Medicare Primary
State Health Plan Benefit Coordination with Medicare
If you are actively employed and eligible for Medicare, the State Health Plan is primary and Medicare is secondary for you and your dependents. The only exception is if you are Medicare primary due to End Stage Renal Disease (ESRD).
If you are a retiree and become eligible for Medicare, the State Health Plan becomes your secondary coverage, and Medicare becomes your primary coverage. The State Health Plan will pay up to the amount that would have been paid had the State Health Plan been primary. Medicare is primary and the State Health Plan is secondary for the following Medicare-eligible individuals:
- Retirees.
- Dependents of retirees who also have Medicare.
- Disability retirees.
- Dependents of disability retirees who also have Medicare.
- Members with End Stage Renal Disease (ESRD) following the 30-month State Health Plan primary period.
- Individuals with "dual" Medicare entitlement. Dual entitlement occurs when Medicare is already paying as primary because of disability or age and the member also becomes eligible because of ESRD. In this case, the 30-month State Health Plan primary period is waived and Medicare continues paying as primary.
- Individuals who have Medicare because of disability and who are not actively working or those who are spouses of non-working employees who also have Medicare.
- Former members and/or Medicare-eligible dependents covered under COBRA.
For more details, please see your Benefits Booklet.
