Illinois Health Insurance Practice Exam

If an employed senior citizen has more than 20 members in their group plan, which insurance is primary?

1. Medicare

2. Group plan

3. No coverage

4. Medicare is secondary

The correct answer is: Group plan

When an employed senior citizen is enrolled in a group health plan that has more than 20 members, that group plan is designated as the primary payer for health insurance claims. In this situation, the group plan pays first on any medical expenses, while Medicare serves as the secondary payer, covering costs that the group plan does not. This order of payment is established under federal law, which ensures that working individuals age 65 and older can utilize their employer-sponsored health insurance as the primary source of coverage if the employer's plan has at least 20 employees. Therefore, the correct interpretation of this scenario confirms that the group plan would take precedence in managing and covering medical expenses, while Medicare would step in only after the group plan has processed its share of the costs.