How Medicare works with other insurance

If you have Medicare and other health insurance (like from a group health plan, retiree coverage, or Medicaid), each type of coverage is called a "payer."

The "primary payer" pays up to the limits of its coverage, then sends the rest of the balance to the "secondary payer." If the “secondary payer” doesn’t cover the remaining balance, you may be responsible for the rest of the costs. If your group health plan or retiree coverage is the secondary payer, you may need to sign up for Medicare Part B before they'll pay. This order of payment is called "coordination of benefits."

If the insurance company doesn't pay the claim promptly (usually within 120 days), your doctor or other provider may bill Medicare. Medicare may make a conditional payment to pay the bill, and then later recover any payments the primary payer should've made. What’s a conditional payment?


What do you want to do next?

Check who pays first

Answer a few questions to find out who pays first if you have Medicare and other health insurance.

Appeal a coverage decision

Learn how to file an appeal if you disagree with a coverage or payment decision by Medicare or your Medicare plan.

If you have questions about who pays first, or if your coverage changes, call the Benefits Coordination & Recovery Center at 1-855-798-2627 (TTY: 1-855-797-2627). Tell your doctor and other health care provider about any changes in your insurance or coverage when you get care. 

Learn how Medicare drug coverage may impact other program benefits.