Florida 2-15 Life, Health and Variable Annuity AgentGeneral Knowledge of Health InsuranceHard
A client is 67 years old, still working, and covered by a group health plan through their employer. They are also eligible for Medicare. According to Medicare Secondary Payer (MSP) rules, which entity is typically the primary payer for their health care expenses?
- AThe client's Medigap policy
- BMedicare Part A
- CThe employer's group health plan
- DMedicare Part B
Show answer & explanationAnswer & explanation
Correct answer: C. The employer's group health plan
Under Medicare Secondary Payer (MSP) rules, if an individual aged 65 or older is still working and covered by an employer's group health plan (for employers with 20 or more employees), the employer's plan is typically the primary payer, and Medicare is the secondary payer.
Why the other options are wrong
- A. A Medigap policy always pays after Medicare, so it would be tertiary, not primary.
- B. Medicare Part A would be secondary in this scenario.
- D. Medicare Part B would be secondary in this scenario.
Medicare Secondary Payer (MSP) Rules - Working Aged
Federal rules that determine whether Medicare or a group health plan pays first for health care services for individuals aged 65 or older who are still working.
- Applies to employers with 20 or more employees.
- Employer's group health plan is primary.
- Medicare is secondary.
- Purpose is to reduce Medicare costs by shifting responsibility to private payers.
Memory trick: Who pays first? It depends on the situation!