Wiki Medicare as secondary coverage

[JAMETH345]

My co-worker and I are seeking clarification - under what circumstances can a patient have a commercial insurance as primary coverage, and Medicare as secondary coverage? I'm thinking maybe they're covered by a spouse's employer provided coverage, and then qualify, either through disability or age, for Medicare. I would appreciate any information.

Thank you.

John Methgen, BS, CPC, CPB

 

[thomas7331]

The situations you mention do usually make the commercial plan primary, but there are additional situations that would also qualify. For a complete list and an explanation of the coordination of benefit rules, here's a link to Medicare's guide on how to determine which payer is primary. If you scroll down to pages 6-8, you'll see a summary chart that lays out all of the situations:

https://www.medicare.gov/Pubs/pdf/02179-Medicare-Coordination-Benefits-Payer.pdf