Explain coordination of benefits when a consumer has both Medicare and a secondary payer.

• A. The secondary payer pays first; the primary pays the remainder
• B. The primary payer pays first; the secondary pays the remaining costs per rules
• C. Both pay 50/50
• D. No coordination needed

Answer: (B)

Coordination of benefits determines which insurer pays first when more than one plan covers you. The designated primary payer processes the claim first and pays its allowed amount according to its rules. The secondary payer then reviews any remaining eligible charges and pays the rest, up to its own coverage limits, reducing what you owe. In a Medicare plus secondary-payer setup, the primary payer handles its share first, and the secondary payer covers what remains not paid by the primary, following its own guidelines. A common rule is that an employer group plan with 20+ employees is primary and Medicare is secondary; if the employer has fewer than 20 employees, Medicare is primary. After both pay, you may still owe deductibles, coinsurance, or non-covered charges depending on each plan’s specifics.