Dear Marci,
I have Medicare due to disability, but I also have health insurance through my husband’s job. When I go to the doctor, how do I know who is supposed to pay first? Medicare or the employer health plan?
—Vivian (Diamond Bar, California)
Click on the blue, underlined hyperlinks for related information available through Medicare Interactive!
Dear Vivian,
It is very important to understand how your two health insurances work together to cover your health care.
If you’re eligible for Medicare because you have a disability and you also have health insurance through a current employer, who pays first depends on how many people work for that employer. The employer coverage may be through your job, your spouse’s job or another family member’s job.
The insurance that pays first on health care claims is called your primary insurance. The secondary insurance pays after the primary insurance. The secondary insurance may cover all or some of the costs the primary insurance does not cover.
If there are fewer than 100 employees at the company where you, your spouse or other family member currently work, then Medicare is your primary coverage and your employer group health plan pays second.
If the company where you, your spouse, or other family member currently work has 100 or more employees, your employer group health plan pays first and Medicare pays second.
If you have Medicare due to disability and are no longer working, but are receiving COBRA or retiree insurance from a former employer, Medicare is your primary insurance. This would then make COBRA or your retiree plan secondary.
The above is only true if you have Medicare because of a disability. The rules are different if you are eligible for Medicare because of End Stage Renal Disease (ESRD) or age.
—Marci
 | Looking for past Dear Marci Answers? Have other Medicare questions? Find your answers with Medicare Interactive (MI), an independent, public resource of the Medicare Rights Center. MI offers expert information and advice on Medicare. Visit Medicare Interactive today! |
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Do you need individual counseling? Call the Medicare Rights Center's consumer hotline at 800-333-4114, between 9 a.m. and 5 p.m., Eastern Time, Monday through Friday. A Medicare counselor will be happy to answer your question.
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Health Tip of the Week
A recent New York Times article discusses how the amount of vitamin D you get affects your health. Getting too little can cause health problems, but so can getting too much.
People who do not get enough sunlight, babies that are breast-fed, seniors, and people living in nursing homes often do not get enough vitamin D. If you do not get enough vitamin D, you are at a greater risk for many chronic illnesses.
However, too much vitamin D can cause vomiting, poor appetite and weight loss. It’s very hard to get to those “toxic” levels especially if you are not taking vitamin D supplements.
Vitamin D is an important nutrient that your brain, heart, muscles, and immune system use. The body’s main way of getting vitamin D is by absorbing sunlight through the skin. You can also get vitamin D by eating certain fish such as canned tuna, salmon, mackerel and bluefish. Cereal and orange juice are also sources of vitamin D.
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Studies have shown that depression can cause weight gain. A recent study by professors at the University of Alabama at Birmingham showed that people who felt depressed gained weight faster in a period of 15 years, when compared with people who felt happier.
In a New York Times health article, Dr. Belinda L. Needham, assistant professor at the University of Alabama, said that “when you’re depressed, you tend to be inactive and not exercise as much, and you tend to eat more.” She also said that stress increases the risk of both depression and obesity by increasing fat storage. Many people think that weight gain makes people depressed, but this study suggests that it’s the other way around – that high stress levels and sadness can cause weight gain. |
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