Does employers insurance or Medicare pay for medical expenses?

1 answer | Last updated: Nov 14, 2016
Caring.com staff asked...

If I have Medicare and also employers insurance through my job, which one pays for my medical expenses?
 


Expert Answers

Many people have both Medicare and health insurance coverage through their own employer or their spouse's. Which coverage pays first depends on the size of the employer. In some cases, Medicare is the primary payer, which means it pays the bills first, and employer-sponsored health insurance is the secondary payer, picking up some costs that Medicare doesn't pay. In other situations, it's the reverse, with employer-based insurance paying first and Medicare paying some of the remaining costs.

Large employer: Group plan is primary. If you or your spouse works for an employer with 20 or more employees, and that employer covers you through a group health plan, then the group plan is the primary payer.

Small employer: Medicare is primary. If you or your spouse works for an employer with fewer than 20 employees, and that employer covers you through a group health plan, then Medicare is the primary payer.
To get more details about how Medicare works in these situations, download Medicare's bookletMedicare and Other Health Benefits: Your Guide to Who Pays First.