Are you eligible for Medicare, but already covered by another plan?

It is normal for people turning 65 to be covered by their employer or spouse’s plan. In this case, it may be best to combine your current coverage with a plan or switch directly to Medicare.

How Medicare interacts with your current coverage

Coverage from your employer and Medicare:

  • If you work for a company with fewer than 20 employees, Medicare is considered your primary coverage. That means pays first and your employer’s coverage pays second.
  • If you work for a larger company, your employer coverage will be your primary coverage, and will be your secondary coverage.
  • In either case, after both insurance companies have paid their share of the medical bill, you pay only the balance.

Individual or Covered California health plans, and Medicare: 

  • Typically, there’s no reason to keep an individual or Covered California plan once you have Medicare.
  • Once you have Medicare:
    • It is illegal for them to sell you an individual or marketplace policy.
    • Not eligible for tax credits or other savings. That means you’d have to pay full price for a Marketplace plan.

Retiree Insurance and Medicare: 

  • If you’re retired and get health insurance through your former employer, you can still sign up.
  • Medicare pays first, and your former employer’s group health plan pays second.
  • After both insurance companies pay, you pay the balance.

Coverage through your spouse’s employer and Medicare: 

  • If your spouse’s employer has fewer than 20 employees, pays first.
  • If it’s a larger company, the company’s health plan pays first.
  • After both insurance companies pay, you pay the balance.

Benefits for military retirees and the Department of Veterans Affairs, and Medicare: 

  • Being covered by Medicare and the Department of Veterans Affairs (VA) allows you to receive care from VA or civilian doctors, depending on your health care needs.
  • Medicare covers visits to civilian doctors, and the Department of Veterans Affairs covers visits to VA facilities.
  • Medicare may pay a portion of your copay if you receive VA-authorized care from a civilian hospital or physician.

Tricare and Medicare: 

  • Active Duty Military: 
    • In most cases, Medicare pays first if you are active-duty military and have TRICARE coverage.
    • TRICARE pays second and may pay Medicare deductibles and coinsurance.
    • TRICARE coverage may also help with some services that Medicare doesn’t cover.
    • You pay for services not covered by Medicare or TRICARE.
  • Retired military:
    • When you become a retired military member, you must enroll in Medicare Part B (medical insurance) to keep your TRICARE coverage.
    • TRICARE for Life (TFL) is offered to TRICARE-eligible individuals who have Medicare Parts A and B. TFL benefits cover the Medicare deductible and coinsurance.

COBRA and Medicare: 

  • COBRA allows you to keep your employer’s group health insurance plan for a limited time after you stop working. That prevents you from losing your health insurance immediately after losing your job.
  • If you have Medicare, Medicare pays first. COBRA works as your secondary coverage. (The only exception is if you have End-Stage Renal Disease [ESRD]. In that case, COBRA pays first.)
  • In most cases, your COBRA coverage will end if you enroll in Medicare.
  • You may be able to get an extension of your COBRA coverage if Medicare doesn’t cover services offered in the COBRA plan, like dental insurance.
  • You can enroll in COBRA if you become eligible and already have a Medicare plan. In that case, you will decide if it is worth paying the extra cost of COBRA.

Medicaid and Medicare: 

  • If you are eligible, the best decision you can make is to keep your Medicare and Medicaid coverage.

 

Still wondering how your coverage will work with Medicare? 

You can call our sales team to learn what options are available to you and to better understand how your current coverage will work with your new Medicare plan. Call (855) 203-3874 [TTY: 711] from 8:00 am to 8:00 pm, any day of the week, from October 1 to March 31, and from 8:00 am to 8:00 pm , from Monday to Friday, from April 1 to September 30

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