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How Does Medicare Work with Other Insurance?

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Some people have Medicare as well as secondary health insurance. But how does insurance work when you have Medicare and other insurance? That’s what we’ll explore in this article.

When you have Medicare, why would you have other health insurance?

When you’re first eligible for Medicare, what if you’re still working and you already have health insurance? You might be covered under an employer’s group plan, a union’s group plan, or under your spouse’s group plan. This is one way that some people might have Medicare and group health insurance at the same time.

If you’re eligible for both Medicare and group health insurance, you have a decision to make. You may want to start by talking with the group health insurance administrator so you can understand the plan’s rules in your situation.

Be aware that if you delay enrollment in Medicare, you might have to pay a late enrollment penalty. Learn how to avoid a penalty if you delay Medicare Part B enrollment.

When you have Medicare, how does insurance work if you also have other health insurance?

So you’re still working at age 65, and you’re covered by your employer’s group plan. Or maybe you’re covered by your spouse’s employer-based group plan. But now, you’re also eligible for Medicare coverage. How would insurance work in this case?

  • If your employer (or your spouse’s employer) has fewer than 20 employees, usually Medicare is the primary payer. That means Medicare pays its share of covered services first, and if there is more to pay, the group plan may cover an additional amount.

However, if the employer joins with other companies to offer a group insurance plan, in some cases the group plan will be the primary payer, and Medicare the secondary payer.

  • If the employer has 20 or more employees, the group plan is usually the primary payer, while Medicare is the secondary payer.

There are many different situations where you might have both Medicare and other health insurance. For example, perhaps you’re a veteran and you qualify for both Medicare and veterans’ benefits. To answer the question “How does insurance work in my case?” perhaps the best strategy is to ask both your group health plan representative, and Medicare.

You can also call eHealth’s licensed insurance agents at 1-888-296-0117 (TTY users 711). Representatives are available from 8 AM to 8 PM Monday through Friday, and from 10 AM to 7 PM Saturdays, Eastern time.

To contact Medicare anytime (24 hours a day, seven days a week), at 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

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