By Susan Stewart, Licensed Insurance Agent
When you have other insurance (like a group health plan, retiree health, or Medicaid) in addition to Medicare, it’s essential to know the rules for whether Medicare or your other coverage pays first.
Here’s a quick overview:
| Coverage Type | Who Pays First |
| · You have retiree health coverage, like insurance from your or your spouse’s employer. | Medicare |
| · You’re 65 or older.
· You have group health plan coverage based on you or your spouse’s current employment. · The employer has at least 20 employees. |
Group health plan |
| · You’re 65 or older.
· You have group coverage based on your or your spouse’s current employment. · The employer has fewer than 20 employees. |
Medicare |
| · You’re under 65.
· You have a disability. · You have group health plan coverage based on you or your spouse’s employment. · The employer has at least 100 employees. |
Group health plan |
| · You’re under 65.
· You have a disability. · You have group health plan coverage based on you or your spouse’s employment. · The employer has fewer than 100 employees. |
Medicare |
| · You have group health plan coverage based on you or your spouse’s employment or former employment.
· You’re eligible for Medicare because of End-Stage Renal Disease. |
Group health plan for the first 30 months
|
| · You have Tri-Care. | Usually Medicare |
| · You have Medicaid. | Medicare |
Remember to always check with your employer's or your former employer's benefits department to see if you have other insurance. If you do have benefits through them, double-check how their coverage works with Medicare.
If you have group coverage, find out if you can pause it while you try out a Medicare Advantage Plan or Medicare Supplement. Alternatively, you may need to relinquish retiree or current employer coverage if you opt for a Medicare plan without the option to reinstate the coverage.
Retiree group coverage can also be a package that includes your pension. If you cancel your group coverage, you could lose your pension. Alternatively, your pension may remain unaffected by your decisions regarding retiree group healthcare. This knowledge is essential for making a wise decisions, so be sure to confirm it.
If you’re considering taking on Medicare, knowing the details of your existing group insurance coverage and costs can help you decide if a Medicare plan is right for you. It may be wise to sit tight with great insurance at a good price, or it could be obvious that leaving that coverage and taking up Medicare could cost less while increasing your benefits. Arm yourself with knowledge before making a change. Licensed agents cannot know these details, and it’s your responsibility to understand the ramifications as well as potential money-saving possibilities.
