Updated as of July 25, 2024

PATIENT SITUATION PAYS FIRST PAYS SECOND
65 or older and has Group Health Plan (GHP) coverage through current employment or spouse’s current employment Entitled to Medicare
Employer has less than 20 employees		 Medicare GHP
65 or older and has Group Health Plan (GHP) coverage through current employment or spouse’s current employment Entitled to Medicare
Employer has 20 or more employees or is part of a multiple or multi-employer group with at least 1 employer employing 20 or more individuals		 GHP Medicare
65 or older, has employer retirement GHP coverage, and isn’t working Entitled to Medicare Medicare Retiree Coverage
Under 65, disabled, and has GHP coverage through their current employment or a family member’s current employment Entitled to Medicare
Employer has less than 100 employees		 Medicare GHP
Under 65, disabled, and has GHP coverage through their current employment or a family member’s current employment Entitled to Medicare
Employer has more than 100 employees or is part of a control group or multi-employer group with at least 1 employer employing 100 or more individuals		 GHP Medicare
End Stage Renal Disease (ESRD) and GHP coverage was primary before individual became eligible and entitles to Medicare based on ESRD diagnosis Before 30 months of Medicare eligibility or entitlement GHP Medicare
ESRD and has GHP coverage After 30 months of Medicare eligibility or entitlement Medicare GHP
ESRD and COBRA coverage before becoming eligible or entitles to Medicare First 30 months of Medicare eligibility or entitlement COBRA Medicare
ESRD and has COBRA coverage After 30 months of Medicare eligibility or entitlement Medicare COBRA
Medicare Parts A and B coverage under Medicare Advantage (MA) Plan Also has a GHP Health Reimbursement Account (HRA) Contact MA Plan for billing guidance None (Employer pays individual from HRA for out-of-pocket expenses)
65 or older or disabled and has Medicare and COBRA coverage Entitled to Medicare Medicare COBRA

This document is designed to highlight various employee benefit matters of general interest to our readers. It is not intended to interpret laws or regulations, or to address specific client situations. You should not act or rely
on any information contained herein without seeking the advice of an attorney or tax professional. © My Benefit Advisor. All Rights Reserved. CA Insurance License #0G33244

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