ESRD With Spouse's Under-20 Employer Plan: Who Pays First?
The 30-month ESRD coordination period can apply when coverage comes through a spouse's active employer. However, if the spouse's employer has fewer than 20 employees, the small group plan may not be required to pay primary — making Medicare the likely primary payer from the start of ESRD eligibility.
Frequently Asked Questions
- Does the 30-month ESRD coordination period apply to my spouse's plan?
- It depends on employer size. Large employer plans (typically 20 or more employees) are generally required to pay primary during the 30-month ESRD coordination period. Small employer plans (under 20 employees) may not be required to pay primary.
- What if my spouse's employer has fewer than 20 employees?
- Small employer plans may not be required to be primary for ESRD Medicare. In that case, Medicare would likely pay primary from the start of your ESRD eligibility. Confirm with your spouse's plan and a Medicare counselor.
- Should I enroll in both Part A and Part B with ESRD even if my spouse has employer coverage?
- Yes. Enroll in both Part A and Part B when you become eligible. Medicare needs to be in place whether it pays primary or secondary, and you want to avoid a Part B enrollment gap.