How Medicare Works with Other Insurances

Although some people who are 65 years old or older only have coverage from Medicare, there are others who also have coverage from other insurances, in most cases because they are still working and they keep receiving benefits from their employment or they receive other benefits, like military or federal retiree. If this is your case, you may want to know how Medicare works with other insurances and how the costs are divided. In this article we will explain everything you need to know about it.

How are payments and benefits coordinated if I have Medicare and a private insurance?

Having both Medicare and other private insurance does not represent a problem as long the insurances know that you have both. There are some terms you need to know to understand how Medicare works with other insurances. When you have a private insurance and Medicare, each of them is known as a “payer”, and there are certain rules called “coordination of benefits” that establish which insurance is going to pay first.

Once the coordination of benefits is established, the payers divide in two: the “primary payer”, which will pay medical claims first up to the amount allowed by your coverage, and the “secondary payer” which will pay for any service that it covers but the primary insurance doesn’t. Depending on the bill and your coverage, there could still be an amount of money that you have to pay. Sometimes there could be a third payer.

When you join Medicare during the Initial Enrollment Period you are required to fill the Medicare Initial Enrollment Questionnaire, in which you will specify if you have coverage from other insurance, so Medicare can coordinate benefits with that insurance.

Medicare supplement Plans

How do I know which insurance pays first?

When you turn 65 and you are still working, you are not required to join Medicare by your employers, but they must offer the same benefit options. In case you decide to enroll on Medicare, generally your employer plan will be the primary payer and Medicare the secondary payer.  Getting a quote from may be the answer for getting the balance paid on your medical bills.  Click to find out more about Medicare supplement Plans.

Knowing the amount of employees that your employer has will be helpful in understanding how Medicare works with other insurances. If your employer has less than 20 employees, Medicare will be the primary payer. In this case, you could be required to enroll on Medicare, so be sure to do your research about it. If your employer insurance is the secondary payer, you may have to enroll in Medicare Part B before your insurance will pay.   

While you receive benefits from your employer, you have the right to delay signing up for Medicare Part B only if your employer has more than 20 employees.  If you decide to delay it, you have a special enrollment period of up to eight months after the employment ends to sign up for Medicare without paying any late penalties.

In case you are joined Medicare because of a disability and you receiving benefits from your employer, Medicare is the primary payer if your employer has less than 100 employees.  Remember: the secondary payer may not completely pay the rest of the bill, as it will depend on the coverage, and you will have to pay the rest.

  What happens if the insurance of my employer does not pay?

If the private insurance does not pay the bill, Medicare may be charged for the services. The private insurance usually has up to 120 days to do the payment. In this case, Medicare may make a conditional payment to pay the bill, so you do not have to use your own money to pay it. However, as the payment is conditional, it must be repaid to Medicare and you will be in charge of making sure that that happens, in case if you get a settlement, judgment, award, or other payment later.