In which scenario is Medicare considered the primary payer?

Medicare is considered the primary payer in the scenario where Medicare patients have no other insurance. This understanding hinges on the relationship between Medicare coverage and other types of insurance. When an individual is enrolled in Medicare but has no other form of health insurance, Medicare assumes the primary responsibility for covering healthcare costs.

In contrast, when a Medicare patient is over 65 and has a Group Health Plan (GHP) through a large employer, Medicare typically acts as a secondary payer after the employer's insurance, unless specific conditions dictate otherwise. If the patient is under 65 and has private insurance, Medicare is generally also the secondary payer. Additionally, treatment location, such as a non-hospital facility, does not typically impact the primary payer status. Thus, having no other insurance is a clear situation where Medicare is the primary payer, ensuring comprehensive coverage for the patient’s healthcare needs.