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Medicare is only secondary to your group coverage if you work for a company with 20 or more employees (could be a combination of part-time and full-time, based on total number of hours per year) and you worked 20 weeks or more, in the current or preceding year. They do not have to be consecutive weeks. If you work less than 20 weeks or your employer employs less than 20 employees, or both, your medicare coverage is your primary insurance coverage.

Primary status of group benefits takes place as soon as the employment and work week criteria are met. It will be primary for at least the rest of the current calendar year and all of the following year.

Primary status for medicare takes place on January 1st of the following year after an employer employs less than 20 employees or you work less than 20 weeks in that year. Medicare remains primary until employment or work week criteria meet levels to make group benefits primary.

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โˆ™ 2010-10-29 19:13:07
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Q: When is Medicare primary under a Group Insurance Plan?
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Related Questions

Can medicare be used for secondary insurance if the primary insurance is paid by your employer?

Medicare is primary if your group is under 20 lives. 20 lives or more and medicare is secondary to your employer paid group plan.

What is my primary insurance my husband's plan at work or medicare?

If you are covered under your husband's plan and he is working, his plan is primary to Medicare. If you are not covered under your husband's plan, Medicare is primary.

You have medicare insurance and your spouse has medical insurance provider which includes you which medical insurance is primary nfor you?

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

Who pays first if you have medicare and are retired hourly from General Motors?

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.

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

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 I recommend you visit 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.

What age does Medicare become primary?

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age with End-Stage Renal Disease.

Why is the car insurance required by federal law to send info to medicare?

This is to determine if injuries from an auto accident can be paid from your insurance coverage or from Medicare. Several years ago the Federal government made auto insurance primary for paying for such injuries medical expenses and Medicare would pay secondarily over and above the auto insurance. They also made Medicare secondary to any other insurance you may have from a former employer under a retirement provision. This was a drastic swing of lots of money off of Medicare and onto other insurance programs for payment.

If you have medicare and your spouse also has you as a dependent on their insurance which is primary and which is secondary?

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 link

I understand when Medicare is primary and when Medicare is secondary. What is the difference in coverage between a Medicare Supplement and Medicare as a secondary insurer?

If you have a Medicare Supplement then the provider will bill Original Medicare first. At that time Medicare will pay the allowable amount and then return an explanation of benefits stating the beneficiary's portion. Based on the Medicare Supplement Plan that is in place (A-N) the Medicare Supplement will pay a portion or all of the remaining amount due. If they pay only a portion based on the plan (A-N), then according the plan guidelines, the beneficiary would pay any outstanding amount at that time. If a Medicare beneficiary is covered on a employer or retiree group plan and due to the size of the plan, the group plan is primary, then the group plan benefits will apply first and any amounts due by the Beneficiary will be billed to Medicare second. If it is a Medicare covered service, then Medicare will pay the remaining amount due as the secondary payor up to the amount allowed by Medicare. If the service is not allowed by Medicare, than the beneficiary's co-insurance or co-payment under the group plan would be their responsibility.

What group of people are covered under Medicare?


Why is medicare the primary provider for those 65 and over?

In 1965, Congress created Medicare under Title XVIII of the Social Security Act to provide health insurance to people age 65 and older. However, for those individuals 65 and over who are still working and covered under an employer sponsored group health plan, the group plan generally pays first *if* the employer has more than 20 employees.

Is your wife covered under Blue Shield and Medicare if you die?

Is ones spouse covered under Medicare and Blue Shield when the primary carrier dies.

Who is primary if person has medicare and not 65 years but also has group coverage?

How many people work at the group? Why does someone under 65 have medicare if they are able to work? Why does it matter which company is primary, just turn in the claims. Medicare's 43 page booklet on who pays first

How do you maintain health insurance coverage for your wife and son after you turn 65 and are eligible for Medicare?

Where you covered under an Employer Group or Individual Plan? If Employer Group - they would be eligible for COBRA - If Individual - then just tell the Insurance Company to take you off.

Can secondary insurance pay claims that are denied by Medicare?

That would be covered under the terms of your policy. In general that is what supplemental, (secondary) insurance is primarily for. Most "supplemental" plans pay the 20% that Medicare didn't pay only AFTER seeing an "explanation of benefits" statement--i.e. proof that Medicare paid their part. If Medicare denies a service all together, the supplemental plan is often under no obligation to pay at all, as they are there to "supplement" Medicare, not take the place of it in cases of denial. This is especailly true if Medicare denies because the service was deemed "not medically necessary". So, in short, no. Medicare supplements often do not cover services if they are denied by the primary (Medicare).

Can someone claim medicare or medicaid if currently under medical coverage?

Having private insurance does not make one ineligible for Medicaid or Medicare.

Is there a penalty for not taking medicare B if covered under wife's insurance and is primary?

No, you are not subject the the late enrollment penalty if you were covered by an insurance plan or your spouse's insurance plan at the time you were eligible. Make sure you receive a copy of your creditable coverage letter once you plan to enroll in Medicare Part B, so you can prove you were covered. For more information on the time frames for enrolling in Part B should you lose or drop coverage, see the link below on the Medicare website to the Medicare & You Handbook, page 21.

Will Medicare Supplement Insurance cover dependents under the age of 16?

Yes, Medicare Supplement Insurance covers dependents and children up to the age of fifteen according to their guidelines which are listed on their website.

You want blue cross to be primary and medicare to secondary can you do that?

No. There is a federal law that requires Medicare is a secondary payer. You can find more information on the CMS website under "Medicare Secondary Payer and You."

How do you find out about medicare advantage for disable under 65?

any insurance company that offers regular medicare cov can offer a disabled person cov.

What is the age limit for Medicare?

Medicare is a health insurance program for:people age 65 or older,people under age 65 with certain disabilities

How do you get a supplement insurance to Medicare when you are under 65?

If you are on Medicare due to disability or End Stage Renal Disease(is this the reason you have Medicare under age 65?), you will need to look into a Medicare Advantage Plan instead of a Medicare Supplement also called Medigap. This is what Medicare says: If you are a person with Medicare under age 65 and have a disability or ESRD, you might not be able to buy the Medigap (also called "Medicare Supplement Insurance") policy you want, or any Medigap policy, until you turn age 65. Federal law doesn't require insurance companies to sell Medigap policies to people under age 65. However, some states require Medigap insurance companies to sell you a Medigap policy, even if you are under age 65. For more info on Medicare Supplements: For more info on Medicare Advantage Plans: IMPORTANT NOTE: You must enroll in a Medicare Advantage Plan before December 31, 2008 or you will need to wait until November 15, 2009 to enroll.

What health insurance program is designed to complement the retirement survivor and disability insurance enacted under Title II of the Social Security Act?


If you have Medicare and Blue Cross which is primary provider?

In most cases, Medicare is primary. Some of the most common situations where Medicare can pay secondary are: -The individual or his/her spouse is currently employed/working and covered under an employer group health plan as a result of current employment. The company has 20 or more employees or participates in a multiple-employer or multi-employer group health plan where at least one employer has 20 or more employees. -Individual in question is entitled to Medicare as a result of a disability, the company has 100 or more employees, or participates in a multi-employer/multiple-employer group health plan where one employer has 100 or more employees. -The individual in question is Medicare entitled due to end-stage renal disease. Medicare is the secondary payer to a group health plan until a 30-month coordination period has ended.

What are some details about the Medicare Supplement Insurance provided by the Mutual of Omaha?

Medicare Supplement Insurance provides health insurance for people older than 65 years or people under 65 with certain disabilities or people of any age with end-stage renal disease.