How Medicaid Works as Secondary Insurance

• by Christian Worstell
• January 12, 2024
• Reviewed by John Krahnert

Medicaid provides health insurance coverage for more than 72 million Americans. But it’s not the only type of health coverage many of these people have. 

Medicaid can work as both a primary or secondary insurer. In this Medicaid review, we explore when and how the program works as secondary, or supplemental, insurance that can coordinate with other types of insurance. 

Can you have Medicaid and another insurance at the same time?

Some people are eligible for both Medicare and Medicaid and can be enrolled in both programs at the same time. These beneficiaries are described as being “dual eligible.”

For services covered by both Medicare and Medicaid, Medicare pays first and Medicaid serves as the secondary payer. That means Medicare will pick up the bill first and pay its share before handing it off to Medicaid. Copayments and coinsurances that are left remaining after Medicare applies its coverage will be picked up by Medicaid.

Dual-eligible beneficiaries can expect to pay little to nothing out of their own pocket after Medicaid has picked up its share of the cost.

There are also some additional ways in which Medicaid beneficiaries can save money on care with Medicare’s help. 

• Dual-eligible beneficiaries are often automatically enrolled in a Medicare Savings Program (MSP), which covers the Medicare Part B premium and may offer additional services.
  
  
• Dual-eligible beneficiaries also generally receive Extra Help, which provides assistance with Medicare Part D drug costs.
  
  
• There are certain types of Medicare Advantage plans known as Dual-eligible Special Needs Plans (D-SNP) that are custom built to accommodate the specific needs of those on both Medicare and Medicaid. 

How does Medicaid coordinate with other insurance?

Medicaid acts as the “payer of last resort” when a beneficiary has an employer-based or other private commercial insurance plan. This means Medicaid will be the last plan to contribute to a medical bill and may pick up copayments and coinsurances in similar fashion to how Medicaid works with Medicare. 

Third party liability

Under federal law, all other sources of health care coverage must pay claims first before Medicaid will pick up any share of the cost of care. This is referred to as “third party liability” (TPL), which means the primary payment for care is the responsibility of any available third-party resources and not that of Medicaid.

Some of the coverage types that may be ordered to pay for care before Medicaid include:

• Group health plans
• Self-insured plans
• Managed care organizations
• Pharmacy benefit managers
• Medicare
• Court-ordered health coverage
• Settlements from a liability insurer
• Workers’ compensation
• Long-term care insurance
• Other state and federal health insurance programs not excluded by law

If you have any questions about how your Medicaid coverage will work with any other existing benefits, contact your state Medicaid program.

Find Medicare-Medicare Plans

If you have Medicaid and are eligible for or enrolled in Medicare, you may be able to find Medicare Dual-eligible Special Needs Plans in your area that can cover many of your health care costs. Learn more today by compare available plans online, or call to speak with a licensed insurance agent.

About the author

Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.

Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.

Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.

Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.

A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.

If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.

 

 

​

Read less