How Medicare Works with Other Insurance

How Medicare Works with Other Insurance

Medicare is a federal health insurance program for people who are 65 or older, people with certain disabilities, and people with end-stage renal disease (ESRD). If you have Medicare and other health insurance, the way Medicare works with your other insurance depends on a number of factors, including:

• The type of Medicare coverage you have (Original Medicare or a Medicare Advantage Plan)
• The type of other health insurance you have
• Your age
• Your employment status

If you have Original Medicare and other health insurance, the rules for how Medicare works with your other insurance are called coordination of benefits (COB). Under COB, one of your insurance plans will be the primary payer and the other will be the secondary payer. The primary payer will pay first, and the secondary payer will pay its share of the cost after the primary payer has paid its share.

In most cases, Medicare will be the secondary payer if you have other health insurance. This is because Medicare is a government-funded program, and other health insurance is usually provided by employers or private insurers. There are a few exceptions to this rule, such as if you have Medicare because of ESRD or if you are under age 65 and have a disability.

If you have a Medicare Advantage Plan, the rules for how Medicare works with your other insurance are different. Medicare Advantage Plans are private health insurance plans that are approved by Medicare. They typically cover all of the benefits that Original Medicare covers, plus some extra benefits, such as dental, vision, and hearing coverage.

If you have a Medicare Advantage Plan and other health insurance, your other health insurance will usually be the secondary payer. This is because Medicare Advantage Plans are considered to be primary payers. There are a few exceptions to this rule, such as if you have employer-sponsored health insurance that you can keep after you retire.

If you are not sure how Medicare will work with your other health insurance, you should contact your Medicare plan or your other health insurance company. They will be able to tell you how the two plans will work together and how much you will have to pay for your health care.

Next, learn: Medicare Assignment