Is Medicare always primary over COBRA?
Asked by: Prof. Ottis Hackett Jr. | Last update: September 25, 2025Score: 4.1/5 (21 votes)
Is Medicare always primary to COBRA?
If you have Medicare Part A or Part B when you become eligible for COBRA, you must be allowed to enroll in COBRA. Medicare is your primary insurance, and COBRA is secondary.
What determines if Medicare is primary or secondary?
If you have non-tribal group health plan coverage through an employer who has fewer than 20 employees, Medicare pays first, and the non-tribal group health plan pays second. If you have health insurance through a tribal health plan, Medicare pays first and the tribal health plan pays second.
How do you determine which insurance is primary and which is secondary?
The insurance that pays first is called the primary payer. The primary payer pays up to the limits of its coverage. The insurance that pays second is called the secondary payer. The secondary payer only pays if there are costs the primary insurer didn't cover.
Who is the primary payer when a patient is also covered by a COBRA plan?
Generally, if you are enrolled in both COBRA and Medicare, Medicare will be the primary payer and COBRA coverage will pay second. The secondary payer might not pay all of the uncovered costs. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare.
Got COBRA? Here's How Medicare and COBRA Work When You're 65+
Is COBRA policy primary or secondary?
COBRA is required to pay first (as the primary insurer) during the 30-month coordination of benefits (COB) period, and Medicare pays second. After this period, Medicare pays first.
Is Medicare always primary for retirees?
If you have both Medicare and retiree coverage from a former employer, generally Medicare pays first for your health care bills. Medicare will submit any amount it doesn't cover to your retiree plan.
What is the best secondary insurance if you have Medicare?
- Best for extra plan benefits: Humana.
- Best for straightforward coverage: State Farm.
- Best for extensive medical care coverage: AARP by UnitedHealthcare.
- Best for a range of Medigap plans: Blue Cross Blue Shield.
Will Medicare pay if primary insurance denies?
If the primary payer denies the claim because of liability, the no-fault or WC insurer must place the reason for denial on the claim, which you can find on your remittance advice that you'll send to Medicare. Without this reason, Medicare will deny the claim.
Does Medicare automatically send claims to secondary insurance?
A: Claims submitted to Medicare by the beneficiary aren't automatically crossed over to the secondary insurance. Once your claim has processed by Medicare you can submit a copy of the Medicare Summary Notice (MSN) received to your secondary insurance.
Is Medicare primary or secondary when disabled?
The employer plan cannot reduce coverage or charge a higher premium for people with disabilities, including spouses and dependents of employees. The employer plan is the primary payer for services covered by the plan. Medicare is the secondary payer for services covered by both the employer plan and Medicare.
In which of the following situations is Medicare the primary payer?
In many cases, when someone has two healthcare plans, Medicare is the primary payer. Medicare remains the primary payer if someone is covered by: a group health plan (GHP), which can be through their own or a spouse's employment if the employer has less than 20 employees. a retirement benefit plan.
Is Medicare supposed to be primary or secondary?
Primary payers are those that have the primary responsibility for paying a claim. Medicare remains the primary payer for beneficiaries who are not covered by other types of health insurance or coverage. Medicare is also the primary payer in certain instances, provided several conditions are met.
What is the 60 day loophole for cobras?
You have 60 days to enroll in COBRA once your employer-sponsored benefits end. Even if your enrollment is delayed, you will be covered by COBRA starting the day your prior coverage ended.
Can I drop my employer health insurance and go on Medicare Part B?
Once you stop working (or lose your health insurance, if that happens first) you have an 8-month Special Enrollment Period (SEP) when you can sign up for Medicare (or add Part B to existing Part A coverage).
Can COBRA be secondary insurance to Medicare?
Medicare will become primary, and if you can keep COBRA, it will become your secondary insurer.
What are the 6 things Medicare doesn't cover?
- Eye exams (for prescription eyeglasses)
- Long-term care.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Hearing aids and exams for fitting them.
Why are people leaving Medicare Advantage plans?
Key takeaways: People leave Medicare Advantage plans because out-of-pocket costs vary between plans, network restrictions can cause frustration, prior authorization requests can delay care, and it can be difficult to use the additional benefits they provide.
Who pays first, Medicare or Cobra?
If you have Medicare, Medicare pays first, and COBRA acts as your secondary coverage. (The only exception is if you have End-Stage Renal Disease (ESRD). In that case, COBRA pays first.) In most instances, your COBRA coverage will end if you enroll in Medicare.
Does everyone have to pay $170 a month for Medicare?
Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.
What is the best health insurance for seniors on Medicare?
Best Medicare Supplement: AARP/UnitedHealthcare. AARP/UnitedHealthcare is the best company for Medigap plans in 2025. For most people, the best company for Medigap coverage is AARP/UnitedHealthcare. Medicare Supplement (Medigap) plans cover many of the costs that you usually pay if you have regular Medicare.
Is there a penalty for Cobra and Medicare Part B?
If you have COBRA before signing up for Medicare, your COBRA will probably end once you sign up. You have up to 8 months after you stop working (or lose your health insurance, if that happens first) to sign up for Part B without a penalty, whether or not you choose COBRA.
Is it a good idea to get Medicare if you're still working at 65?
If your or your spouse's employer has 20 or more employees and a group health plan, you don't have to sign up for Medicare at 65. But if you get Medicare Part A for free, typically you should sign up. (After all, it's free.) In some cases, Medicare Part A may cover what your employer plan doesn't.
Will secondary pay if primary denies?
If your primary insurance denies coverage, secondary insurance may or may not pay some part of the cost, depending on the insurance. If you do not have primary insurance, your secondary insurance may make little or no payment for your health care costs.