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How does Medicare work with other insurance?

Introduction

Medicare is a health insurance program for people who are 65 and older, or for younger people with disabilities. It's a federally-administered program that provides coverage for many of the costs associated with medical services.


Medicare doesn't pay for everything though; some things are covered by other insurance, like your employer's plan or retiree coverage from a former employer. That means there may be times when you have to pay out-of-pocket while waiting on Medicare to pay its share of the bill.


Understanding Medicare and its role

Medicare is health insurance for people 65 and over. It's a federal program, but it's run by private insurance companies. The Medicare Part A program covers hospital stays in the United States, while the Part B medical insurance covers doctor visits and other healthcare services outside of hospitals. Medicare also offers a prescription drug plan (Part D) in many cases that provide coverage for medications when you're on Medicare.


When you're still working, your employer may provide health benefits for you through a group policy—this type of coverage is called "job-based coverage" or employer-sponsored coverage. You can keep this job-based coverage even if you're offered Medicare before turning 65 years old as long as:

  • Your employer has at least 20 full-time equivalent employees (FTEs) during either last year or this year who were eligible to participate in the group health plan at any time during the period;

  • You are currently employed by that same employer;

  • You worked 30 or more hours per week;

If none of these criteria are met and your company offers a group health plan, they have until January 1st each year following their hiring date to notify employees whether they are continuing participation after December 31st of that same calendar year before which would have been their 65th birthday."


Starting Medicare with other coverage

If you’re already covered under another insurance plan and are starting Medicare, your other coverage will be considered secondary. This means that if you have other insurance, it must be coordinated with your Medicare coverage.

It’s important to remember that if you want the full range of benefits available through Medicare, enrolling in Part A and Part B is a requirement. If you do not enroll in these parts when first eligible at age 65 or later (or meet certain exceptions), there may be a permanent 10% penalty on all future Social Security benefits based on earnings/losses (see our article on Social Security benefits for more info).


Other types of plans can include: employer-sponsored retiree health care plans like Blue Cross Blue Shield; individual health plans purchased through the Marketplace; Medicaid; TRICARE; the Veterans Affairs (VA) health system; union-sponsored group health plans; COBRA coverage from an employer or former employer; or self-funded retiree health plans.


Medicare plus an employer or union's plan

  • You can keep your employer's plan.

Employers often offer health insurance as a benefit to their employees. If you have coverage through your current job, you can continue to receive the same coverage under Medicare Part B if you choose to enroll in it.

  • You can keep your union’s plan.

If you are a member of a union and have been covered by the union for at least one year, Medicare will allow you to continue receiving the same benefits from that union after age 65 without paying any premium or enrollment fee for Part B coverage (as long as it covers hospital and medical services). You may also continue receiving free Part A benefits if they were being provided before age 65 by means of an employer or government program such as VA health care services or Medicaid/Medicare Dual Eligibility Special Needs Plan (MNEP).


Coordination of Benefits (COB)

Coordination of Benefits (COB) is a process that helps you determine which insurance company pays your medical bills. COB is used when you have more than one insurance policy, such as Medicare and private health insurance.

When an insured person has two or more policies that cover the same service, they are called "primary" and "secondary." Your primary policy will be the first to pay any claims for services covered by both policies, but it may not pay all expenses. In this case, the secondary plan will kick in and pay whatever remains after your primary plan has paid its share.


In most cases, Medicare will be considered the primary plan because it covers hospital stays and other services provided by doctors who have opted into Medicare's provider network. If there's any money remaining after Medicare has paid its share of covered expenses under Part A or Part B (depending on whether it's a hospital stay or doctor visit), then another insurer with which you're enrolled can step in and pay out-of-pocket costs for things like coinsurance or deductibles—

but only if there's still money left after Medicare's payment was made!


Medicare plus retiree coverage from a former employer or your spouse's former employer.


Medicare plus retiree coverage from a former employer or your spouse's former employer.


Retiree group coverage may be from an employer, union, or association that was available to you immediately before you became eligible for Medicare Part A and/or

Medicare Part B. Retiree group is not a Medicare option and does not qualify as creditable coverage for purposes of determining whether an individual is eligible for premium-free Part A and/or Part B. Retiree group does not qualify as a secondary payer to Medicare benefits either when you receive services as an active employee or after you terminate employment with your employer.


The retiree group is neither required nor excluded from being part of the Medicare program in any way. However, if it provides prescription drug coverage, there are some special rules that apply that limit payment by both private health plans (including retiree drug plans) and Medicare under its catastrophic outpatient prescription drug benefit (Part D).


Questions about enrolling?

If you have questions about how Medicare will work with other insurance, call 1-800-MEDICARE (1-800-633-4227). You can also visit Medicare.gov or visit your local Social Security office. And make sure to enroll in the program by the time you turn 65, even if that's not for another few years. If you're automatically enrolled in Part B because of a disability and don't want it, contact your local Social Security office within 6 months of receiving notification from them that they've approved your disability application; otherwise, their decision will become final and cannot be changed.


If you received an automatic enrollment notice but do not want to receive Part B benefits when they begin on July 1st of this year—or any future year—you must call 1-800-MEDICARE (1-800-633-4227) between January 2nd and March 31st each year between 7 am and 7 pm local time every day except Sundays or holidays designated by state law (if applicable), including Saturdays; if there is no answer at any time during those hours on any day except Sunday or holidays designated by state law (if applicable), leave a message saying: "I wish to cancel my [Medicare] [Part B] coverage."

If you have other insurance, it's important to know how it works with Medicare.


Medicare works with other insurance.

If you have another type of health insurance, it's important to know how it works with Medicare. Medicare does not pay for everything and doesn't cover all services or providers. The following are some examples of how Medicare interacts with other types of coverage:

  • You may be able to get medical care from doctors and hospitals outside the United States if you travel while on vacation or business. If you live in a foreign country, ask your local Social Security office about coverage before going overseas so that you don't lose any benefits.

  • Medicaid is a federal-state program for low-income people who have little money to pay for their own healthcare needs and often have no other source of healthcare coverage (such as employer-sponsored group health insurance). Medicaid pays for some nursing home costs after all other sources are exhausted; however, most long-term care expenses must be paid out-of-pocket by families who cannot afford them otherwise because most residents leave with very little in savings after spending several decades paying out thousands upon thousands of dollars during retirement years just so they can get basic necessities like food & shelter plus medical treatment when needed without having any extra funds left over afterward due largely because they didn't spend enough time planning ahead at younger ages when they still had plenty more energy left over after working full-time jobs every day instead focusing solely on raising kids instead which should've been done differently back then but wasn't since nobody knew better until now.


Conclusion

About Preferred Senior Benefits in Meridian, Idaho

Medicare is a federal program that provides healthcare coverage to individuals 65 years or older. Original Medicare coverage is broken into two parts - Part A and Part B - and is accepted by nearly every doctor and hospital in the country. Medicare Part A covers inpatient or hospital stays, while Part B covers outpatient or medical care. Together, Part A and B cover about 80% of the typical healthcare costs seniors face. This leaves a few significant gaps in coverage. Medicare Supplement (Medigap) and Medicare Advantage plans are policies designed to help extend coverage, lessen costs and ultimately give beneficiaries peace of mind. If you or someone you know would like more information about how to enroll in Original Medicare or one of the Medicare Advantage plans, call now to speak with a licensed agent (208) 818 - 2523. We cannot wait to help you learn about your options.


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