Which payer is typically primary when an individual has both a group health plan and Medicare?

Which payer is typically primary when an individual has both a group health plan and Medicare?

• A. The group health plan
• B. Medicare
• C. Medicaid
• D. The patient

Answer: (A)

When both a group health plan and Medicare exist, the group health plan is typically the primary payer. This means the group plan pays first on covered benefits up to its limits. Medicare then pays secondary, helping cover what remains, according to its rules. Medicaid isn’t the primary sender in this common scenario, and the patient isn’t the payer. There are exceptions (such as specific employer size or retiree arrangements) where Medicare can be primary, but under standard circumstances the group health plan takes the lead.

When both a group health plan and Medicare exist, the group health plan is typically the primary payer. This means the group plan pays first on covered benefits up to its limits. Medicare then pays secondary, helping cover what remains, according to its rules. Medicaid isn’t the primary sender in this common scenario, and the patient isn’t the payer. There are exceptions (such as specific employer size or retiree arrangements) where Medicare can be primary, but under standard circumstances the group health plan takes the lead.