Not Covered

Medicare Says Another Insurance Should Pay First

Name: Medicare Says Another Insurance Should Pay First
Creator: Barley Billing Team
Published: 2026-03-26

Written by Barley Billing Team, Medicare Billing Experts | Last reviewed March 26, 2026

Does your notice say something like this?

"This care may be covered by another payer"

"Medicare is the secondary payer for this claim"

"Another insurer is responsible for paying first"

"This claim should be submitted to your primary insurance"

If so, you're in the right place. Here's what it means and what to do.

What This Means

Medicare believes another insurance plan should pay for this service before Medicare does. Under the Medicare Secondary Payer (MSP) rules, when you have other health coverage, that other insurer may need to pay first. Medicare then pays second, covering some or all of what’s left.

This is usually not a permanent denial. It’s a coordination issue that can be resolved once the right insurer processes the claim first.

Why This Happens

You have employer group health coverage. If you or your spouse works for an employer with 20 or more employees, that employer’s group health plan is typically the primary payer for people age 65 and older. Medicare pays second.
The injury is related to a car accident or workers’ comp. Auto insurance, no-fault insurance, or workers’ compensation pays first for injuries covered under those policies. Medicare only pays after those insurers have paid their share.
You’re in the ESRD coordination period. If you qualified for Medicare because of End-Stage Renal Disease, your group health plan remains the primary payer for the first 30 months of your Medicare eligibility.
Medicare’s records are outdated. Medicare may have old information showing you have other coverage that has since ended. This is one of the most common causes of these denials and is the easiest to fix.

Should You Appeal?

Appeal outlook: Mixed — but this is usually a fixable issue

This type of denial is usually a coordination problem, not a judgment about your care. The resolution depends on your situation:

If you do have other insurance, the claim needs to go to that insurer first. Once they process it, Medicare can process their portion.
If you don’t have other insurance (or it has ended), you need to update Medicare’s records. Once corrected, the claim can be reprocessed.

In either case, this is typically resolved without a formal appeal.

What To Do Next

Determine whether you actually have other coverage. Check if you have any active health insurance through an employer, an auto policy, or workers’ compensation that might apply to this claim.
If you do have other insurance, contact that insurer and ask them to process the claim first. Then have your provider submit the remaining balance to Medicare as the secondary payer.
If you don’t have other insurance, call the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 to update your records. Let them know your other coverage has ended (or never existed). They can update Medicare’s files so the claim can be reprocessed.
Contact your provider’s billing office. Let them know about the coordination issue so they can resubmit the claim once it’s resolved.
If the issue isn’t resolved, call 1-800-MEDICARE (1-800-633-4227) for help or contact your State Health Insurance Assistance Program (SHIP) for free counseling.

Sources

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Appeal Deadlines — Check Your Notice for Exact Dates

Original Medicare

120 days from the date on your MSN

Medicare Advantage

At least 60 days (check your denial notice for exact deadline)

Not sure which you have? Check the top of your denial notice. If it names a private insurance company (like Humana, UnitedHealthcare, or Aetna), you have Medicare Advantage. If it says "Centers for Medicare & Medicaid Services," you have Original Medicare.

Frequently Asked Questions

When is Medicare the secondary payer?

Medicare pays second when you have employer group health coverage (if the employer has 20 or more employees), workers' compensation for a work-related injury, auto insurance or no-fault coverage for an accident, or during the first 30 months of Medicare eligibility based on End-Stage Renal Disease (ESRD).

How do I know which insurance pays first?

The 'primary payer' depends on your situation. Generally, if you're still working and have employer coverage from an employer with 20+ employees, that plan pays first. If you're retired and have retiree coverage, Medicare usually pays first. Your employer's benefits office or 1-800-MEDICARE can help clarify.

What if Medicare's records are wrong about my other insurance?

If Medicare thinks you have other coverage but you don't (or it has ended), contact the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 to update your records. This is the most common reason for these denials.

Will I have to pay out of pocket while this gets sorted out?

Usually not, as long as you follow up promptly. Once the correct payer order is established and the claim is submitted to the right insurer first, the claim should be processed normally. If your provider asks you to pay, explain that you are working to resolve a coordination-of-benefits issue.

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This information is for educational purposes only and is not legal or medical advice. Always verify with your doctor's office and insurance company.