If you have Medicare and other health or drug coverage, it’s important to know who will pay your bills first.
Here’s a look at what primary and secondary payer means, when Medicare is primary or secondary and how Medicare knows you have other coverage.
Each type of coverage you have is called a “payer.” When you have more than one payer, there are rules to decide who pays first, called the coordination of benefits. The “primary payer” pays what it owes on your bills first and sends the remaining amount to the second or “secondary payer.” There may also be a third payer in some cases.1
Important facts to know include:
- The primary payer pays up to the limits of its coverage.
- The secondary payer only pays if there are costs the first payer didn’t cover.
- The secondary payer (which could be Medicare) might not pay all of the uncovered cost.
- If Medicare is the primary payer and your employer is the secondary payer, you’ll need to join Medicare Part B (medical coverage) before your employer insurance will pay for Part B services.
A number of things can affect when Medicare pays first. The following chart explains some common scenarios.2 For information on several other scenarios, check out how Medicare works with other insurance, opens new window.
Medicare doesn’t automatically know if you have other coverage. But your insurers must report to Medicare when they’re the primary payer on your medical claims.
In some situations, your healthcare provider, employer or insurer may ask questions about your current coverage and report that information to Medicare.3 You also may be asked about other coverage at the time of enrollment.
If you have additional questions about who pays your Medicare bills first, contact your insurance provider or call Medicare’s Benefits Coordination & Recovery Center (BCRC) at 855-798-2627 (TTY: 855-797-2627).