Categories: Medicare

If I have Medicare and other health coverage, who pays first?

This issue comes up when an individual is eligible for Medicare, but also has other coverage. It’s known as “coordination of benefits.” The answer is, it depends on the type of coverage you have.

For example, if you have Medicare and Medicaid, then Medicare always pays first. Medicaid would only pay the amount remaining after Medicare pays for it’s share.

If you are 65 or older and covered by a group health plan because you or your spouse is working, then it depends on how many employees your employer has. If there are 20 or more employees, then the group health plan pays first, and Medicare pays any amount remaining. If there are less than 20 employees, then Medicare pays first and the group health plan pays the remaining amount.

Other situations, such as coordination of worker’s comp, Veteran’s benefits and TRICARE are addressed in Medicare’s Guide to Who Pays First:  https://www.medicare.gov/Pubs/pdf/02179.pdf

Published by
David L. McGuffey

Recent Posts

What happens if I don’t fund my Qualified Income Trust?

Qualified Income Trusts (also known as Miller Trusts or a QIT) are necessary when the…

3 months ago

Changes in How Trusts are Taxed

Trusts, like everyone else, pay taxes when they earn income or sell capital assets for…

3 months ago

What is a Medicaid Asset Protection Trust?

People often visit us and ask about using a trust to protect assets in the…

4 months ago

QLACS Update

Last year we wrote about qualified longevity annuity contracts, sometimes referred to as QLACs. On…

4 months ago

Trusts and Medicaid: Protecting Assets

People regularly ask us whether they should use a trust to protect assets in case…

7 months ago

Elle

We haven't posted much lately because we've been busier than a one-armed paper-hanger, but we…

11 months ago