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Coordination of Medicare And Other Health Benefits

Medicare and Group Health Insurance: People Age 65 or Over

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Medicare is Primary to employer based insurance if you are over age 65 and:

  • You are covered by a group health plan because of you, your spouse's or significant other's current active employment and your employer has less than 20 employees, OR
  • You or your spouse or significant other are self-employed and also covered by a group health plan of an employer that has less than 20 employees.

Otherwise, Medicare is Secondary.

To determine if an employer has 20 or more employees, the Medicare regulation states that an employer does have 20 or more employees for these purposes when an employer has 20 or more full time and/or part-time employees for each working day in each of 20 or more calendar weeks in the current or preceding year. It doesn't matter if less that 20 employees participate in the health plan.


  • You are over 65 and retired, but your wife, who works for a company with 5,000 employees covers you as her spouse. Your wife's plan is Primary.  Medicare is Secondary.
  • You get Medicare when you turn 65 but you continue to work and are covered under your employer's plan. Your employer is a small machine shop with 14 employees. Your group health plan is Secondary.  Medicare is Primary.
  • You are over age 65, self-employed and work as an independent contractor selling cosmetics for a large cosmetic firm with hundreds of employees. The cosmetic firm permits you to be covered under their policy. The cosmetic company plan is Primary. Medicare is Secondary.
  • You are a dependent under your spouse's retiree coverage so Medicare is Secondary to your retiree coverage.

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