Lesson 1.3 — Who Pays for Health Care Before and After Age 65
Before age 65, health insurance is typically provided through an employer plan, retiree coverage, COBRA, or individual insurance. These plans usually act as the primary payer for medical expenses.
After age 65, Medicare generally becomes the primary payer for health care services. This means Medicare pays first, and any other insurance pays second.
There is an important exception. If you or your spouse is still working and covered by a large employer group health plan, that employer coverage may remain primary while Medicare is secondary. An employer is considered large if they offer a health insurance plan to 20 or more employees.
Understanding which insurance pays first is critical. If Medicare should be primary and you fail to enroll, other insurance may refuse to pay, leaving you responsible for the full cost of care.
Three Key Points
- Medicare usually becomes primary coverage at age 65.
- Large employer plans can delay Medicare’s primary role.
- Incorrect enrollment can result in unpaid medical bills.