Coordination Of Benefits : When You Are Covered Under Two Or More Health Plans

The rules are the same as if there were two plans, but they must be applied to each plan in turn. Confusion can often result.

For Example:

• Your employer continues your health insurance as long as you collect Long Term Disability benefits;
• you are covered as a dependent under your spouse's plan who works for a company with 150 employees;
• you are under age 65 and eligible for Medicare due to disability (not End Stage Renal Disease).

According to the rules:

• Your plan is Secondary to Medicare since you are disabled and therefore considered a "retiree" for Medicare purposes.
• Your plan is Primary to your spouse's because you are the employee under your plan.
• Your spouse's plan is Primary to Medicare since that coverage comes through someone actively working and there are over 100 employees.

Generally, in this situation, Medicare will accept liability as being Primary, letting your plan be Secondary and your spouse's plan be Tertiary (Third).

To see what would happen between two plans, see How To Determine Which Plan is Primary and click on the description of your situation.

In the event of a dispute between two plans, the general rule is that the plan that has insured the person the longest is the Primary Payer. If this rule were used in the above example, your plan would be the Primary Payer since it had covered you longer than Medicare.

For more information about Medicare, see: Medicare, Coordination of Benefits.

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