When group health coverage is available to employees over age 65, which coverage is primary?

When employees over the age of 65 have access to group health coverage through their employer, the group health plan typically serves as the primary coverage. This means that the group health insurance pays for covered medical expenses first, and Medicare serves as the secondary coverage.

In a scenario where both the group health plan and Medicare are available, the coordination of benefits rules dictate that the group health plan is designed to provide primary coverage as long as the employer has 20 or more employees. This ensures that the group plan handles the initial payment for healthcare services, while Medicare may cover additional costs that the group plan does not, such as copayments or coinsurance, once the primary plan has processed the claims.

This framework helps optimize the benefits for older employees, allowing them to take advantage of both types of coverage, as long as their employer’s plan qualifies to be primary.