Illinois Health Insurance Practice Exam

For an employed senior citizen with less than 20 members in their group plan, which insurance is primary?

1. Group plan

2. Medicare

3. No coverage

4. Medicare is secondary

The correct answer is: Medicare

The correct answer, indicating that Medicare is primary, is appropriate because of the coordination of benefits rules that apply when an individual is covered by both a group health plan and Medicare. For individuals who are employed and have health insurance through a small group plan (which is defined as having fewer than 20 members), Medicare generally acts as the primary payer for their medical expenses. This means Medicare will cover the medical bills first, and the group plan will cover any remaining eligible costs afterward. This rule is designed to ensure that seniors, who may often have more healthcare needs, have access to comprehensive coverage and benefits while also promoting the proper utilization of Medicare resources. As such, knowing when Medicare is the primary payer is crucial for understanding how benefits are coordinated between different types of insurance coverage for those in this specific situation.