Alyssa Lane
Medicare Part A, also known as Hospital Insurance, is one of the two parts of Original Medicare, the other being Medicare Part B or Medical Insurance. Medicare Part A is available to individuals in two ways: most people get Part A for free, while some have to pay a premium for it. If you have Medicare and other health insurance, such as group health insurance, Medicare is considered the 'primary payer and pays up to the limits of its coverage, after which the secondary payer pays the remaining balance. If you have group health insurance, you can still sign up for Medicare Part A when you turn 65 or anytime later.
| Characteristics | Values |
|---|---|
| Medicare Part A | Hospital Insurance |
| Medicare Part B | Medical Insurance |
| Medicare Part D | Drug Program |
| Medicare Advantage | Alternative to Original Medicare |
| Primary payer | Pays up to the limit of its coverage |
| Secondary payer | Pays the remaining balance |
| Large group health plan | Employer has 100 or more employees |
| Non-tribal group health plan | Employer has fewer than 20 employees |
| COBRA | Temporary private insurance coverage after employment ends |
| TRICARE | Coverage for active and retired military members and their dependents |
| Medigap | Supplemental Medicare insurance |
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What You'll Learn
Medicare Part A and Part B
Medicare is a federal health insurance program for individuals aged 65 and older, as well as some individuals under 65 with certain disabilities or conditions. It is divided into several parts, with Part A and Part B making up Original Medicare.
Medicare Part A, also known as Hospital Insurance, covers inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care. Most individuals are eligible for premium-free Part A if they meet certain requirements, such as having a specified number of quarters of coverage (QCs) and filing an application for Social Security or Railroad Retirement Board (RRB) benefits. Individuals who do not qualify for premium-free Part A can purchase it by paying a premium.
Medicare Part B, on the other hand, is referred to as Medical Insurance. It covers outpatient medical services, such as doctor visits, preventive services, and durable medical equipment. Similar to Part A, individuals may be eligible for premium-free Part B under certain conditions. Those who do not meet these conditions can purchase Part B by paying a premium.
It is important to note that Medicare Part A and Part B have different eligibility criteria and enrollment processes. Individuals must enroll in these parts separately, and the timing of enrollment can impact the premium costs. Additionally, Medicare Advantage, also known as Part C, is an alternative to Original Medicare that bundles Part A, Part B, and usually Part D (prescription drug coverage).
When an individual has both Medicare and other health insurance, Medicare coordinates with the other insurance to determine the primary and secondary payer. The primary payer covers its portion first, and then the secondary payer covers any remaining balance.
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Medicare with private insurance
Medicare is available to individuals with Part A (Hospital Insurance) and Part B (Medical Insurance). Most people get Part A for free, but some have to pay a premium for this coverage. If you have Medicare and other health insurance, each type of coverage is called a "payer". The "primary payer" pays up to the limits of its coverage and then sends the remaining balance to the "secondary payer". If the secondary payer does not cover the remaining balance, you may be responsible for the remaining costs. This order of payment is called "coordination of benefits".
If you have a non-tribal group health plan coverage through an employer with 20 or more employees, the non-tribal group health plan pays first, and Medicare pays second. If you have health insurance through a tribal health plan, Medicare pays first and the tribal health plan pays second. If you get drugs through an Indian health facility, you will continue to receive them at no cost, and your coverage will not be interrupted. Joining a Medicare drug plan or Medicare Advantage Plan with drug coverage may help your Indian health facility because the plan pays the Indian health facility for the cost of your drugs.
TRICARE For Life (TFL) provides expanded medical coverage to Medicare-eligible uniformed services retirees aged 65 or older, to their eligible family members and survivors, and to certain former spouses. To get TFL benefits, you must have Medicare Part A and Part B. If you have TRICARE, you don't need to join a Medicare drug plan. However, if you do, your Medicare drug plan pays first, and TRICARE pays second.
If you did not enroll in premium Part A when first eligible, you may have to pay a higher monthly premium if you decide to enroll later. The monthly premium for Part A may increase by up to 10%. The individual will have to pay the higher premium for twice the number of years the individual could have had Part A but did not enrol.
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Medicare and group health plan
A Group Health Plan (GHP) is health insurance offered by an employer, union, or association to its members while they are still working. GHP coverage is dependent on current employment. Employers with 20 or more employees are legally required to offer current workers and their spouses aged 65 or older the same GHP health benefits as younger employees. If your GHP is based on current employment, you may not need Medicare Part B when you turn 65. However, you may get a "Special Enrollment Period" (SEP) to sign up for Part B later without penalty after your employment or GHP coverage ends. If you qualify, you can sign up for Part B anytime while covered by an employer or union GHP or within eight months after your coverage ends.
Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) are available to individuals who are entitled to receive Medicare based on their earnings or those of a spouse, parent, or child. Most people get Part A for free, but some have to pay a premium. To receive premium-free Part A, a worker must have a specified number of quarters of coverage (QCs) and file an application for Social Security or Railroad Retirement Board (RRB) benefits. The exact number of QCs required depends on whether the person is filing for Part A based on age, disability, or End Stage Renal Disease (ESRD). QCs are earned by paying payroll taxes under the Federal Insurance Contributions Act (FICA) during one's working years.
If you have Medicare and other health insurance, each type of coverage is called a "payer." The "primary payer" pays up to the limits of its coverage and then sends the remaining balance to the "secondary payer." If you have questions about who pays first or if your coverage changes, you can call the Benefits Coordination & Recovery Center.
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Medicare and retiree coverage
Medicare is a public health insurance program that provides health coverage for individuals after they retire. However, retiree coverage may also be provided by employers, unions, or trusts to retiring employees and their spouses. This coverage is typically in the form of group health insurance, similar to the plans offered to active employees.
When an individual becomes eligible for Medicare upon retirement, they may need to enroll in both Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) to receive the full benefits of their retiree coverage. In some cases, retiree coverage may include additional benefits, such as extended hospital stays. However, retiree coverage may not pay for medical costs during any period when an individual was eligible for Medicare but did not enroll.
If an individual has both Medicare and retiree coverage, Medicare typically acts as the primary payer, paying up to the limits of its coverage. The remaining balance is then sent to the retiree coverage, which acts as the secondary payer. In some cases, the secondary payer may not cover the remaining balance, leaving the individual responsible for the remaining costs.
Retiree coverage may provide additional benefits that Medicare does not cover, such as vision care, dental care, and prescription drugs. It may also help cover some of the costs that Medicare does not, such as copayments, coinsurance, or deductibles. Therefore, it may be worthwhile to retain retiree coverage if high Medicare costs are anticipated.
Individuals with retiree coverage can choose to purchase a Medigap policy, which is a supplemental health insurance plan that helps cover additional costs. To purchase a Medigap policy, individuals typically need to have both Medicare Part A and Part B. It is important to note that Medigap policies do not cover certain services, such as long-term care, vision, dental, or prescription drugs.
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Medicare and drug coverage
Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) are available to individuals who are either entitled to receive Medicare based on their earnings or those of a spouse, parent, or child, or have a specified number of quarters of coverage (QCs) and have filed an application for Social Security or Railroad Retirement Board (RRB) benefits. Most people get Part A for free, but some have to pay a premium. If an individual did not enroll in premium Part A when first eligible, they may have to pay a higher monthly premium if they decide to enroll later.
There are two main ways to get Medicare drug coverage. Firstly, you can join a Medicare Advantage Plan (Part C) or other Medicare health plan with drug coverage. You must have Part A and Part B to join a Medicare Advantage Plan, and you usually get your drug coverage through that plan. Secondly, you can get your Part A, Part B, and Medicare drug coverage (Part D) through a single plan. If you are in a Health Maintenance Organization, HMO Point-of-Service Plan, or Preferred Provider Organization, and you join a separate drug plan, you will be disenrolled from your Medicare Advantage Plan and returned to Original Medicare.
You can also have Medicare and other health insurance, in which case each type of coverage is called a "payer". The "primary payer" pays up to the limits of its coverage and then sends the rest of the balance to the "secondary payer". If you have employer or union drug coverage, you may be able to keep it, but you should talk to your current plan about what will happen to your current health coverage if you get Medicare drug coverage. You should also be aware that your spouse or dependents may lose all of their employer or union health coverage if you get Medicare drug coverage.
Even if you don't take any drugs now, consider getting Medicare drug coverage when you first sign up for Medicare. If you go 63 days or more in a row without Medicare drug coverage or other creditable prescription drug coverage after you were eligible for Medicare, you may have to pay a Part D late enrollment penalty if you sign up for Medicare drug coverage later.
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Frequently asked questions
Medicare Part A is hospital insurance. Most people get Part A for free, but some have to pay a premium for this coverage.
Group insurance is health insurance coverage that is available to a group of people, typically employees of a company.
Yes, it is possible to have both Medicare Part A and group insurance. If you have Medicare and other health insurance, each type of coverage is called a "payer". The "primary payer" pays up to the limits of its coverage, and then the rest of the balance is sent to the "secondary payer".
Medicare pays first when an individual has non-tribal group health plan coverage through an employer with fewer than 20 employees.
