In coordination with Medicare for a business with more than 20 employees, which statement is true regarding active employees' group plans and Medicare?

• A. The active employee's group health plan is primary and Medicare is secondary, unless the employee chooses otherwise
• B. Medicare is always primary
• C. The group plan is always secondary
• D. Medicare never pays if group plan exists

Answer: (A)

When Medicare and a current employer group plan both cover an active employee, the payoff order is determined by coordination of benefits rules. For a business with 20 or more employees, the employer’s group health plan is the primary payer, and Medicare acts as the secondary payer. This means the group plan pays first for covered services, and Medicare may pay after, helping to coordinate benefits and avoid duplicate payments. The statement notes an allowance for the employee to opt into a different arrangement in some cases, but the standard rule for large employers is that the group plan remains primary. The other options imply Medicare or the group plan always pays first or never pays, which doesn’t align with how primary and secondary payers are supposed to coordinate when a large employer group plan is involved.