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Q: Can You Have Private Insurance and Medicare at the Same Time?

Asked by Anonymous on October 12, 2017

Hal Levy October 12, 2017

Well, Medicare IS health insurance. You’ll pay monthly Medicare premiums and present your Medicare card to the doctor to pay for services, just like you would with other health insurance. There are, though, several cases where you can have both private insurance and Medicare at the same time.

If You Have Employer-Sponsored Private Insurance and Medicare: Whether you get insurance through your own employer or that of a spouse or family member, your main concern will be to determine whether or not it pays for claims before Medicare does (as a “primary payer”) or after Medicare (as a “secondary payer”). This depends on the size of the employer that you receive coverage from.

  • Your employer coverage will be primary if:
    • Your employer has 20 people or more, and you’re over 65 years old OR
    • Your employer has 100 people or more, and you qualify for Medicare due to a disability.
  • Your employer coverage will be secondary – meaning that Medicare will have to pay most of your claims first – if:
    • Your employer has fewer than 20 people and you’re over 65 years old OR
    • Your employer has fewer than 100 people, and you qualify for Medicare due to a disability.

It’s important to check with your insurance administrator to make sure that they coordinate appropriately with your Medicare coverage. You may be responsible for overpayments or penalties if your primary insurance isn’t synced with your Medicare correctly. It’s difficult to coordinate this and may make it harder to get supplementary coverage later on, but you may want to keep employer insurance for cost savings or for the sake of your spouse.

If You Have VA Coverage: Although you don’t need to enroll in Medicare Part B, the VA recommends that you do. This will expand the range of emergency care and outpatient doctors that you can visit.

If You Have COBRA or Retiree Insurance: Your coverage won’t end automatically once you’re eligible. If you hold onto it, you won’t be eligible for a penalty-free Medicare enrollment period once your coverage does end.

If You Have an Individual Health Insurance Plan: It’s generally against the law for insurers to sell Medicare beneficiaries a new individual health insurance plan (these are sometimes called “Obamacare”, “major medical”, “qualified”, or “Marketplace” plans). If you currently have this coverage, you’ll lose eligibility for tax credits that you’d otherwise receive for having private insurance, and your insurance might decline to pay simply because Medicare could have paid.

You’ll still be responsible for a small portion of your medical bills when you have Medicare. You’ll probably want additional coverage that pays the medical bills that Medicare leaves to you.

86 percent of Medicare enrollees enter into certain types of supplementary coverage that coordinate with Medicare. These plans take care of potentially costly coverage gaps in your Medicare coverage, like coinsurance, at a fraction of the out-of-pocket rate:

  • Medicare Supplement plans (also known as “Medigap”) are available in every state. There are 10 different types of plans, each with different levels of coverage to pay for your excess Medicare costs.
  • Medicare Advantage plans (also known as “Part C”) replace your Part A & Part B coverage. Instead of getting Medicare through the government, you’ll go through a private insurer who may offer you extra benefits and smaller doctor networks. Part C plans also limit your yearly out-of-pocket costs.
  • Medicare Part D plans pay for prescription drugs. Part D coverage might be included with Medicare Advantage plans, but Medigap and Original Medicare beneficiaries will sign up separately.

There are also three major services that aren’t covered by Medicare: hearing aids, dental work, and vision care. If you’re a Medicare beneficiary, you can:

  • Pay for these services on your own;
  • Enroll in separate vision, dental, or hearing insurance; or
  • Join a Medicare Advantage plan that covers these services.

In a few very unusual circumstances, you can switch from Medicare to individual health insurance. However, this isn’t cost-effective for most people.

Taking the Next Steps

Once you determine which type of supplementary Medicare coverage is right for you, HealthCare.com’s innovative comparison tool can help you find the policy that fits you best. Both Medicare Supplement and Medicare Advantage plans are widely available.

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