Can we bill Medicare as secondary?


Editorial team Published on

Yes, Medicare Secondary Payer rules mean Medicare can be a secondary payer and pay for healthcare costs only after another primary insurance plan pays first.

When Medicare is Secondary

Medicare acts as the secondary payer in specific situations involving group health plans or injury-related claims:

  • Working Aged (Age 65 or Older): If you or your spouse are actively working and covered by a group health plan from an employer with 20 or more employees, that employer plan pays first.
  • Disability: If you have Medicare due to a disability and are covered by a large group health plan from an employer with 100 or more employees, that plan pays first.
  • End-Stage Renal Disease (ESRD): Group health plans pay first for a 30-month coordination period if you are eligible for Medicare due to ESRD before Medicare becomes primary.
  • Accidents and Injuries: Workers' compensation, no-fault insurance, or liability/auto insurance pay first for medical costs related to a job injury or accident.

You can learn more about how Medicare works with other insurance on the official government site.