Can I Have Both Employer Insurance and Medicare?
Entrusted Legacy Law
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Feb 10, 2023
Pennsylvania - Greater Pittsburgh Area
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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’s
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 doesn’t
cover. Medicare Part A bears hospital fees, Part B extends
to outpatient medical costs, and Part D applies to prescription
drugs. However, Medicare generally doesn’t 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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