If you have Medicare plus another form of coverage—like an employer plan, retiree insurance, or Medicaid—you might wonder which one handles your medical bills first. This is managed by Coordination of Benefits (COB) rules.
The Basics: Primary vs. Secondary
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Primary Payer: This insurance pays first, up to the limits of its coverage.
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Secondary Payer: This insurance only pays if there are costs left over that the primary plan didn’t cover. Note: The secondary payer may not cover 100% of the remaining balance.
What is a “Conditional Payment”?
If your primary insurance is supposed to pay but hasn’t done so within 120 days, Medicare may step in and make a “conditional payment” so you don’t have to pay out of pocket. However, this is essentially a bridge loan—Medicare must be repaid if you eventually receive a settlement or payment from the other insurer.
When is Medicare the Primary Payer?
In many common situations, Medicare pays first. This usually includes:
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You only have Medicare and Medicaid.
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You are 65+ and have retiree coverage.
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You are 65+ and work for a small company (fewer than 20 employees).
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You are 65+ or disabled and have COBRA coverage.
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You have Medicare and TRICARE (and are not on active duty).
How to Keep Your Coverage Current
Medicare doesn’t always know when you have other insurance. To avoid billing delays:
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Report Changes: Tell your doctor and your insurer if your coverage changes.
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Contact the BCRC: The Benefits Coordination & Recovery Center (BCRC) manages these records. You can reach them at 1-855-798-2627.
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Ask HR: When in doubt, contact your HR department to clarify how your specific plan interacts with Medicare.