When you have other types of insurance in addition to Medicare, who pays first?
Medicare is the largest health insurance provider in the U.S. Many Medicare beneficiaries may also have other types of health insurance, such as retiree health insurance benefits, military insurance, COBRA or other types of coverage in addition to their Medicare benefits.
Read below to find out when Medicare pays first, when it serves as the secondary payer and how it works with military coverage and workplace health insurance.
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If you have Medicare as well as another type of insurance, your coverage is provided through a coordination of benefits. In some situations, Medicare will serve as your primary payer, which means Medicare pays first. Your other insurance coverage will then serve as your secondary payer.
In the following situations, Medicare acts as your primary payer:
Medicare serves as the secondary payer in the following situations:
If you are entitled to both Medicare and Veteran’s Administration benefits, Medicare pays for any Medicare-covered services or items. Your Veteran’s benefits will pay for any VA-authorized services or items that are not covered by Medicare.
Medicare and the VA generally do not work together to pay for the same service or item. You may use both types of insurance for your health care, but they will operate separately from each other.
TRICARE does work with Medicare. Active-duty military personnel who are enrolled in Medicare may use TRICARE as a primary payer, and then Medicare pays second as a secondary payer.
For inactive members of the military who are enrolled in Medicare, Medicare acts as the primary payer and TRICARE pays second, provided that the services or items are received in a military hospital or other approved federal provider.
If you have been injured in an accident where liability insurance is involved and you are also entitled to Medicare benefits, the liability insurance provider pays first, and Medicare pays as the secondary payer.
If you are covered under workers’ compensation due to a job-related injury or illness and are entitled to Medicare benefits, the workers’ compensation insurance provider will be the primary payer. There typically is no secondary payer in such cases, but Medicare may make a payment in certain situations.
Part A and Part B of Medicare are provided by the government, and your eligibility is typically based on your age. But there are three types of Medicare coverage that are sold by private insurance companies.
These private Medicare insurance options include:
Because each of these types of Medicare coverage is sold by private insurance companies, the cost and availability of plans may vary from one location or provider to the next.
Read additional Medicare cost guides to learn more about Medicare costs and how they will affect you.
Learn more about when Medicare pays first for your care and compare Medicare plan options that may be available where you live. To get started, call to speak with a licensed insurance agent or compare plans for free online.
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Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
Christian has written hundreds of articles for MedicareAvantage.com that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.
If you’re a member of the media looking to connect with Christian, please don’t hesitate to email our public relations team at Mike@tzhealthmedia.com.