Conley & Conley Insurance Solutions

How Does Medicare Work with Other Health Insurance?

Medical cost concept with calculator

Medicare is a specialized form of health insurance geared toward a specific group of people. This generally includes retirees, those 65 years of age or older and others who meet certain health requirements. However, some individuals may have more than one health insurance policy. Claims and compensation can become complicated if you have more than a single Medicare plan, so it is important to understand which plan is your primary payment and how the policies work together.

Medicare and Group Health Insurance

Many of those who qualify for Medicare are retired, but some may still work or have spouses who still work. If this applies to you, you may still be covered under an employer’s group health insurance plan. In general, a group health insurance policy should provide payment before Medicare. For example, if you have a procedure that is covered under your health insurance, group health insurance should cover the primary bills while the remaining costs are sent to your Medicare plan.

However, there is an exception. If you or your spouse’s employer has less than 20 employees, Medicare may pay first while group health insurance pays second.

As with all overlapping plans, these policies must work together on who is the primary payer and secondary payer. A primary payer—in this case, the group health insurance—covers the bills immediately owed while a secondary payer—in this case, Medicare—acts as a supplemental insurance. This can be useful if you have medical bills that exceed the limits of your primary payer, as the secondary payer can cover the remaining balance.

Medicare and Retiree Health Plans

Some employers offer retirement group health plans for previous employees who retire. If you have both a retiree group health plan and Medicare, Medicare will generally pay first while your group health insurance provides supplement. To qualify for this, you must not be currently employed.

Medicare and Family Group Health Insurance

In the case where you are covered under a family member’s group health insurance who is not a spouse, the requirements for payment between Medicare and the group health insurance are different. In cases where the employer employs more than 100 workers, their group health insurance plans will pay first. If the employer has less than 100 workers, Medicare will generally pay first while group health insurance pays second.

Medicare and Liability Accidents

Many of your other insurance policies, such as home insurance and auto insurance, come with medical payments coverage. If you are in a car accident, for example, your vehicle’s medical payments coverage should help with medical bills you and your passengers may face. Generally, this type of insurance will pay first even if you already have Medicare. However, if a claim on your other insurance policy exceeds a certain time limit (such as 120 days), your bills may instead go to your Medicare plan. Keep in mind that Medicare will still only cover expenses that are covered normally under the policy. If you have a liability claim denied and Medicare does not cover all of your expenses, you will be held responsible for the remaining costs.

The same rules apply if you are injured due to a workplace injury and are out on workers compensation.

Medicare and Veterans’ Benefits

Veterans’ benefits act differently with Medicare than most other insurance policies. Since many of these plans overlap, you may not be able to receive compensation from both Medicare and VA for the same medical service.

Can You Have More Than One Medicare Plan?

In general, you cannot have more than one Medicare plan at a time, including Medicare Advantage plans. Even though Medicare Advantage plans are primarily available through private insurers, individuals are still only able to enroll in a single plan at a time. There may be short overlap when transferring from one plan to another or switching from Original Medicare to Medicare Advantage, but otherwise only one plan is allowed.

Also keep in mind that Medicare operates differently than health insurance plans such as group health insurance. Where some private health insurance plans may cover spouses, Medicare only covers individuals. If you and your spouse both need Medicare Advantage, you will have to purchase separate policies in order for you both to be covered.

If you have any questions about your Medicare plan and other health insurance policies, be sure to speak with your insurance agent. An agent can help you decide what coverage you need and identify who will pay first when it comes to medical bills with multiple insurers.