In the past when I have looked this up for a client the reference I found mentions less than 20 employees or 20+ as the break point for group health and Medicare.
Yesterday I found a new source and saw this.
CMS certainly goes out of their way to make it confusing.
If your employer has fewer than 20 employees, Medicare generally pays first.
But if your employer joins with other employers or employee organizations (like unions) to sponsor a group health plan (called a multi-employer plan), and any of the other employers have 20 or more employees, Medicare would generally pay second.
Your plan might also ask for an exception, so even if your employer has fewer than 20 employees, you'll need to find out from your employer whether Medicare pays first or second.
Generally, if your employer has fewer than 100 employees, Medicare pays first if you're under 65 or you have Medicare because of a disability.
Sometimes employers with fewer than 100 employees join with other employers to form a multi-employer plan or multiple employer plan. If at least one employer in the multi-employer plan or multiple employer plan has 100 employees or more, Medicare pays second.
If the employer has at least 100 employees, the health plan is called a large group health plan. If you're covered by a large group health plan because of your current employment or the current employment of a family member, Medicare pays second.
If you go outside your employer plan's network, it's possible that neither the plan nor Medicare will pay
https://www.medicare.gov/supplement...first/which-insurance-pays.html#collapse-2446
Yesterday I found a new source and saw this.
CMS certainly goes out of their way to make it confusing.
If your employer has fewer than 20 employees, Medicare generally pays first.
But if your employer joins with other employers or employee organizations (like unions) to sponsor a group health plan (called a multi-employer plan), and any of the other employers have 20 or more employees, Medicare would generally pay second.
Your plan might also ask for an exception, so even if your employer has fewer than 20 employees, you'll need to find out from your employer whether Medicare pays first or second.
Generally, if your employer has fewer than 100 employees, Medicare pays first if you're under 65 or you have Medicare because of a disability.
Sometimes employers with fewer than 100 employees join with other employers to form a multi-employer plan or multiple employer plan. If at least one employer in the multi-employer plan or multiple employer plan has 100 employees or more, Medicare pays second.
If the employer has at least 100 employees, the health plan is called a large group health plan. If you're covered by a large group health plan because of your current employment or the current employment of a family member, Medicare pays second.
If you go outside your employer plan's network, it's possible that neither the plan nor Medicare will pay
https://www.medicare.gov/supplement...first/which-insurance-pays.html#collapse-2446