If a person has both Medicare and Medicaid, which one is considered the primary payer?

In the case of individuals who are eligible for both Medicare and Medicaid, Medicare is designated as the primary payer. This means that when a person has medical expenses, Medicare will cover its share of the costs first. After Medicare has paid its portion, Medicaid may then provide supplemental coverage to help cover additional expenses that Medicare does not cover.

This system is in place because Medicare is a federal program that generally pays first for healthcare services, while Medicaid, a state program, serves as a secondary payer. The coordination of benefits aims to ensure that healthcare costs are effectively managed, and that enrollees receive the maximum benefits available to them.

Understanding this hierarchy of coverage is essential for navigating healthcare services and ensuring that eligible individuals receive the appropriate benefits from both systems effectively.