O if you have medicare because youre 65 or over or because you have a disability other than end stage renal disease esrd medicare pays first o if you have medicare based on esrd cobra pays first medicare pays second to the extent cobra coverage overlaps the first 30 months of medicare eligibility or entitlement based on esrd. Who pays first if i have other health coverage if you have medicare and other health coverage each type of coverage is called a payer when theres more than one payer coordination of benefits rules decide who pays first the primary payer pays what it owes on your bills first and then your provider sends the rest. If you have medicare and other health coverage each type of coverage is called a payer when theres more than one payer coordination of benefits rules decide who pays first the primary payer pays what it owes on your bills first and then you or your health care provider sends the rest to the secondary payer to pay in some rare cases there may also be a third payer. An alphabetical list of what is in this guide medicare and other health benefits your guide to who pays first isnt a legal document the official medicare program provisions are contained in the relevant laws regulations and rulings the information in this guide was correct when it was printed changes may occur after printing for the most up to date version visit wwwmedicaregov on the web select