What Medicare Secondary Does and Does Not Cover

Medicare secondary insurance (also called Medigap or a secondary plan through your employer or union) does not pay your primary Medicare deductible. Your primary Medicare deductible is your responsibility first. Secondary insurance steps in only after Medicare has processed the claim and paid its share — it covers costs that Medicare leaves unpaid, such as copayments, coinsurance, and amounts above Medicare's approved charge.

The order matters. When you receive care, the provider bills Medicare first. Medicare applies your deductible, then pays its percentage of the approved amount. Only then does secondary insurance look at what Medicare did not pay. If you have not yet met your primary deductible, secondary insurance will not pay it for you — you still owe it out of pocket.

The one exception is if you have a Medigap plan (supplemental insurance sold by private insurers). Some Medigap plans, particularly Plan C and Plan F, are designed to cover your primary Medicare Part B deductible after you meet it. But even these plans do not pay the deductible itself upfront; they reimburse you or the provider after the deductible has been satisfied through your own payments.

Key Takeaways

  • Your primary Medicare deductible must be paid by you before secondary insurance will pay anything toward your medical bills.
  • Secondary insurance covers what Medicare leaves unpaid after your deductible is met — copayments, coinsurance, and excess charges.
  • Medigap plans may reimburse your Part B deductible, but only after you have already paid it yourself.
  • The billing order is always Medicare first, then secondary insurance second, so secondary cannot bypass the primary deductible.
  • If you have employer or union retiree coverage as secondary, check your plan documents to see what it covers after Medicare pays.

How the Billing Order Works in Practice

When you see a doctor or receive hospital care, the provider submits a claim to Medicare. Medicare checks whether you have met your deductible for that year. If you have not, Medicare subtracts the deductible amount from what it would normally pay and sends you a bill for that deductible portion. The provider may also bill you directly.

Once your deductible is satisfied, Medicare pays its share of the approved amount (usually 80 percent for Part B services). The remaining 20 percent coinsurance is what secondary insurance typically covers. If the provider charges more than Medicare's approved amount, secondary insurance may cover that overage too — depending on your specific plan.

Secondary insurance never receives the claim until after Medicare has processed it. This means secondary insurance cannot pay your deductible because it does not see the claim until Medicare has already applied the deductible and determined what it will pay.

Medigap Plans and Deductible Coverage

Medigap policies are standardized plans sold by private insurance companies that work alongside Medicare. Some Medigap plans cover your Part B deductible, but the coverage works differently than you might expect. Plan C and Plan F (available only to people who first enrolled in Medicare before January 1, 2020) include Part B deductible coverage. Plan G, available to everyone, covers the Part B deductible for people who enrolled in Medicare on or after January 1, 2020.

Even when your Medigap plan covers the deductible, you typically pay the deductible first, then submit proof of payment to your Medigap insurer for reimbursement. Alternatively, some providers may bill your Medigap plan directly if you authorize them to do so, but the deductible still comes out of your pocket initially. The Medigap plan reimburses you after the fact.

Not all Medigap plans cover the deductible. Plans A, B, D, K, L, M, and N do not include Part B deductible coverage. If you have one of these plans, you are responsible for the full deductible amount yourself, and your Medigap plan covers only the costs that come after the deductible is met.

Employer and Union Retiree Coverage as Secondary

If you are retired and have health coverage through a former employer or union, that coverage becomes secondary to Medicare once you turn 65 and enroll in Medicare. Employer retiree plans vary widely in what they cover after Medicare pays.

Some employer plans will cover your Medicare deductible as part of their benefit design. Others will not. You need to review your specific plan documents or call your plan administrator to find out. The plan summary or evidence of coverage should state whether it covers Medicare deductibles, copayments, and coinsurance.

If your employer plan does cover the deductible, it typically works the same way as Medigap: you pay the deductible first, then the plan reimburses you, or you authorize the provider to bill the plan directly after Medicare has processed the claim.

What Happens If You Do Not Meet Your Deductible

If you receive care early in the year and have not yet met your annual deductible, you are responsible for paying the full deductible amount before Medicare or secondary insurance pays anything. Secondary insurance will not step in to cover this cost, even if you have a plan that normally covers deductibles.

This is why some people choose to delay non-urgent care until later in the year if they have already met their deductible with another family member or in a previous year. However, you should never delay necessary medical care to avoid the deductible. Your health comes first.

Keep track of your deductible status throughout the year. You can check your remaining deductible on your Medicare.gov account or by calling Medicare at 1-800-MEDICARE. Knowing where you stand helps you understand what you will owe when you receive care.

Understanding Your Out-of-Pocket Costs

Even with secondary insurance, you will have some out-of-pocket costs. Your primary deductible is always your responsibility. After that, secondary insurance covers what Medicare does not, but there may still be gaps depending on your plan.

For example, Medicare does not cover routine dental, vision, or hearing care. Secondary insurance typically does not cover these either unless your plan specifically includes them. Similarly, Medicare has limits on certain services like physical therapy or mental health visits. Secondary insurance may or may not extend those limits.

Review your secondary plan's coverage details to understand what is and is not covered. This helps you budget for medical expenses and avoid surprises when you receive a bill.

Frequently Asked Questions

Can my secondary insurance pay my Medicare deductible for me?

No, secondary insurance does not pay your primary Medicare deductible. You must pay it yourself first. Some Medigap plans will reimburse you for the deductible after you have paid it, but the deductible is your responsibility upfront.

What is the Medicare Part B deductible for 2024?

The Part B deductible changes each year based on inflation. Contact Medicare at 1-800-MEDICARE or visit Medicare.gov to find the current year's deductible amount. Your Medicare Summary Notice also shows your deductible status.

If I have both Medicare and employer coverage, which one pays first?

Medicare always pays first. Your employer coverage becomes secondary and pays only after Medicare has processed the claim and paid its share. This is true even if you enrolled in employer coverage before Medicare.

Does my Medigap plan cover the Part A hospital deductible?

Most Medigap plans cover the Part A deductible. Plans A, B, D, K, L, M, and N all include Part A deductible coverage. Plans C, F, and G also cover it. Check your plan documents to confirm, as coverage varies by plan letter.

What if I cannot afford to pay my Medicare deductible?

If you have limited income, you may be may be able to access for programs like Medicaid or the Medicare Savings Program, which can help pay Medicare premiums and deductibles. Contact your state Medicaid office or call 1-800-MEDICARE to learn about programs in your area.