If you have another health insurance policy, you may feel hesitant to add Medicare. But getting Medicare won’t cause you to lose your coverage – in fact, it will coordinate with your existing coverage. However, it coordinates differently depending on the circumstances.
How Does Coordination Work?
When you have two policies, they pay in an order instead of simultaneously. The policy that pays first is the “primary payer” and the one paying second is the “secondary payer”. Each policy covers up to plan limits. While you get twice the coverage, you may still have out-of-pocket expenses.
What If I Have Employer Health Insurance?
With Medicare and employer coverage, the number of employees you or your spouse’s employer has will decide which policy pays first. If you or your spouse’s employer has 20 or more employees, or has less than 20 but is part of a multi-employer group health plan, then your employer health plan pays first.
If your employer has fewer than 20 employees and isn’t part of a multi-employer group health plan, then Medicare will be the primary payer. Your employer plan may require you to get Medicare Part B before they will pay as a secondary payer.
However, if you had Medicare prior to getting your group health plan, Medicare will pay first.
What If I’m Retired & Get Coverage Through My Spouse’s Employer?
If you’re retired and covered by your spouse’s employer insurance, his or her employer insurance will pay first as long as your spouse is currently working and the employer has at least 20 employees (or has under 20 but is part of a multi-employer group health plan).
How Does Medicare Work With TRICARE?
TRICARE pays first if you’re on active duty. If you’re not on active duty, it will pay first if you get treatment in a military hospital, from another federal healthcare provider.
Medicare pays first when you’re not on active duty and receive treatment in a non-military facility. TRICARE may pay second, but that is not guaranteed.
What If My Insurance Fails To Make Its Payment?
If your insurance is supposed to cover an item but doesn’t, Medicare will provide a conditional payment. Medicare covers what the other insurer didn’t in exchange for repayment later. If your insurer grants you a settlement, for instance, you will have to repay Medicare with those funds if a conditional payment was made.
We Will Work With You
At ReLion Insurance Solutions, we want you to be able to get the most from your insurance coverage. As costly as medical expenses are, we want to help you fight to make them as low as possible. We’ll get you a Medicare plan that works, and you can take that first step to have better savings today. Don’t hesitate – call us today at (858) 999-2858.
