Presley General Insurance Agency

Group Coverage

How does Medicare work if you have other health insurance coverage? Some people encounter this situation because they have group coverage through an employer, plus Medicare coverage that starts when they turn 65.

coordination of benefits


When there is more than one payer, then rules are followed for the “coordination of benefits” to determine which insurance plan pays first. Through this process, the primary payer covers their agreed portion up to the limits of your coverage, then the bills are sent to the secondary payer. This secondary payer only pays if outstanding costs are not covered by the primary payer. The uncovered costs may or may not be paid in full by the secondary provider, depending on available coverage.

Common Types of Group Coverage

Group insurance coverage is available through a variety of circumstances. For example, you might have insurance through:

  • Current employment – either yourself, a spouse, or a domestic partner
  • Group health plan coverage from a previous employer
  • COBRA continuation coverage
  • Indian Health Services
  • Veteran’s benefits
  • Worker’s Compensation Claim

Who Pays First: Medicare or Group Coverage?

If you have a group health plan and Medicare, then generally Medicare pays first and the group health plan is a secondary payee. It’s important to understand more about your full coverage and the coordination of benefits between the two plans. For information about retiree health coverage, talk to our team to learn about your options.

Are you new to Medicare?

Register for Our 6-Part
Medicare Mini-Course

Our mini-course is sent to you via email in an easy-to-understand video format that you can watch from the comfort of your own home. You’ll learn all of the basic elements of Medicare and get answers to the most common questions.

Feel free to contact us at any time for personal assistance:

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