In the case of Medicare and employer insurance, which is considered the primary plan?

In the context of Medicare and employer insurance, the primary plan is typically the employer insurance plan for individuals who are under 65 years of age and who have access to group health coverage through their employer. This is because employer-sponsored health insurance is designed to provide coverage as the primary resource for medical expenses.

When a person has both Medicare and employer insurance, the general rule is that the employer plan pays first as long as the employer has 20 or more employees. Under these circumstances, Medicare serves as the secondary payer, meaning it will cover costs that the employer insurance does not, potentially reducing out-of-pocket expenses for the beneficiary.

This arrangement helps ensure that individuals have comprehensive coverage while leveraging the benefits of both plans, and it is particularly advantageous for those who are still employed or receiving insurance through their spouse's employment. Understanding this relationship is crucial for navigating billing and claims processes for healthcare services under both types of insurance.