One of the most confusing parts of turning 65 is figuring out who pays first when you have more than one type of insurance.

If you’ve ever wondered, “Does my employer plan pay first, or does Medicare?” — you’re not alone.

Understanding this one detail can protect you from denied claims, big medical bills, or lifetime penalties.

Let’s simplify what “primary” and “secondary” really mean — and how to know which applies to you.

What “Primary” and “Secondary” Mean

When you have more than one insurance plan, one will pay first (that’s the primary payer) and the other will pay second (the secondary payer).

The primary payer pays up to its coverage limits. Then the secondary payer may cover what’s left — if it’s covered under that plan.

If Medicare is supposed to be primary and you’re not enrolled, your other insurance might pay nothing for what Medicare would have covered.

Why It Matters

If your insurance pays in the wrong order, your claims can be delayed or denied.

Even worse, you could be responsible for the full cost of care — simply because the coordination rules weren’t followed.

That’s why knowing when Medicare pays first (and when it doesn’t) is so important.

When Medicare Pays First (Primary)

Medicare usually pays first when:

• You’re 65 or older and covered by a small employer plan (fewer than 20 employees)

• You’re retired and have COBRA or retiree coverage.

• You’re under 65 and disabled and the employer has fewer than 100 employees.

• You have coverage through a Medicare Supplement or Medicare Advantage plan.

• You’re on TRICARE for Life and receiving care at a civilian (non-military) facility.

In all these cases, Medicare is the foundation — the first payer.

When Medicare Pays Second (Secondary)

Medicare usually pays second when:

• You’re 65 or older and have active coverage from a large employer (20+ employees), either through your own job or your spouse’s.

• You’re under 65 and disabled and covered by an employer with 100+ employees.

• You’re receiving workers’ compensation or care covered by no-fault or liability insurance (those pay first).

In these situations, your employer insurance is primary, and Medicare fills in the gaps.

How to Confirm Which Applies to You

Here’s a quick 3-step checklist to make sure your coverage pays in the right order:

1. Ask your HR or benefits department:
   “Is my coverage primary or secondary to Medicare?”
   Get the answer in writing if possible.

2. Check your plan documents:
   Look for language about coordination of benefits. Some plans specifically state that Medicare pays first once you turn 65 — even if you haven’t enrolled.

3. Review your claims:
   If you’ve had recent medical visits, see which insurer paid first. Errors happen — and catching them early prevents major headaches later.

A Real-Life Example

We recently met a client who was still working at a small family business with 12 employees.

He assumed his employer insurance was primary, so he delayed signing up for Medicare Part B.

When he needed outpatient surgery, his group plan denied the claim — because their plan stated it was secondary to Medicare.

Since he hadn’t enrolled, he was stuck with a $14,000 bill.

After enrolling in Medicare and coordinating correctly, his next procedure cost him less than $300.

The Bottom Line

Getting the “primary vs. secondary” order right isn’t just a technical detail — it’s the difference between full coverage and a surprise medical bill.

At Mere, we help people avoid these costly mistakes every day.

We’ll walk through your employer plan, confirm whether Medicare should pay first or second, and make sure you’re protected before any bills come your way.

📞 Call 904-654-5450 or visit www.merebenefits.com to schedule a no-cost consultation.

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