Health Insurance Mastery Practice Exam

For an employee aged over 65 who is eligible for both Medicare and group health insurance, which will serve as the primary payor?

1. Medicare will be the primary

2. The individual will select the primary payor

3. The group health insurance will be the primary

4. It depends on the insurance company policy

The correct answer is: The group health insurance will be the primary

When an employee aged over 65 is eligible for both Medicare and group health insurance, the group health insurance typically serves as the primary payer. This is a standard coordination of benefits rule that applies to individuals who are still actively working and covered under their employer's health plan. Group health insurance plans often take precedence over Medicare when employees are still employed and have coverage from their employer, particularly when the employer has 20 or more employees. In these situations, the group plan pays first, and Medicare acts as the secondary payer to help cover any remaining costs. This arrangement allows the individual to maximize their benefits by utilizing the coverage of the group plan first, which can often offer broader benefits or lower out-of-pocket costs compared to Medicare alone. Therefore, understanding this primary-secondary payer relationship is crucial for employees who are navigating their health coverage options after turning 65.