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MEDICARE - Coordination of benefits - Who pays first? - Coggle Diagram
MEDICARE - Coordination of benefits - Who pays first?
Are they on Medicaid?
Yes
MediCARE pays 1st
NO
under 65 & disabled?
No
65 or older and has a group health plan coverage based on theirs or their spouse’s
current employer?
Yes
does the employer have 20 or MORE employees?
NO
is the employer part of a multi-employer or multiple
employer group health plan?
2 more items...
Yes
group plan pays 1st
Over 65, retired, still have coverage from former employer?
if eligible for medicare and didn't sign up, employer insurance may not cover costs
No
65 or older, retired, and have group health plan coverage from spouse’s current
employer?
Yes
20 or more employees?
2 more items...
No
Veteran?
2 more items...
Under 65 and disabled?
UNDER 65, disabled, retired, and have group health plan coverage from former
employer?
No
1 more item...
Yes
1 more item...
Yes
Accident?
Yes
No Fault or Liability Insurance?
NO
Workers Comp?
yes
Workers Comp pays 1st
No
?
Yes
Insurance 1st
source document
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