usually, secondary insurance pays some or all of the costs left after your primary insurance pays. (For example, deductibles and copays.)

Type of insurance	Conditions	Primary	Secondary
65+ with job-based insurance	Fewer than 20 employees	Medicare	Employer
	20+ employees	Employer	Medicare
Disabled with job-based insurance	Fewer than 100 employees	Medicare	Employer
	100+ employees	Employer	Medicare
Retiree insurance	Not eligible for Medicare	Retiree	N/A
	Eligible for Medicare	Medicare	Retiree
COBRA	Had COBRA before enrolling in Medicare	Medicare	N/A*
	Had Medicare before becoming eligible for COBRA	Medicare	COBRA

*COBRA ends if you had COBRA before enrolling in Medicare.

Note: Different rules apply if you have Medicare because of End-Stage Renal Disease (ESRD). There are also different rules if you have retiree Federal Employee Health Benefits (FEHB).

How does Medicare work with job-based insurance?

• If your job-based insurance is primary, you may wish to delay Medicare enrollment because you already have primary coverage and can sign up for Medicare Part B later.
• If your job-based insurance is secondary, you should enroll in Medicare Part B to avoid high costs for your care. If Medicare is supposed to be your primary coverage, your job-based coverage may provide little or no coverage if you’re not enrolled in Part B.

 

 

 

 

 

How does Medicare work with retiree insurance and COBRA coverage?

• Retiree insurance is health coverage an employer may provide to former employees. Retiree coverage is almost always secondary to Medicare. This means you need to enroll in Medicare to be fully covered.
• If you have COBRA coverage when you become Medicare-eligible, COBRA usually ends the date you get Medicare. You should enroll in Part B right away. If you have Part A or Part B when you become eligible for COBRA, you must still be allowed to enroll in COBRA – and you should enroll in or keep Part B. Medicare is primary insurance, and COBRA is secondary insurance.
• Retiree insurance and COBRA do not entitle you to an SEP to enroll in Part B. You may have to wait for coverage and pay a penalty.

 

 

 

 

 

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