A Primer for Employers on Medicare Coordination of Benefits
March 24, 2023
A Primer for Employers on Medicare Coordination of Benefits

When a plan participant or beneficiary has Medicare and other health insurance, such as group health plan insurance, retiree coverage or Medicaid, there can often be confusion as to which insurance pays first on claims. Coordination of Benefits (COB) rules, which are specified in plan documents or insurance policies, decide which insurance pays first. One plan is considered the primary payer that covers most expenses, while the secondary plan covers any remaining allowable expenses not covered by the primary plan. The COB allows health plans to provide health or prescription drug coverage to individuals receiving Medicare to determine their payment responsibilities. This helps ensure that the total amount paid by all insurance plans does not exceed the total costs of the health care expenses for Medicare-covered services and items.


This article provides a general overview of COB rules under Medicare.

How Does Medicare Work With Other Insurance?

There are many important facts to remember regarding how other insurance works with Medicare-covered services and items, such as the following:


  • The primary payer pays first and up to its coverage limits.
  • The secondary payer only pays if there are costs the primary payer doesn’t cover.
  • The secondary payer, which may be Medicare in certain situations, might not pay all the uncovered costs from the primary payer.
  • If a group health plan or retiree coverage is the secondary payer, the individual may need to enroll in Medicare Part B before that insurance would pay.


If a Medicare-covered individual’s other health insurance is the primary payer and fails to promptly pay a claim, typically within 120 days, that individual’s doctor or service provider may bill Medicare. Medicare can make a conditional payment for the individual’s claim, recovering any payments the primary payer should have paid at a later date.


What’s a Conditional Payment?

A conditional payment is a payment Medicare makes for services for which another payer may be responsible. Medicare makes this payment, so the plan participant or beneficiary won’t have to pay the claim. The payment is conditional because it must be repaid to Medicare if the Medicare-covered individual receives a settlement, judgment, award or other payment later.


Who Pays First?

When an individual has Medicare and other insurance, there are rules for whether Medicare or the other insurance is the primary payer for Medicare-covered services and items. 


Medicare is typically the primary payer for Medicare-covered services and items in the following circumstances:

  • An individual is covered by only Medicare and Medicaid.
  • An individual covered by Medicare refuses group health coverage.
  • Medical services or supplies are not covered under a group health plan but are covered under Medicare.
  • A Medicare-covered individual is covered by a group health plan but has exhausted their coverage under the group health plan.
  • A Medicare-covered individual is 65 or older and covered by a group health plan (because the individual or their spouse is still working) offered by an employer with fewer than 20 employees.
  • A Medicare-covered individual is 65 or older and covered by an employer group health plan after retirement.
  • A Medicare-covered individual is 65 or older (or disabled) and covered by Medicare and the Consolidated Omnibus Budget Reconciliation Act (COBRA) coverage.
  • A Medicare-covered individual is disabled and covered by a large group health plan offered by an employer with fewer than 100 employees.
  • A Medicare-covered individual has end-stage renal disease and is enrolled in a group health plan or COBRA (after 30 months of eligibility or entitlement to Medicare).
  • A Medicare-covered individual has only Medicare and TRICARE coverage unless the individual is on active duty and receives services and items from a military hospital, clinic or other federal health care provider.


For a complete list of situations where Medicare is the primary payer, visit Medicare.gov or review the Centers for Medicare and Medicaid Services’ guide, Medicare & Other Health Benefits: Your Guide to Who Pays First.


How Does Medicare Know if an Individual Has Other Coverage?

COB permits an individual’s Medicare eligibility information to be shared with other payers and sends Medicare-paid claims to secondary payers for payment. The Benefits Coordination and Recovery Center (BCRC) does the following on Medicare’s behalf:


  • Collect and manage information on other types of coverage an individual with Medicare may have.
  • Determine whether an individual’s other coverage pays before or after Medicare.
  • Pursue repayment when Medicare makes a conditional payment.


Medicare doesn’t automatically know if a Medicare-covered individual has other health insurance; however, insurers are required to notify Medicare when they’re responsible for paying first for Medicare-covered services and items. In some instances, the individual’s health care provider, employer or insurer may ask them about their current coverage so they can report that information to Medicare. Additionally, insurers must report coverage changes to Medicare.


Summary

Understanding COB rules is vital to ensuring that a Medicare-covered individual’s claims are paid correctly. While COB rules can be complex, they can help Medicare plan participants and beneficiaries make the best use of their health care coverage.


For more health care resources, contact SimcoHR today.

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How Employers Can Support Working Parents This Summer

June 2, 2025
When school lets out, many working parents face a new set of challenges: piecing together childcare, coordinating summer camps, adjusting work schedules, and simply trying to maintain a sense of balance. For employers, this season presents a valuable opportunity to demonstrate empathy and build stronger connections with your workforce—especially your working parents. By offering the right policies, benefits, and workplace flexibility, your company can help parents manage the summer shuffle—while keeping productivity and morale strong. Here are a few impactful ways to make that happen. 1. Offer Flexible Scheduling Options Summer schedules are rarely predictable, especially for parents with younger children or teens involved in day camps, sports, or part-time jobs. Allowing employees to shift their working hours or compress their workweeks can be a game-changer. Early start and end times, four-day workweeks, or staggered hours give parents the flexibility to handle family logistics without sacrificing their jobs. What you can do: Encourage managers to have open conversations with team members about their summer availability. Promote cross-training so employees can support each other during flexible hours or time off. Formalize a “Summer Flex Hours” program to show company-wide support. This kind of trust-driven flexibility not only improves work-life balance but also boosts engagement and retention. 2. Revisit Your Remote or Hybrid Work Policy For companies that support remote work, summer is an ideal time to offer extra flexibility. Parents may need to be closer to home for child supervision or to avoid time-consuming commutes during camp drop-offs and pickups. Even one or two remote days per week can ease the mental load on parents—helping them stay focused and productive during working hours. And it signals a deeper commitment to employee wellbeing. Ways to implement: Offer a seasonal “summer remote work option” if your company is traditionally office-based. Empower department heads to tailor remote work flexibility to their team’s needs. Reinforce accountability and results-based performance to support this model. Tip: Simco is happy to help you review your remote work policy for both compliance and employee satisfaction! 3. Promote and Educate on Dependent Care Benefits Many organizations offer dependent care support, but employees often forget—or aren’t aware—of what’s available. Summer is a perfect time to highlight programs like: Dependent Care FSAs (tax-free childcare reimbursements) Childcare subsidies or stipends Backup care assistance Employee Assistance Programs (EAPs) with parenting or caregiver resources Tip: Create a simple “Summer Benefits Guide” or a quick email campaign highlighting available benefits. If your team uses a digital portal or app, make sure this information is easily accessible and up to date. 4. Plan Ahead for PTO and Team Coverage Summer means vacations—and for working parents, this might be the only chance they get to spend extended time with their families. That’s why it’s crucial to encourage early vacation planning and transparent communication among teams. Strategies to support summer PTO:  Ask employees to submit summer PTO requests as early as possible. Use shared calendars and collaborative tools to coordinate team coverage. Train back-up team members ahead of time to avoid last-minute stress. Consider adding a floating summer holiday or mental health day to give employees a breather. When employees feel supported in taking time off, they’re more likely to return refreshed and ready to re-engage. 5. Build a Family-Friendly Workplace Culture Supporting working parents isn’t just about policies—it’s about creating a culture of empathy and understanding. That starts with leadership modeling flexibility, and continues with teams who respect boundaries and accommodate personal obligations. Ideas to build culture: Create a parent resource group or Slack channel to exchange ideas and support. Share local summer camp or childcare resources in your company newsletter. Avoid scheduling late afternoon meetings that may interfere with family commitments. Celebrate family milestones or kid-friendly moments in a light-hearted way. These small cultural cues can go a long way in helping working parents feel seen, supported, and valued—especially during a season that’s often more stressful than relaxing. Final Thoughts Supporting working parents through summer break isn’t just the right thing to do—it’s a smart business strategy. Offering flexibility, benefits education, and an understanding culture helps companies retain top talent, foster loyalty, and create a healthier workplace for all. Need Guidance? At Simco, we specialize in helping businesses implement people-first policies and scalable benefit solutions. If you’re looking to enhance your workplace support for parents (or all employees), our specialists are here to guide you! Let’s talk about how we can help your workforce thrive—this summer and beyond.

The Leader’s Guide to Running Impactful Mid-Year Performance Reviews

May 30, 2025
Let’s be honest—mid-year reviews often don’t get the attention they deserve. They sneak up between vacations, project deadlines, and Q3 planning. But when done right, these check-ins can be one of the most valuable tools you have for keeping employees engaged, aligned, and growing. They’re not just about checking a box or filling out a form. Mid-year reviews are a chance to reconnect, recalibrate, and reenergize your team—and they can have a big impact on retention and performance. So, how do you make these conversations count? Let’s break it down. Why Mid-Year Reviews Actually Matter Think of the mid-year review as a strategic pit stop. You’ve made it halfway through the year—now’s the time to assess what’s working, what needs adjusting, and where your people want to grow. And here’s why that matters: Companies that implement regular performance feedback see 14.9% lower turnover rates than those that don’t, according to Gallup Employees who receive consistent feedback perform better and are more engaged overall, according to studies conducted by the Harvard Business Review Employees are far more likely to stay when they know their growth is supported The takeaway? People want feedback. But more importantly, they want useful feedback—along with the tools to take the next step forward. What to Ask: High-Impact Questions Performance reviews should feel like conversations, not interrogations. Open-ended, thoughtful questions help create space for honest dialogue. Below are a few ideas to keep the conversation flowing—and meaningful. Goals & Achievements What’s been your proudest accomplishment this year? What challenges have you worked through—and what did you learn? Are we on track with the goals we set earlier this year? Strengths & Value What are you most confident about in your role? Where do you feel you're making the biggest impact? Growth Opportunities Are there any skills you’re itching to develop? Where could we offer more support or resources? Looking Ahead Where do you see yourself a year from now? What kind of training or experiences would help you get there? This isn’t just about reviewing the past—it’s about setting the tone for the future. Turning Feedback into Development: Exploring the Role of Learning Management Systems Identifying growth opportunities during a performance review is just the first step—real transformation happens when you take action on that feedback. One effective way to support employee development is by leveraging a Learning Management System (LMS) . An LMS provides a structured and scalable way to turn feedback into forward momentum—whether you're preparing someone for a promotion or helping them build confidence in new skills. Key LMS features that support performance development include: Personalized learning paths aligned with individual or team goals Access to broad training libraries, including compliance and skill-building content Tools to track progress and measure learning impact Engaging elements like AI assistance, gamification, and peer learning These tools transform performance feedback into growth, helping businesses create a continuous learning culture. Look No Further At Simco , we support our clients through every stage of the performance management journey — from crafting the right review questions to delivering personalized, scalable learning opportunities. Our integrated HCM technology includes the isolved Learn & Grow Module, which features: 89,000+ courses including SCORM and state-compliant training Custom curriculums for individuals and teams AI-driven search and chatbot support Dashboards, reporting, gamification, and more Final Thoughts: Mid-Year Reviews Are a Strategic Lever Mid-year reviews are more than a checkpoint — they’re a chance to re-engage your team, show appreciation, and chart a clear path forward. When you treat them as an opportunity for dialogue, reflection, and action, the benefits ripple across retention, morale, and performance. Want to make your next round of reviews truly impactful? Let’s talk about how Simco can help streamline your process and empower your people.

Burn Ban Lifted in New York: Here’s How to Stay Safe and Protected

May 15, 2025
Each spring, New York State enforces a residential burn ban from March 16 through May 14 to help prevent wildfires. As of yesterday, the ban has officially been lifted , but fire safety should remain top of mind. While the Finger Lakes has seen steady rain this week, the risk of fire can still escalate quickly with a few dry, breezy days. If you’re planning to burn brush, enjoy a backyard fire pit, or take part in spring clean-up, it’s important to do so with caution. Why Does the Burn Ban Exist? The annual burn ban is in place to reduce the threat of wildfires during one of the most vulnerable times of the year. In early spring, before trees and vegetation fully green up, dead grass, leaves, and branches are dry and highly flammable. Combined with seasonal winds and low humidity, even small outdoor fires can spark large, fast-moving wildfires—especially in rural areas. This proactive ban has proven to significantly lower the number of wildfires across the state each year, protecting homes, farmland, and natural habitats. What Homeowners Should Do Now With the ban lifted, it’s a good time to: Review your homeowners insurance to ensure you're protected against fire-related damages. Practice safe outdoor burning , such as keeping fires a safe distance from structures and never leaving them unattended. Consider additional coverage for properties with wooded acreage or high-risk features. At Simco , we’re here to help you navigate risks like these—before they become problems. Whether you need a policy review or simply want to make sure your coverage keeps pace with your lifestyle, we’re just a call or click away .

Have a question? Get in touch.