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Home > Resources > PAF Publications > PAF Guides & Major Publications > Disability Process Guide > Appendix A

A quick look: Know who pays first if you have other health insurance or coverage

If you have Medicare and other health insurance or coverage, be sure to tell your doctor and other providers. This will help them send your bills to the correct payer to avoid delays. Whether Medicare pays first or second depends on a number of things. You should consider those listed in teh chart below to help find who pays first. However, this chart does not cover every situation. If you have questions about who pays first or if your insurance changes, call the Medicare Coordination of Benefits Contractor at 1-800-999-1118. TTY users should call 1-800-318-8782.

If you...ConditionPays FirstPays Second
Are age 65 or older and covered by a group health plan because you are working or are covered by a group health plan of a working spouse of any ageEntitled to MedicareGroup Health PlanMedicare
The employer has 20 or more employees
The employer has less than 20 employeesMedicareGroup Health Plan
 
Have an employer retiree plan and are age 65 or olderEntitled to MedicareMedicareRetiree Coverage
 
Are disabled and covered by a large group health plan from your work or from a family member who is workingEntitled to MedicareLarge Group Helath PlanMedicare
The employer has 100 or more employees
The employer has less than 100 employeesMedicareGroup Health Plan
 
have End-Stage Renal Disease (permanent kidney failure) and group health plan coverage (including a retirement plan)First 30 months of eligibility or entitlement to MedicareGroup Health PlanMedicare
After 30 monthsMedicareGroup Health Plan
 
have End-Stage Renal Disease (permanent kidney failure) and COBRA coverageFirst 30 months of eligibility or entitlement to MedicareCOBRAMedicare
After 30 monthsMedicareCOBRA
 
have been in an accident where no-fault or liability insurance is involvedEntitled to MedicareNo-fault or Liability insurance, for accident related servicesMedicare
 
Are covered under workers' compensation because of a job-related illness or injuryEntitled to MedicareWorker's compensation, for works' compensation claim related servicesUsually doesn't apply. However, Medicare may make a conditional payment
 
Are a Veteran and have Veterans' benefitsEntitled to Medicare and Veterans' benefitsMedicare pays for Medicare-covered servicesUsually doesn't apply
Veterans' Affairs pays for VA authorized services
NOTE: Medicare and VA cannot pay for the same service
 
Are covered under TRICAREEntitled to Medicare and TRICAREMedicare pays for Medicare-covered servicesTRICARE may pay second
TRICARE pays for services from a military hospital or any other federal provider
 
Have black lung disease and covered under the Federal Black Lung ProgramEntitled to Medicare and Federal Black Lung ProgramFederal Black Lung Program, for black lung related servicesMedicare
 
Are age 65 or older OR disabled and covered by Medicare and COBRA coverageEntitled to MedicareMedicareCOBRA