Medicare Primary vs. Group Plan Primary Definition:

Sep 06 2010

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	Medicare Primary vs. Group Plan Primary Definition:

Solution Under Federal Law, certain employers must provide group benefits primary to Medicare for their active employees age 65 and over, as well as for spouses 65 and over, and for active employees of any age.

Group Plan Primary Status: (With respect to working employees)
If an employer had 20 or more full and/or part-time employees each working day in each of 20 or more calendar weeks during the current or preceding calendar year, the employer must provide group benefits primary to Medicare. Group primary status takes effect the 1st of the insurance month subsequent to meeting the 20-week requirement and remains in effect for at least the remainder of that calendar year and all of the following calendar year. The requirement is met if the employer had 20 or more employees for a total of 20 or more weeks at any time throughout the calendar year (i.e., the 20 weeks need not be consecutive).1

Medicare Primary Status: (With respect to working aged employees)
If the employer does not meet the Group Primary status requirements stated above, then the employer's group benefits are secondary to Medicare. Medicare primary status takes effect January 1st of the calendar year immediately following an entire calendar year in which the employer did not have 20 or more full and/or part-time employees for 20 or more weeks.

Important: The aforementioned information does not set forth all rules governing group level Medicare status. The employer should contact their legal and/or tax advisor(s) for information regarding other rules that may impact the group's Medicare status. Under federal law, it is the employer's responsibility to accurately determine its Medicare status.

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