Medicare Coordination When You Qualify Through Disability or ESRD

Adapted from How Medicare Works with Other Insurance, Centers for Medicare & Medicaid Services. The selected guidance concerns Medicare coverage and payment, not a recommendation for medical treatment. Numbered page references below refer to the linked source publication.

Coverage can depend on medical necessity, the setting, provider participation, and your plan’s rules. Use the cited publication for the full conditions and check the plan year when comparing costs or enrollment choices.

Medicare coverage because of End-Stage Renal Disease (ESRD) or a disability

Who pays first depends on things like:

• Your age
• Your disability
• How long you’ve gotten disability benefits
• Your other health plan coverage

You have Medicare because of ESRD and have group health plan (including retiree) coverage (or coverage from a spouse or family member). Who pays first?

Once you become eligible for Medicare because of permanent kidney failure, there will be a 30-month coordination period. During this time, your group or retiree health plan will continue to pay first for your health care bills, regardless of:

• The employer’s number of employees
• Whether you’re currently employed or retired
• Whether your group or retiree plan says its policy is to pay second to Medicare, or otherwise rejects or limits its payments to people with Medicare

During your 30-month coordination period, if your plan doesn’t pay for covered services in full, Medicare may pay second for all Medicare-covered items and services, not just ones for the treatment of ESRD. Check with your plan if you’re not sure if it will pay for covered services in full.

After the coordination period ends, Medicare pays first and your group health plan (or retiree coverage) pays second.

Tell your health care provider if you have group or retiree health plan coverage so they bill your services correctly. Your group or retiree health plan coverage may still pay for services that Medicare doesn’t cover. Check with your plan’s benefits administrator for more information.

You first got Medicare when you turned 65 or because of a disability other than ESRD. You also have group health plan coverage (including retiree coverage or coverage from a spouse or family member). Now you have ESRD. Who pays first?

Whichever coverage paid first when you became eligible for Medicare because of your age or non-ESRD disability continues to pay first when you become eligible because of ESRD.

You have Medicare because of ESRD and COBRA coverage. Who pays first?

COBRA pays first and Medicare pays second during the coordination period that lasts up to 30 months after you’re first eligible for Medicare because of ESRD. After the coordination period ends, Medicare pays first.

You’re under 65 and have Medicare because of a disability and group health coverage. Who pays first?

Who pays first depends on if your group health coverage comes from your (or a spouse or family member’s) current or former employer and the size of that employer.

• You’re under 65 and have Medicare because of a disability, and you have coverage from a former employer. In this case, Medicare pays first because the employer coverage isn’t based on active employment.

Note: Retiree coverage might not pay your medical costs during any period when you were eligible for Medicare but didn’t sign up for it. When you become eligible for Medicare, you’ll need to sign up for both Medicare Part A and Medicare Part B to get full benefits from your retiree coverage.

Check with your retiree coverage to find out if you’ll lose retiree benefits (including any non-drug health coverage) for yourself and/or your spouse or dependents if you get Medicare drug coverage.

• You’re under 65 and have Medicare because of a disability. You also have coverage from your (or your spouse or family member’s) current employer. If that employer has either 100 or more employees or has fewer than 100 employees but is part of a multi-employer group where one or more companies has at least 100 employees, the group health plan pays first, and Medicare pays second.

Example: Mary works full-time for a company that has 120 employees. She has large group health plan coverage for herself and her husband. Her husband has Medicare because of a disability, so Mary’s group health plan coverage pays first for Mary’s husband, and Medicare pays second.

Note: Health plans offered by employers with 100 or more employees are also called “large group health plans.” They can’t treat any plan member differently because they’re disabled and have Medicare.

If that employer has fewer than 100 employees and isn’t part of a multi-employer group plan (where one or more companies has 100 or more employees), then Medicare pays first, and the group health plan pays second.

You’re under 65 and have Medicare because of disability. You also get disability benefits from either the Social Security Administration (SSA) or Railroad Retirement Board (RRB). Who pays first?

If you’ve been getting disability benefits from the SSA or the RRB for less than 24 months, you aren’t eligible for Medicare coverage yet. That means your group health plan is your only payer.

Once you’ve had disability benefits for 24 months, you’ll automatically be signed up for Medicare, and who pays first will be determined by your group health coverage.

Note: There’s no 24-month waiting period for people with Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease.

You’re under 65 and have Medicare because of a disability. You also have retiree group health plan coverage through your former employer. Who pays first?

If you aren’t currently employed, Medicare pays first for your health care bills and your retiree group health plan coverage pays second.

Retiree coverage might not pay your medical costs during any period when you were eligible for Medicare but didn’t sign up for it. When you become eligible for Medicare, you’ll need to sign up for both Medicare Part A and Medicare Part B to get full benefits from your retiree coverage.

Check with your retiree coverage to find out if you’ll lose retiree benefits (including any non-drug health coverage) for yourself and/or your spouse or dependents if you get Medicare drug coverage.

Source and further reading

How Medicare Works with Other Insurance — Centers for Medicare & Medicaid Services. Public domain U.S. government educational material, accessed October 28, 2026. Fynoptic has selected sections, removed print navigation, and reformatted the text for this guide. The agency does not endorse Fynoptic.