When signing up for Medicare, some people have other insurance, such as coverage from a current employer, or retiree’s or military insurance. Beneficiaries of Original Medicare or Medicare Advantage may keep their additional coverage, as the providers work together to bear health care costs.
Can You Have Medicare and Private Insurance?
People may have Medicare and other insurance simultaneously for several reasons.
- Some Medicare enrollees have retiree health coverage through their (or a spouse’s) former employer.
- Others remain in the workforce past 65 and are on employer-backed insurance or are enrolled in their working spouses’ insurance.
- Younger people with disabilities can receive Medicare coverage while also on their employer’s insurance.
- Active and retired service members and their families can get health coverage through Tricare while also enrolled in Medicare.
- Qualifying individuals with limited income and resources can obtain Medicare and Medicaid coverage at the same time. This is called being dually eligible.
Allocating Coverage
People with more than one insurance provider may receive more coverage, as the providers allocate costs. Depending on the situation, Medicare might be the primary payer, or the other insurance provider may act as the principal insurer. Once the primary payer has covered the maximum amount, the secondary payer contributes to the remaining costs. Each insurance source will determine what and how much coverage it provides for services and treatments.
Though the coverage can be greater with multiple providers, you may be responsible for outstanding fees that neither program fully includes.
For those with two insurance providers, the “Medicare & You” handbook as well as the guide to “Who Pays First” (both in PDF format) explain the protocol that determines which provider is the primary payer.
In general, Medicare pays first when people have retiree health coverage or receive coverage from a smaller organization. An employer’s coverage typically takes precedence when it originates from current employment at a larger organization.
- Covering costs first, Medicare is the primary insurance for those who also have retiree health coverage.
- Medicare is also the first insurer for older adults with current employer health coverage when the company has less than 20 employees.
- It is also the primary payer for younger people with disabilities with current employer coverage from establishments with fewer than 100 workers.
In other instances, Medicare is the secondary payer.
- The employer’s insurance pays first for those who receive insurance because they or their spouse currently works at a larger business (more than 20 employees). Then Medicare covers the remaining costs.
- For disabled people with coverage based on their or their family member’s current employment at a larger organization (more than 100 employees), the employer’s insurance is the primary payer.
- Tricare is the primary insurer for individuals on active duty or those receiving care in a military hospital, clinic, or federal health care provider. Others on Tricare get Medicare coverage first.
How Medicare and Medicaid Work Together
Those who qualify for Medicare as well as Medicaid can receive assistance from both programs. When people benefit from both programs, Medicare is the primary payer. If both Medicare and Medicaid cover the same service or treatment, Medicare pays first, and Medicaid contributes to any remaining costs.
Sometimes, Medicaid will pay for expenditures that Medicare does not cover. Medicare Part A bears hospital fees, Part B extends to outpatient medical costs, and Part D applies to prescription drugs. However, Medicare generally does not take care of nursing home expenses, which Medicaid can cover.
Speak to an elder law attorney to learn how having other insurance coverage affects Medicare.
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