How Medicare Coordinates With Other Forms of Health Insurance

We typically think of Medicare as the form of health insurance used by retirees. But not everyone retires at age 65 (when Medicare eligibility begins), or some might still have a working spouse with a group healthcare plan. If you’re already covered by a health insurance plan, you can delay your Medicare enrollment. Or, your other choice is to go ahead and enroll, but allow Medicare and your other health insurance policy to work in tandem.

One policy will serve as the primary plan, with the other serving as secondary insurance. The primary policy pays each medical bill up to its regular limits of coverage, and the secondary insurance kicks in to pay some or all of the remaining costs. Secondary insurance does not always cover the rest of the bill, but it can make a significant dent in your out-of-pocket expenses.

So, which policy is considered primary, and which is secondary? That will depend upon the size of your (or your spouse’s) employer.

If your company employs more than 20 workers, then your group healthcare plan will become the primary policy. Medicare will serve as secondary insurance. Your group health plan must offer you the same coverage as all the other employees on the plan.

If your company employs fewer than 20 workers, Medicare will usually be primary and your group healthcare plan will become secondary insurance. Exceptions to this rule occur when the employer is part of a multi-employer group plan and at least one of the other employers in the group has more than 20 employees.

At some point, you might drop your group coverage or end your employment status. At that point Medicare will become your primary insurance.

Whatever you decide to do, remember that you have many options with regard to your Medicare policy. You can choose between Original Medicare and Medicare Advantage, and you can also add things like a Part D (prescription) plan or a Medigap policy to round out your coverage. Consult with one of our Medicare specialists, and we can help you compare costs and decide which type of plan works best for your situation.


Posted by PGIA
2 years ago / September 27, 2022

Filed Under: Medicare Info