How Does Medicare Work With Private Insurance?

Original Medicare (Part A and Part B) is a federally funded government program.

There are certain parts of Medicare that are actually private insurance, however, such as Medicare Part C (Medicare Advantage), Medicare Part D prescription drug plans and Medicare Supplement Insurance (Medigap).

Original Medicare can also work with other types of private insurance you may have, depending on your situation.

This guide helps explain how Medicare works with private insurance, including information on eligibility, benefits and potential costs.

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Can you be on Medicare and have private insurance?

It’s possible to utilize both Medicare and private insurance.

Some types of other private insurance you might be able to use alongside your Medicare coverage can include:

In some cases, Medicare will pay its share first (which means Medicare is the “primary payer”), while your private insurance plan will then pay second (the other insurance is the “secondary payer”).

In some other cases, private insurance acts as the primary payer, and your Medicare coverage is the secondary payer.

The primary payer typically pays up to the limits of its coverage, and the secondary payer covers some of the costs that were not covered by the primary payer. But the secondary payer may not necessarily pay all of the uncovered costs.

Which insurance pays first is determined by the rules regarding the coordination of benefits between Medicare and your private insurance. Coverage can also be determined based on your unique circumstances.

For questions about how your private insurance plan may work with Medicare, call the Medicare Benefits Coordination & Recovery Center at 1-855-798-2627 (TTY: 1-855-797-2627).

Your private Medicare insurance coverage choices

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:

  • Medicare Part C plans, or Medicare Advantage plans, offer all the same basic benefits as Medicare Part A and B.

    In addition to those basic benefits, Medicare Advantage plans can also offer some additional coverage for things like prescription drugs, dental, vision, hearing aids, SilverSneakers programs and more.

    While you must remain enrolled in Medicare Part A and Part B (and pay the associated premiums), your Medicare Advantage plan serves as your Medicare coverage.

  • Medicare Part D, which provides coverage for prescription drugs, is another type of private Medicare insurance.

    These plans can be used in conjunction with Medicare Part A and Part B (or with a Medicare Advantage plan that doesn’t include prescription drug coverage) to provide coverage exclusively for certain prescription drugs.

    You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online in as little as 10 minutes when you visit MyRxPlans.com.1

  • Medicare Supplement Insurance, or Medigap, can help cover some of the out-of-pocket costs associated with Part A and Part B of Medicare. These costs can include certain Medicare deductibles and coinsurance or copayments.

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.

Explore your private Medicare Advantage coverage options

For more information about private Medicare Advantage insurance and to learn about plan options available in your area, call today to speak with a licensed insurance agent.

 

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