How Does Medicare Work If You Have Other Insurance?

how does medicare work if you have other insurance coverage healthcare policy

Did you know that there are 44 million beneficiaries enrolled in the Medicare program? If you are wondering how does Medicare work if you have other insurance, we are here to answer your question and clear up any confusion you might have.  

Keep reading to learn the ins and outs of Medicare healthcare coverage along with other types of health insurance policies. 

How Does Medicare Work If You Have Other Insurance?

Any time you have Medicare and other insurance coverage, each coverage you have is called a payer. Anytime there is more than one payer, then there are rules called "coordination of benefits" to help decide which payer will pay first. 

The primary payer will then pay their portion of the bill and will send the balance to the secondary payer. If there is another insurance coverage then they will receive any final balance not covered by the primary and secondary payers. 

Payers Responsibilities

The primary payer will pay the limits that it covers based on its policies. The secondary payer will only pay if the primary insurer does not cover all of the costs and there is a balance left. 

Keep in mind that sometimes the secondary payer will not pay all of the costs and you will either have to pay out of pocket or enroll in Medicare Part B.

In some circumstances, the insurance company might not pay the claim on time (typically within 120 days of receiving the bill) and your doctor might end up billing Medicare. Medicare will cover most of the bill and will then attempt to recover the payments that the primary payer was supposed to pay. 

Delaying Medicare Enrollment

In some situations, it is best to delay Medicare enrollment if you have private health insurance already. Especially when enrolling in Medicare Part B. Part B is medical insurance for doctor visits and extra services and will charge you a monthly premium. 

In this healthcare situation, you will end up paying two monthly premiums instead of one. You will pay for your personal insurance and for your Part B coverage. 

Delaying enrollment in Part B will mean that you only have to pay for your personal coverage. The easiest way to make a decision is to call your private insurance plan and ask them how your plan works if you were to opt for Medicare at the same time. 

They should be able to tell you if they will become the primary or secondary payers or if they will lower your Medicare coverage

Feeling Like a Medicare Pro?

Now that you know more about how does medicare work if you have other insurance, you might be feeling more knowledgeable and less overwhelmed. The best thing to do is to inform your pharmacy, doctor, or hospital if you have both Medicare and another insurance provider. This will help avoid any confusion on the coverage and billing side. 

Did you find our article on Medicare and health insurance helpful? Feel free to click around and browse the rest of our articles for more helpful posts. Visit the Healthcare and Insurance sections of our site right now to learn more about Medicare and coverage options.

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