Medicare & Other Insurance
How Medicare Works with Other Insurance | Employer/ Union Coverage/ Retiree Benefits | Medicare + Medicaid
Having Medicare in combination with other insurance can be a powerful tool to help keep your healthcare costs low and your coverage robust, however, it is very important to remember some key things about how other insurance works with Medicare covered services:
Your primary insurance (the insurance that pays for your healthcare bills first) pays up to the limit of its coverage.
Your secondary insurance (the insurance that pays for your healthcare bills AFTER your primary insurance) only pays if there costs the primary insurance didn’t cover.
Your secondary insurance (which can sometimes be Medicare depending on how your insurance is set up) might not pay all of the uncovered costs.
In certain cases, if your employer sponsored health insurance is your secondary insurance (also referred to as secondary payer), you might need to enroll in Part B before your insurance will pay.
Here are some helpful general guidelines to help you understand whether your Medicare is your primary payer or secondary payer:
Medicare pays first if:
You have retiree insurance (insurance from you or your spouse’s former employment)
You are age 65 or older, have employer sponsored group health coverage based on you or your spouse’s current employment at a company with fewer than 20 employees.
You are under 65 and have disability, and have employer sponsored group health coverage based on you or an immediate family member’s current employment at a company with fewer than 100 employees.
You have Medicaid.
Your group health plan pays first if:
You are age 65 or older, have employer sponsored group health coverage based on you or your spouse’s current employment at a company with 20 or more employees.
You are under 65 and have disability, and have employer sponsored group health coverage based on you or an immediate family member’s current employment at a company with 100 or more employees.
**If you received Medicare because of your End-Stage Renal Disease (ESRD): Your group health plan will pay for the first 30 months after you become eligible to enroll in Medicare, then after that 30 month period Medicare will pay first.**
How Medicare Works with Other Insurance | Employer/ Union Coverage/ Retiree Benefits | Medicare + Medicaid
Employer/ Union Coverage/ Retiree Benefits
Unsure of how Medicare will work with your employer sponsored health or retirement plan, retiree coverage or state & federal retirement coverage? Because every retiree plan or employer based coverage is different, we always recommend contacting your benefits administrator first to understand how your current coverage works. We cannot stress this enough. This is especially important because some people’s retiree health coverage can be tied to and dependent on other types of retiree benefits such as 401k(s) etc. If you leave your current coverage you may potentially be at risk of losing or affecting your other benefits (depending on your plan).
We cover this topic in more detail, as it relates to whether or to not to enroll in PART B, here.
Once you understand your current benefits, feel free to contact us and we’d be happy to help you help understand how it relates to Medicare.
How Medicare Works with Other Insurance | Employer/ Union Coverage/ Retiree Benefits | Medicare + Medicaid
Medicare + Medicaid
Medicare and Medicaid are distinctly different programs with different eligibility requirements that can in some cases work together to cover certain healthcare needs and costs.
Medicare is a federally run health insurance program for people aged 65 and over (or individuals with certain disabilities). That means in general that the rules and operation of Medicare are the same for you in your state of residence and for your family, friends, coworkers or neighbors living in a different state.
Medicaid is a state-run financial and healthcare assistance program based entirely on an individual’s income. That means the rules for eligibility, and operations are different for you in your state than they are for your family, friends, coworkers or neighbors living in another state.
There are a few very helpful programs available to you if you think you may need assistance paying for your healthcare.
You can find more about your state’s Medicaid programs through www.Medicaid.gov by clicking here.
You can also find out if you qualify for prescription drug cost assistance offered through the Social Security Administration anywhere in the USA by clicking here.
Have both Medicare and Medicaid and want additional benefits? See our article on Dual Special Needs plans here.
How Medicare Works with Other Insurance | Employer/ Union Coverage/ Retiree Benefits | Medicare + Medicaid