Jeffrey Wade
It is possible to have both private health insurance and Medicare at the same time, which is known as dual coverage. This can provide additional coverage and potentially lower out-of-pocket costs, but it can also be more complex to manage your benefits and claims. When you have both, a process called coordination of benefits determines which insurance provider pays first. This provider is called the primary payer and pays up to the limits of its coverage. The secondary payer then pays for costs that the primary payer doesn't cover, but it may not cover all remaining costs. The order of payment depends on the type of private insurance you have and your individual situation.
| Characteristics | Values |
|---|---|
| Can you have both private medical insurance and Medicare? | Yes, this is known as "dual coverage". |
| What is Medicare? | A federal insurance program for people over the age of 65 and for certain people with disabilities or a health condition such as end-stage renal disease (ESRD) and Lou Gehrig's disease (ALS). |
| What is private health insurance? | Private health insurance is provided by private companies. |
| How do the two types of insurance work together? | A process called "coordination of benefits" determines which insurance provider pays first. This provider is called the "primary payer". The primary payer pays for any covered services until the coverage limit has been reached. The "secondary payer" pays for any costs that the primary payer doesn't cover. |
| How to determine which insurance is the primary payer? | The type of private insurance and your individual situation determine the primary payer. |
| Can you use the ACA marketplace if you already have Medicare? | No, it is against the law for someone who knows you have Medicare to sell or issue you a Marketplace policy. |
| Can you use the ACA marketplace to buy a private insurance plan if you are already enrolled in Medicare? | No, if you are already enrolled in Medicare, you cannot use the ACA marketplace to buy a private insurance plan. |
| Can you have a Medicare Advantage plan if you have private insurance? | Yes, you are still considered enrolled in Medicare, but the Medicare Advantage plan administers your benefits. |
| Can you have both Medicare and private insurance if you are covered under an employer-provided plan, COBRA, or TRICARE? | Yes. |
| What if you are covered under your spouse's private health insurance? | You can still have Medicare. |
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What You'll Learn
- Medicare and private insurance can be combined in certain instances
- Medicare and private insurance together is known as dual coverage
- COBRA, TRICARE, and employer-provided plans can be combined with Medicare
- The primary payer pays first, then the secondary payer pays the remaining balance
- Medicare Advantage plans are an alternative way to receive Original Medicare benefits
Medicare and private insurance can be combined in certain instances
If you are covered under an employer-provided plan, COBRA, or TRICARE, you can have both Medicare and private insurance. In these cases, a process called "coordination of benefits" determines which insurance provider pays first. This provider is known as the "primary payer". The primary payer pays for any covered services until the coverage limit has been reached. The "secondary payer" then pays for any costs that the primary payer does not cover, although they may not cover all costs. The order of payment is known as "coordination of benefits".
The primary payer is determined by the type of private insurance you have and your individual situation. For example, if you have Medicare and COBRA, the provider that pays first depends on your specific situation. If you are 65 or older, or have a disability, Medicare pays first. If you have ESRD, COBRA pays first, and Medicare may pay second, depending on whether there is an overlap between your COBRA coverage and your first 30 months of Medicare eligibility. If you have TRICARE, the provider that pays first depends on whether or not you are on active duty. If you are on active duty, TRICARE pays first for any services covered by Medicare, and if you are not, Medicare pays first.
It is important to understand how the two types of insurance work together and to review your coverage carefully to ensure that you are getting the best possible coverage for your needs. While having both types of health insurance can provide additional coverage and potentially lower out-of-pocket costs, it can also be more complex to manage your benefits and claims.
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Medicare and private insurance together is known as dual coverage
Medicare and private insurance can be combined in certain instances. This is known as "dual coverage" and can provide additional coverage and potentially lower out-of-pocket costs. However, it can also be more complex to manage your benefits and claims. It is important to understand how the two types of health insurance work together and to review your coverage carefully to ensure that you are getting the best possible coverage for your needs.
If you have both Medicare and private insurance, a process called "coordination of benefits" determines which insurance provider pays first. This provider is called the "primary payer". The primary payer pays for any covered services up to the limits of its coverage, after which the remaining balance is sent to the "secondary payer". If the secondary payer doesn't cover the remaining balance, you may be responsible for the remaining costs. The provider who is the primary payer depends on the type of private insurance you have and your individual situation. In some cases, Medicare may be the primary payer, while in others, it may be the secondary payer.
There are a few scenarios in which you can have both Medicare and private insurance. Firstly, if you're covered under an employer-provided plan, COBRA, or TRICARE, you can have both. COBRA allows you to temporarily keep private insurance coverage after your employment ends, and TRICARE provides coverage for active and retired military members and their dependents. Additionally, you can have Medicare and also be covered by your spouse's private insurance plan.
Medicare Advantage plans are another way to have dual coverage. These are private, Medicare-approved insurance plans that administer your Original Medicare Part A and Part B benefits. They often provide some coverage of supplemental benefits, such as vision and dental, and can be designed specifically for dual-eligible individuals enrolled in both Medicare and Medicaid.
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COBRA, TRICARE, and employer-provided plans can be combined with Medicare
Let's look at each scenario separately:
COBRA and Medicare:
If you already have Medicare coverage and are enrolled in COBRA through your employer or your spouse's employer, you can use both simultaneously. COBRA allows individuals to temporarily maintain their private insurance coverage after their employment ends. This can be beneficial as COBRA plans may cover additional services that Original Medicare (Parts A and B) doesn't, such as dental and eye care. However, it's important to note that if you become eligible for Medicare while already enrolled in COBRA, your COBRA coverage will end.
TRICARE and Medicare:
You can have both TRICARE and Medicare if you meet certain conditions. Firstly, if you are 65 or older, you must be enrolled in Medicare Part B to maintain TRICARE coverage. Additionally, if you have a disability, end-stage renal disease (ESRD), or amyotrophic lateral sclerosis (ALS), you must be enrolled in both Medicare Part A and Part B to keep your TRICARE coverage. TRICARE determines which insurance pays first. If you are on active duty, TRICARE pays first for any services covered by Medicare, and Medicare may pay for any remaining costs.
Employer-Provided Plans and Medicare:
You can also have both employer-provided insurance and Medicare. This can be your own employer-provided insurance or your spouse's. If you have employer-provided insurance when you become eligible for Medicare, you can delay Medicare enrollment without penalty. However, it's important to consider whether Medicare or your employer insurance will pay first, as this can impact your coverage and costs.
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The primary payer pays first, then the secondary payer pays the remaining balance
It is possible to have both private insurance and Medicare at the same time. This is known as "dual coverage" and can provide additional coverage and potentially lower out-of-pocket costs. However, it can also be more complex to manage your benefits and claims. When you have both, a process called "coordination of benefits" determines which insurance provider pays first. This provider is called the primary payer.
The primary payer pays first, up to the limits of its coverage, and then sends the remaining balance to the secondary payer. The secondary payer then pays for any costs that the primary payer does not cover. However, the secondary payer may not cover all of the remaining costs, in which case you may be responsible for the rest of the balance.
The provider that is the primary payer depends on the type of private insurance you have and your individual situation. For example, if you are covered by a group health plan through your employer or your spouse's employer, and the employer has less than 20 employees, Medicare pays first. On the other hand, if you have TRICARE and are on active duty, TRICARE pays first for any services covered by Medicare.
It is important to understand how the two types of health insurance work together and to review your coverage carefully to ensure that you are getting the most comprehensive care without paying more than necessary. You can call the Benefits Coordination & Recovery Center at 1-855-798-2627 (TTY: 1-855-797-2627) if you have questions about who pays first or if your coverage changes.
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Medicare Advantage plans are an alternative way to receive Original Medicare benefits
In certain instances, private health insurance and Medicare can be combined. This is known as "dual coverage". When you have both, a process called "coordination of benefits" determines which insurance provider pays first. This provider is called the "primary payer". The primary payer pays for any covered services until the coverage limit is reached, after which the "secondary payer" covers any remaining costs that the primary payer doesn't cover. In some cases, Medicare may be the primary payer, while in other cases, it may be the secondary payer.
Medicare Advantage plans, also known as "Part C" or "MA plans", are one type of Medicare health plan that is offered by private, Medicare-approved insurance companies. These plans provide an alternative way to receive your Original Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) benefits. If you have Part A and Part B, you can join a Medicare Advantage Plan. The plan sets its premiums, deductible, and coinsurance/copayment amounts. Most Medicare Advantage plans include prescription drug coverage, and many have extra benefits, like routine dental care.
It is important to note that if you are already enrolled in Medicare, you cannot use the ACA marketplace to buy a private insurance plan. Also, if you have a Medicare Advantage plan, you are still considered enrolled in Medicare and therefore cannot use the ACA marketplace. Before joining a Medicare Advantage plan, it is recommended to talk to your employer, union, or other benefits administrator about their rules, as joining a Medicare Advantage Plan might cause you to lose your employer or union coverage.
Medicare Advantage plans are not the only type of Medicare health plan available. There are several types of plans to choose from, and some types of plans that are part of Medicare are not Medicare Advantage Plans. The coverage offered by these plans varies depending on the specific type of plan. Some include Medicare Part A and Part B coverage, but most only offer Part B coverage. Some also include Medicare drug coverage (Part D).
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Frequently asked questions
Yes, you can have both Medicare and private health insurance at the same time. This is known as "dual coverage".
When you have both, a process called "coordination of benefits" determines which insurance provider pays first. This provider is called the "primary payer". The primary payer pays for any covered services until the coverage limit has been reached. The "secondary payer" pays for costs that the primary payer doesn't cover.
You can call the Benefits Coordination & Recovery Center at 1-855-798-2627 (TTY: 1-855-797-2627) to ask questions about who pays first or if your coverage changes.
