Medicare and Employer-Sponsored Insurance
Because knowing who pays first can save you confusion (and surprise bills).
How It Works
If you have both Medicare and employer-sponsored health insurance, each plan has its own role in paying for your care.
- The plan that pays first is called the primary payer.
- The plan that pays second is called the secondary payer.
The secondary payer may cover only part of what’s left after the primary payer processes your claim—or sometimes nothing at all. Knowing which plan is primary helps you avoid gaps, billing errors, and double payments.
If You’re 65 or Older and Have Employer Coverage
Your Employer Has 20 or More Employees
Your employer’s group health plan pays first, and Medicare pays second.
Example:
Let’s say your doctor visit costs $75.
- Your employer plan pays $50.
- If you haven’t met your Medicare Part B deductible, you’d pay the remaining $25, which counts toward that deductible.
- Once your deductible is met, Medicare would typically pay 80% of the remaining balance (in this case, $20).
Your Employer Has Fewer Than 20 Employees
Medicare pays first, and your employer plan pays second.
This is common in small businesses where group plans aren’t considered primary once you’re eligible for Medicare.
If You’re Under 65 and Have Medicare Through a Family Member’s Employer
If you’re under 65, already on Medicare (for example, due to disability), and have coverage through a family member’s current employer:
- If the employer has 100 or more employees, the employer’s group plan pays first, and Medicare pays second.
- If the employer has fewer than 100 employees, Medicare usually pays first.
If You Have TRICARE (Military Coverage)
Rules depend on whether you or your spouse are active duty:
- Active duty: TRICARE pays first for Medicare-covered services, and Medicare pays second.
- Not active duty (retired or family member): Medicare pays first, and TRICARE pays second.
- If you’re treated at a military hospital or federal healthcare facility, TRICARE always pays first.
If You Have Retiree Coverage
If your coverage comes from a former employer—yours or your spouse’s—Medicare pays first, and your retiree health plan pays second.
Before You Enroll in Medicare
If you’re still working or covered under a spouse’s employer plan, talk to your HR department or benefits manager before enrolling.
They can tell you:
- Whether your plan is considered creditable (meaning you can delay Medicare without penalty)
- What happens to your coverage after you enroll in Medicare
- Whether your dependents can stay on your plan
Need Help Sorting It Out?
If you’re not sure how your coverage coordinates with Medicare, call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 (TTY: 1-855-797-2627).
Hours: Monday – Friday, 8 a.m. – 8 p.m. ET (except holidays)
Keep Exploring
Still working or covered by an employer plan? Learn how Medicare and job-based insurance work together—and when it’s the right time to enroll.
👉 Read: Working Past 65? How It Affects Your Medicare Enrollment
Want to understand your full Medicare costs before you decide?
👉 Explore with ALEX® to see your personalized costs and next steps
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We work with multiple Medicare plan carriers including:
- Aetna Inc.
- Devoted Health, Inc.
- Humana Inc.
- Mutual of Omaha Insurance Company
Need help? Contact us(opens in a new tab)
Talk to a licensed insurance agent: (833) 748-5302 TTY: 711
Enrollment in a plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period or you are in your Medicare Initial Enrollment Period. Enrollment depends on plan’s contract renewal with Medicare.
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Medicare Advantage and Part D plans are insured by a Medicare Advantage HMO, PPO and PFFS organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment depends on plan’s contract renewal with Medicare.
We do not offer every plan available in your area. Currently we represent 4 organizations which offer 1056 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.
Not all carriers offer these benefits. Plans vary by region and state. Limitations and exclusions may apply.
Every year, Medicare evaluates Medicare Advantage and Part D plans based on a 5-star rating system.
Estimated annual costs are based on the usage you provided + yearly premiums. Medicare Advantage and Medicare Supplement plan calculations include the standard Part B premium + any Part B premium reductions. Actual annual costs depend on your usage, along with your Part B premium and the date you enroll.
Medicare Supplement insurance is generally available to individuals age 65 and older enrolled in Medicare Parts A and B. Availability for beneficiaries under age 65 who qualify for Medicare due to disability or End Stage Renal Disease varies by state. Benefits, eligibility, and premiums may vary by state.
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