Question

When a patient is covered by a large employer group health plan (EGHP) and Medicare, which is primary?

1) Medicare
2) The plan that has been in place longest
3) No distinction is made between the plans
4) EGHP

Answer 1

When a patient is covered by both a large employer group health plan (EGHP) and Medicare, Medicare is the primary payer. The EGHP is considered the secondary payer, covering any remaining costs after Medicare has made its payment.

Step-by-step explanation:

When a patient is covered by a large employer group health plan (EGHP) and Medicare, the primary coverage is determined by what is known as the 'coordination of benefits' rules. According to these rules, Medicare is the primary payer when a patient is covered by both Medicare and an EGHP based on their own or their spouse's current employment. The EGHP is considered the secondary payer. This means that Medicare pays first for healthcare services, and the EGHP pays second, covering any remaining costs after Medicare has made its payment. The patient may still be responsible for deductibles, copayments, or coinsurance.