Coordination of Benefits

• If you have Medicare and other health insurance there are rules that determine which insurance pays first. These guidelines are called coordination of benefits. The primary insurance, or payer, pays what it owes on your bills, and then sends them to the secondary insurance. In some cases, there may be a third, or tertiary, payer. Whether Medicare pays first depends on a number of things, including, but not limited to, whether you or your spouse still work and are covered by a group health plan, have veterans benefits or TRICARE, have COBRA benefits and end-stage renal disease, or if you qualify for the Federal Black Lung Program.
  
  

Disclosure

• Your insurance companies do not automatically know if you have other insurance. It is your responsibility to notify each insurance company of your situation and benefits. Medicare sends you a form, the Initial Enrollment Questionnaire, about three months before you are entitled to Medicare. If you have group health plan coverage through your workplace or that of a family member you must let Medicare know. You must let the other insurance know of your Medicare benefits as well. This is how the insurance companies make sure that your medical claims are paid correctly.
  
  

Group Health Plan

• Many men and women over the age of 65 are still employed and eligible for group health plan coverage. This is insurance offered by many employers and unions for current employees or retirees and their family members. If you have Medicare you can choose or reject group health plan coverage. According to Medicare, your group health plan generally pays first if you are age 65 or older and covered because of your current employment or the current employment of a spouse of any age. Additionally, that employer has to have 20 or more employees and if the group plan covers many of the same services as Medicare.
  
  

Veterans Benefits

• If you qualify for both Medicare and Veterans benefits you can get treatment under either program. The Veterans Administration (VA) will pay for medical services at a VA facility or in some cases will authorize services in a non-VA facility. Medicare will pay for services outside the VA. Some veterans are given a fee-basis ID card for service-connected disabilities or long-term care needs. If you have fee-based benefits you may choose any doctor who is listed on your card to treat you. If the doctor accepts you as a patient and bills the VA for services, the doctor must accept the VA's payment as payment in full. The doctor can't bill either you or Medicare for these services.
  
  

TRICARE

• "In general, Medicare pays first for Medicare-covered services. TRICARE will pay the Medicare deductible and coinsurance amounts and for any service not covered by Medicare that TRICARE covers," explains the Medicare guidelines. If you get services from a military hospital or any other federal provider, TRICARE will pay the bills because Medicare usually does not pay for services you get from a federal provider or agency.
  
  

Other Exceptions

• In general, the rules for group health plans apply to COBRA continuation coverage and Medicare pays first. An exception is if you have Medicare based on end-stage renal disease, then COBRA continuation coverage pays first, and Medicare pays "to the extent COBRA coverage overlaps the first 30 months of Medicare eligibility or entitlement based on ESRD."
  Another exception to Medicare paying first is the Federal Black Lung Program, which pays first for any health care for black lung disease that is covered under that program. For all other medical care not related to black lung, Medicare pays first.