Medicare Secondary Payer
Medicare Secondary Payer is a term generally used when Medicare is not the primary payer of health claims for individuals who are eligible for active health coverage through their employer. The U.S. government designed Medicare to provide health coverage for retired individuals, not actively employed individuals.
If you are age 65 or older and are eligible for active health coverage through your employer, then Medicare will not be the primary payer for your health claims. Instead, you should receive coverage under your employer’s health plan for active employees. This is true regardless of whether or not you have retired under the Clergy Pension Plan.
If you have already retired, however, you need to pay particular attention to the Medicare Secondary Payer rules because they affect your eligibility to receive the Medicare Supplement Health Plan Subsidy. If you continue to work in the Episcopal Church after retirement (whether that work falls under a Working While Pensioned exception or not) and are eligible for your employer’s active health coverage, you should receive coverage under your employer’s active health plan. This means that you will not be eligible for coverage under a Medicare Supplement Health Plan offered by The Episcopal Church Medical Trust. If you were receiving the Medicare Supplement Health Plan Subsidy prior to your return to work, that subsidy will stop for as long as you continue to be eligible for active health coverage.
There is an exception from the Medicare Secondary Payer rules for active employees who are employed by small employers. Learn more about the Medicare Secondary Payer Small Employer Exception.
For details about Medicare, please visit the Medicare website at www.medicare.gov.
Refer to the Bulletin for Group Benefit Administrators: Understanding Health Plan Options for Employees Age 65+ for more details.