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Medicare and Medicaid

Is Medicare primary when the spouse is still working or if the Medicare beneficiary works?

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2005-03-08 21:36:12
2005-03-08 21:36:12

Medicare is primary if you work for a company with less than 20 employees. It would also depend on if the spouse is covered under the employer group health insurance. For more info. see www.SteveShorr.com/medicare.htm I recommend you visit www.cms.gov. to answer your question, If you are not 65+ years old, completely disabled, or both, and your spouse is employed by a company with 100+ employees, then your spouses insurance is primary. However, if you are disabled, 65+ yrs old, or the company your spouse works for has less than 100 employees, then your medicare would be primary.

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Chances are Medicare would pay first as long as you are no longer working, or if your spouse does not have you covered under insurance through their employer. If your spouse IS working and you do have coverage through them, the group insurance would be primary if their employer has more then 100 employees working for them. Otherwise, Medicare will be primary.

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A non-working spouse can be eligible for Medicare coverage through their spouse who is qualified. To be able to file a claim for your non-working spouse, you must be Medicare eligible and at least 62 years of age.

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Medicare is primary unless you are working and have coverage thru your employer. Coverage thru the spouse's employer would be secondary to your own Medicare coverage.NO. The answer posted above is incorrect! Medicare is Secondary.Medicare is secondary when :-The individual or his/her spouse is currently employed/working and covered under an employer group health plan as a result of current employmentsee this linkhttp://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_adp.php?p_faqid=871

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If you have medicare and you are a dependent on your spouses medical insurance policy then you would be primary under your spouse and Medicare would be secondary payor. There are a few circumstances where Medicare would be primary but very few (your spouse is covered under COBRA, the group is less than 20 members, or you have end stage renal disease.) Medicare is 99.99 % always secondary because it is a government program (much like Medicaid.) I hope this helps:) Evan


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