Can You Have Medicare and Another Insurance at the Same Time?

Many Americans have Medicare along with some other type of health insurance. This is commonly referred to as having dual coverage. The most common types of additional coverage that people pair with Medicare are employer group health plans, Medicare Supplement Insurance (Medigap), Medicaid, TRICARE, and Veterans Affairs (VA) health benefits.

Let’s take a closer look at whether you can have Medicare plus these other types of insurance and how the different coverages work together.

Medicare and Employer Group Health Plans

Medicare beneficiaries can absolutely have employer-sponsored group health coverage in addition to their Medicare benefits. This is a very common situation.

In fact, the latest statistics show that over 30% of people with Medicare are also covered by employer group health plans.

There are two main ways this dual coverage comes about:

• Employed individuals age 65+ who are still working and have employer coverage
• Retirees who have retiree coverage from a former employer

If you or your spouse is still actively employed at age 65+, your employer group plan generally pays first on your health claims as the primary payer. Medicare acts as the secondary payer, picking up any costs the employer plan did not cover.

Some key things to know if you have Medicare and group health plan coverage through current employment:

• The employer plan pays first if the employer has 20+ employees.
• For employers with under 20 employees, Medicare pays first.
• You must sign up for Medicare Part B to maximize coverage.
• You don’t have to enroll in the employer plan, but should consider it.

Once you retire, Medicare will become your primary insurance in most cases. Retiree group coverage from a former employer acts as supplemental secondary insurance to Medicare.

Retirees getting health benefits through a pension plan of a former employer should be aware of some key considerations:

• Retiree coverage can change or terminate at any time.
• Make sure to enroll in Medicare Part B when first eligible.
• Compare retiree coverage to Medigap plans.
• Costs and benefits can vary significantly.

Understanding how Medicare coordinates with group health plans for both active employees and retirees is important to ensure you get the most comprehensive coverage.

Medicare and Medicare Supplement Insurance

Many Medicare beneficiaries pair their Original Medicare coverage (Part A hospital and Part B medical) with private Medicare Supplement Insurance plans, also called Medigap.

Medigap policies are specifically designed to supplement Original Medicare benefits. This dual coverage combination is very common because Original Medicare has significant out-of-pocket costs that Medigap helps fill in.

Here are some key facts about having both Medicare and Medigap:

• Medigap plans cover Medicare cost-sharing amounts like coinsurance and deductibles.
• Premiums for Medigap plans are separate from Medicare premiums.
• 10 standardized plans (A, B, C, D, etc.) are offered in most states.
• Medigap covers only Medicare-approved services.
• You must have Part A and Part B to purchase a Medigap plan.
• Monthly Medigap premiums vary by plan type and insurer.

Since Medigap provides supplemental coverage to Original Medicare, the coordination between the two is fairly seamless. Medicare pays its share of costs first, then any remaining expenses get sent to your Medigap plan to pay second.

This combination provides comprehensive coverage with minimal out-of-pocket expenses for beneficiaries when using Medicare providers and services. The premiums are usually the only costs incurred.

Medicare and Medicaid

Lower-income seniors and younger disabled individuals who meet eligibility criteria can qualify to have both Medicare and Medicaid. This is known as dual eligibility.

Over 12 million Americans are dually eligible, which covers over 20% of the total Medicare population. Those who are dual eligible have very comprehensive health coverage.

Here are some key points about being dual eligible for Medicare and Medicaid:

• Must meet income and asset limits for Medicaid.
• Medicaid pays Medicare premiums and cost-sharing.
• Get Extra Help paying for Medicare drug coverage.
• Often have $0 copays and deductibles.
• May have more coverage like dental, vision, transportation.
• Special Needs Plans provide coordinated benefits.

Since Medicaid programs are run by state governments, the dual coverage benefits can vary by state. But in general Medicaid picks up lots of out-of-pocket costs and provides extra coverage that Medicare does not.

Medicare and TRICARE

Current and former military members and families may have dual coverage under Medicare and TRICARE. TRICARE is the health program for the military health system.

If you have Medicare and TRICARE, the two generally coordinate coverage in this manner:

• TRICARE pays first for active duty service members.
• Medicare pays first for retirees using Medicare providers.
• TRICARE supplements Medicare with additional benefits.
• Must enroll in Medicare Part B to keep TRICARE.
• TRICARE for Life (TFL) works with Medicare.

Having both TRICARE and Medicare provides very extensive and low cost medical and pharmacy benefits for many retired military families. TRICARE fills significant gaps in Medicare coverage.

It’s important for military retirees to sign up for Medicare Part B when first eligible to take full advantage of TRICARE benefits. Understanding TRICARE For Life policies at age 65 is also critical.

Medicare and Veterans Affairs (VA) Health

In addition to TRICARE, some veterans are also eligible for VA health benefits from the Veterans Health Administration. VA health coverage can complement Medicare in certain circumstances.

The coordination between Medicare and VA benefits generally works like this:

• Can’t use both to cover the same service or item.
• Must choose which one to use for specific care.
• VA pays for care at VA and approved facilities.
• Medicare pays at other health providers.
• Doesn’t require Part B to have VA coverage.

One of the big advantages of VA health benefits is that most services at VA facilities have very low or no copays. Prescription drugs for veterans are also offered at a discount.

However, VA facilities may not accept Medicare assignment, so using Medicare at VA facilities can result in higher out-of-pocket costs. Understanding these coverage coordination intricacies is important.

Key Takeaways on Dual Coverage with Medicare

• Employer coverage, TRICARE, VA benefits, and Medicaid can supplement Original Medicare benefits and provide additional coverage.

• Coordination of coverage rules determine which insurance pays first when you have Medicare plus other coverage.

• Enrolling in Medicare Part B is essential to maximize benefits from other insurance like employer plans and TRICARE.

• Dual coverage provides comprehensive medical and drug benefits for many beneficiaries.

• Compare coverage levels and costs across different options when choosing supplemental plans.

• Notify your medical providers about any dual health insurance coverage you have.

• Work through Customer Service if you have claims issues involving multiple insurers.

Understanding how Medicare interacts with other types of health coverage is very important to get the most value from your benefits. Be sure to consider how dual coverage through Medicare can provide you with more comprehensive and affordable medical care.