Medicare can either be primary or secondary to employer insurance. This usually depends on the size of the employer and whether or not someone is currently working. Primary insurance pays first for health care claims. Secondary insurance pays after the primary insurance for some or all of what the primary insurance did not cover. Often, secondary insurance will refuse to pay anything if the primary insurance has not paid anything.
You should talk to your employer to find out how your employer insurance will work with Medicare.
Important: The information below is about insurance from your or your spouse’s current employer. If you have retiree insurance or COBRA see the scripts Enrolling in Medicare when you have retiree insurance and Can I keep my COBRA coverage when I enroll in Medicare. This also does not apply to people with Medicare due to End-Stage Renal Disease (ESRD), for more information see the script Should I enroll in Medicare if I have ESRD, am under 65 and have insurance from my (or my spouse’s) job?
If you are eligible for Medicare because you are 65 or older, your employer insurance is primary to Medicare if you or your spouse is currently working and there are 20 or more employees at the company where you or your spouse work.
If you are eligible for Medicare because you are 65 or older, your employer insurance is secondary to Medicare if there are fewer than 20 people at the company where you or your spouse work.
If you are eligible for Medicare because of a disability, your employer insurance is primary to Medicare if you, your spouse, or other family member are currently working and there are 100 or more employees at the company where you, your spouse or other family member work.
If you are eligible for Medicare because of a disability, your employer insurance is secondary to Medicare if there are fewer than 100 people at the company where you, your spouse or other family member work.
Enrolling in Part B with primary insurance from my employer
If your employer insurance is primary that means that it pays first on your health care claims and Medicare pays second. Some people who have primary insurance from their employer choose to delay enrollment into Medicare, until they no longer have this primary insurance, retire or go on COBRA. If you are going to delay enrollment into Medicare you should check with Social Security first by calling them at 800-772-1213. Write down who you spoke to and the date and time.
If you feel that you are adequately covered by your employer insurance you may not need Medicare at this time. If you do have Medicare, it will help pay some of what your primary insurance did not pay for.
If you drop your employer insurance and you have Medicare, Medicare will become your primary insurance. If you do not have Medicare and are thinking about dropping your current employer insurance you should sign up for Medicare before you drop it so that you have no gaps in coverage.
It is important to remember that your employer insurance can only be primary when you are currently working. If your work status changes and you retire or go on COBRA you will need to enroll in Medicare.
Enrolling in Part B with secondary insurance from my employer
Secondary insurance usually pays for some or all of what the primary insurer did not pay. Secondary insurance may also pay for things that Medicare does not cover, such as vision, dental or hearing care.
If you do not have Medicare when it should be your primary insurance, your secondary insurance may refuse to cover your health care costs. In many cases not having primary insurance is like having no insurance at all.
It is very important that you talk to your benefits manager at your job when you become eligible for Medicare, as your employer insurance will work differently with Medicare. Sometimes companies do not realize that you are eligible for Medicare and they may continue to pay primary when they should not be. When the company realizes they may be able to take back money they paid for your medical services while you should have had Medicare and you may be left very large bills.