Medicare Advantage as a Secondary Payer

Victoria Burke by Victoria Burke | Licensed since 2011
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This article was updated on: 10/05/2018

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If you’re eligible for Medicare, but you have already have health coverage – for example, through an employer plan – you might want to know which type of insurance is the “secondary payer.” For example, if you want to sign up for a Medicare Advantage plan, would it be the primary or the secondary payer? We’ll explore whether Medicare Advantage plans can be secondary payers.

Medicare Advantage as secondary payer: a quick Medicare Part C overview

The Medicare Advantage program is also called Medicare Part C. As you may already know, Medicare Advantage plans contract with Medicare to administer your Original Medicare (Part A and Part B) benefits. Medicare Advantage plans are available from private insurance companies.

Some Medicare Advantage plans offer benefits beyond Part A and Part B. Routine dental, hearing, or vision services are just a few examples. Most Medicare Advantage plans include prescription drug coverage.

When you have a Medicare Advantage plan, you’re still in the Medicare program, you still need to keep paying your Medicare Part B premium.  Of course, you’ll also have to pay the Medicare Advantage plan premium, if it charges one.

What is a secondary payer?

When you have two types of health insurance – for example, a Medicare Advantage plan and an employer plan – generally one will be the primary payer and the other will be the secondary payer. Health insurance companies and Medicare use “coordination of benefits” rules to determine which company pays first, according to the Center for Medicare & Medicaid Services.

The primary payer generally pays for covered services up to its limits. Then the secondary payer may cover the remaining costs, if there are any. Sometimes the secondary payer doesn’t cover all remaining costs.

Sometimes Medicare is the primary payer, and sometimes the secondary payer.

So, can Medicare Advantage be the secondary payer?

Certainly Medicare can be the primary or the secondary payer, depending on the situation. If you have a Medicare Advantage plan, see below.

If you have questions about whether Medicare Advantage is the secondary payer (or the primary payer) in your situation, you can:

  • Call your plan.
  • Call the Medicare Benefits Coordination & Recovery Center at 1-855-798-2627 (TTY users: 1-855-797-2627). Representatives are available Monday through Friday, 8AM – 8PM ET.

Do you want to know more about Medicare Advantage plans? Use the links below to set up a phone call with me at your convenience, or to have me send you customized information by email. To compare plans anytime, just click the Find Plans button on this page.

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