Life & Health Insurance Exam (National Portion)Health InsuranceMedium
A client is 65 years old, still actively working for a large employer (more than 20 employees), and is covered by the employer's group health plan. They are also eligible for Medicare. According to Medicare Secondary Payer rules, which insurance plan is primary for their medical expenses?
- AMedicare Part A
- BThe employer's group health plan
- CA Medicare Supplement (Medigap) policy
- DMedicare Part B
Show answer & explanationAnswer & explanation
Correct answer: B. The employer's group health plan
When an individual aged 65 or older is actively working and covered by a large employer's group health plan (20 or more employees), the employer's group health plan is primary, and Medicare is secondary.
Why the other options are wrong
- A. Medicare Part A (hospital insurance) would be secondary in this scenario.
- C. A Medigap policy supplements Medicare and would pay after Medicare, making it tertiary in this situation.
- D. Medicare Part B (medical insurance) would be secondary in this scenario.
Medicare Secondary Payer (MSP) - Working Aged
Rules that determine whether Medicare or a group health plan pays first for medical expenses for individuals aged 65 or older who are actively working and covered by an employer's group health plan.
- If employer has 20+ employees, group health plan is primary.
- If employer has fewer than 20 employees, Medicare is primary.
- Applies to individuals 65+ who are actively working.
Memory trick: Who pays first? It depends on the group size and the reason for coverage.