How does Medicare work with other insurance?

Texas Medicare provides federally funded health and medical coverage to Texas seniors as well as some younger people with serious conditions.

Medicare is robust insurance with many options, but it may not be your only form of coverage.

Whether you still have access to insurance through an employer or qualify for other government programs, you may have a variety of insurance options.

Learn about other kinds of coverage you may be able to combine with Medicare in Texas, as well as how to manage your coordination of benefits for optimum care.

How does Medicare work with other insurance? 1

What Other Types Of Coverage Can You Have With Texas Medicare?

Health insurance can be split into two groups depending on how your policy is funded.

Private insurance is provided by privately-held companies.

Most people who have private insurance receive coverage through an employer.

If your job or your spouse’s job covers your insurance, you have private coverage.

Some people also purchase private insurance directly from the insurance company.

Public insurance is paid for by the government.

Medicare, Medicaid, Veteran’s Affairs (VA) benefits, and other similar programs are all considered public insurance.

It’s possible to have multiple insurance policies.

You can be covered by Medicare, which is a public insurance plan, as well as a private insurance plan.

These are the most common situations where a patient holds both types of insurance.

Coverage through an employer

If you’re still working when you become eligible for Medicare, you may still have access to your private health insurance through your job.

In this scenario, there is a coordination of benefits process that determines which coverage pays for your treatments.

How does Medicare work with other insurance? 3

Coverage under your spouse’s private health insurance

Similarly, you may be covered by a spouse or partner’s private health insurance when you reach Medicare eligibility.

COBRA

Through the COBRA program, you can temporarily keep your private insurance policy after coverage ends through your employer.

COBRA can also cover you if you lose coverage through a spouse or partner.

How does Medicare work with other insurance? 5

TRICARE

TRICARE provides insurance for both active and retired military personnel, as well as their dependents.

There are several scenarios where you’re eligible for both Medicare and TRICARE coverage:

  • You’re age 65 or above and are enrolled in Medicare Part B
  • You have a disability, amyotrophic lateral sclerosis (ALS), or end-stage renal disease (ESRD) and are enrolled in Medicare Part A and Part B
  • You have Medicare coverage and are a dependent of active-duty personnel with TRICARE coverage
How does Medicare work with other insurance? 7

Texas Medicare And Group Insurance

Most people become eligible for Medicare coverage when they turn 65.

If you’re still working on your 65th birthday, you may be covered by your employer’s group insurance when your Medicare enrollment window opens.

The same scenario applies if you’re covered through your spouse’s insurance plan.

Either way, you’ll be eligible for both Texas Medicare and private group insurance at the same time

You have the right to stay with your private insurance and delay enrolling in Medicare.

If you decide to use both insurance types at once, your coverage and coordination of benefits will depend on the size of your company.

Medicare coverage is considered secondary if you’re actively working in a company with 20 or more employees.

This means that your private insurance will be charged first for any claims. 

Medicare coverage is primary if your company employs less than 20 people. In these cases, Medicare will be charged first for your claims.

How does Medicare work with other insurance? 9

Texas Medicare And COBRA Insurance

If you lose your private health care coverage, the COBRA law allows you to keep your policy for a limited amount of time.

Most people use COBRA when they lose their insurance through losing a job.

COBRA is only available if you worked in a company with more than 20 employees.

You’ll pay more for COBRA coverage because you’re responsible for all the costs, including the portion your employer used to pay.

Combining COBRA insurance and Medicare can be complicated.

How does Medicare work with other insurance plans accessed through COBRA?

You’ll have to pay a premium for COBRA coverage if you’re also eligible for Medicare.

How does Medicare work with other insurance? 11

Texas Medicare And TRICARE

If you’re active-duty military, a veteran, or a military dependent, you may wonder, “How does Medicare work with other insurance from the government?”

The TRICARE coordination of benefits depends on whether you’re on active duty.

Active-duty personnel are covered by TRICARE first.

TRICARE will pay for any services that would typically be covered by Medicare, as well as your Medicare deductibles and copays.

If you’re not on active duty, Medicare will pay first. TRICARE is the secondary coverage if you have TRICARE For Life.

How does Medicare work with other insurance? 13

Who Pays First For Your Services And Medications?

When you have both Medicare and another form of coverage, your insurance providers work together to decide your coordination of benefits.

One insurance is your primary payer and will pay for your claims first.

If there’s any remaining amount owed, the bill is sent to your other insurance coverage.

This insurance is your secondary payer and will pay towards the remaining amount of your bill.

You may be responsible for some of your medical costs even with two forms of insurance.
How does Medicare work with other insurance?

The coordination of benefits will be different depending on your coverage.

How does Medicare work with other insurance? 15

Private insurance through a company with 20 or more employees

Your private insurance is the primary payer and pays first for services and medication. Medicare is the secondary payer.

Private insurance through a company with less than 20 employees

In most cases, Medicare pays first and your private insurance pays second.

How does Medicare work with other insurance? 17

COBRA coverage

Medicare pays first for most COBRA recipients, with COBRA coverage paying second.

If you have ESRD, COBRA pays first according to the standard coordination of benefits.

How does Medicare work with other insurance? 19

TRICARE coverage

Active-duty personnel are covered by TRICARE first. TRICARE will pay for any services that would typically be covered by Medicare, as well as your Medicare deductibles and copays. If you’re not on active duty, Medicare will pay first and TRICARE will pay second.

Do you have more questions about how Medicare works with your insurance?

Get in touch with us today and a licensed Texas medicare agent will be happy to assist you.

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