Is Medicare always primary to private insurance?


Editorial team Published on

No, Medicare is not always the primary insurance.

Medicare's status as a primary or secondary payer depends on your employment situation, the size of your employer, and other types of insurance you may hold. You can review Who pays first? from Medicare for detailed official guidelines.

When Medicare is Primary

Medicare pays first in most common situations:

  • You have retiree health coverage.
  • You have coverage through COBRA.
  • You work for a small employer with fewer than 20 employees.
  • You have a disability and work for an employer with fewer than 100 employees.
  • You have Medigap (Medicare Supplement) insurance, Medicaid, or tribal self-insurance.

When Medicare is Secondary

Medicare pays second (meaning your other insurance pays first) when:

  • You are actively working and have group health coverage from a large employer with 20 or more employees.
  • You have a disability and are covered by a large employer's group health plan with 100 or more employees.
  • Your medical costs are related to workers' compensation, liability, or no-fault insurance.
  • You are in the first 30 months of treatment for End-Stage Renal Disease (ESRD) and have a group health plan.