Medicare is the largest health insurance provider in the U.S. Many Medicare beneficiaries may also have other types of health insurance, such as retiree health insurance benefits, military insurance, COBRA or other types of coverage in addition to their Medicare benefits.
When you have other types of insurance in addition to Medicare, who pays first? Read below to find out when Medicare pays first, when it serves as the secondary payer and how it works with military coverage and workplace health insurance.
If you have Medicare as well as another type of insurance, your coverage is provided through a coordination of benefits. In some situations, Medicare will serve as your primary payer, which means Medicare pays first. Your other insurance coverage will then serve as your secondary payer.
In the following situations, Medicare acts as your primary payer:
Medicare serves as the secondary payer in the following situations:
If you are entitled to both Medicare and Veteran’s Administration benefits, Medicare pays for any Medicare-covered services or items. Your Veteran’s benefits will pay for any VA-authorized services or items that are not covered by Medicare.
Medicare and the VA generally do not work together to pay for the same service or item. You may use both types of insurance for your health care, but they will operate separately from each other.
TRICARE does work with Medicare. Active-duty military personnel who are enrolled in Medicare may use TRICARE as a primary payer, and then Medicare pays second as a secondary payer.
For inactive members of the military who are enrolled in Medicare, Medicare acts as the primary payer and TRICARE pays second, provided that the services or items are received in a military hospital or other approved federal provider.
If you have been injured in an accident where liability insurance is involved and you are also entitled to Medicare benefits, the liability insurance provider pays first, and Medicare pays as the secondary payer.
If you are covered under workers’ compensation due to a job-related injury or illness and are entitled to Medicare benefits, the workers’ compensation insurance provider will be the primary payer. There typically is no secondary payer in such cases, but Medicare may make a payment in certain situations.
Medicare Advantage plans (Medicare Part C) offer the same benefits as those that are covered by Original Medicare (Medicare Part A and Part B). In situations where Medicare pays first before your other insurance providers, a Medicare Advantage plan would typically act as the primary payer and replace your Original Medicare coverage.
Learn more about when Medicare pays first for your care and compare Medicare Advantage plan options that may be available where you live. To get started, speak with a licensed insurance agent by calling TTY Users: 711 24 hours a day, 7 days a week.