Health insurance is a necessity no matter your age or your disability status. Maintaining your coverage only becomes a real concern when either the premiums are too high or your needs are not met. Those are times when you may have to get additional insurance to help cover the costs that a single insurance may not cover. It is possible to get supplemental coverage, even if one of those coverages are Medicare.
It’s a good idea to understand how Medicare works together with the other insurance to help you get the amount of coverage you need, and it’s also important to know all the coverage you are receiving in case some of your services are not covered by a particular insurance. Read on to take a closer look at how Medicare works together with private health coverage, and see what special role it takes on when an individual is covered under Medicare.
The short answer is yes, you can be enrolled in both Medicare and private health insurance. The combination of coverage between Medicare and private insurance creates a dual coverage where each type of coverage is considered a payer. The benefits are coordinated in such a way that there's a designated primary and secondary payer.
How Medicare works largely depends on the size of the company you are working for. For instance, if you are eligible for Medicare but your employer’s insurance is for less than 20 employees (less than 100 if you are younger than 65 and disabled), you should get Medicare. It will function as the primary insurance.
If you do not get Medicare it will look like you do not have any health coverage. Another important thing to note is if your employer's insurance includes a health savings account you can not contribute to the HSA and enroll in Medicare parts A or B, but you can continue withdrawing money from the HSA you enrolled in under your employer's health insurance. If your company happens to be larger with more than 20 employees (100 or more if you are younger and disabled), then you don't need to get Medicare part B yet. Your employer's health insurance will be the primary payer even if you signed up.
You will be allowed a special enrollment period to get part B with no penalty while you're currently working and for up to eight months after either you lose your current employer coverage or you retire.
The primary payer will pay what it owes on the medical bill first and then the remaining balance is sent to the secondary payer to pay. You can also have a third payer. If you are 65 and older, your employer will pay first as the primary insurance.
The primary payer will only pay up to its coverage limit. The secondary insurance will only kick in if there are charges that were not covered by the primary. Keep in mind the secondary payer may not cover all of the remaining costs, even if it's Medicare. If your employer falls under the secondary payer category you may have to enroll in Medicare Part B before your insurance kicks in.
If you are covered through your spouse's employer's health insurance the employer will be primary as long as you are 65 or older and the company has 20 or more employees. The only exception here is if you are disabled and have insurance through your spouse's employment. Then the employer's health insurance will be primary if there are 100 or more employees.
If you have Medicare and private insurance but a claim isn't paid within 120 days your provider can bill Medicare. Medicare will then cover the costs and get reimbursed later on from the primary payer. When you have Medicare and private insurance it's a great idea to contact your insurance companies to verify what services are covered, because if none of your insurance covers your services, you are responsible for payment.
In order to get clarity on what insurance is listed as your primary and secondary payers contact the Benefits Coordination & Recovery Center 1-855-798-2627. Some states have additional programs to assist with benefit clarity. For instance, the state of Florida has the SHINE (Serving Health Insurance Needs of Elders) program to help seniors with health insurance questions. Check with your Medicare and private insurance to see if your state offers something similar.
