If an employee qualifies for both group and Medicare, which is the primary insurance?

When an individual is eligible for both a group health insurance plan and Medicare, the coordination of benefits rules determine which insurance is considered primary. Typically, if the group health plan covers an employee who is actively working and has access to the plan, that group plan will take precedence as the primary insurance. This means it will pay benefits first, covering expenses before Medicare contributes.

This arrangement exists because the group health plan generally provides more extensive coverage for active employees, which is recognized by Medicare as the secondary payer. Once the group plan has paid its share, Medicare can then cover additional eligible expenses not fully paid by the group plan.

Understanding this hierarchy is crucial for navigating healthcare costs effectively and making informed decisions about coverage. It ensures that the employee's medical expenses are managed efficiently, helping to minimize out-of-pocket costs.