May 30, 2013

Do I Need Medicare If I Have Other Health Insurance?

Paula Morgan Portrait

By Paula of Allsup

What happens if you’re about to become eligible for Medicare plans—but you already have health insurance through an employer, a spouse’s employer or a retiree plan? Do you need to enroll in Medicare, or can you just keep the coverage you have now?


Medicare’s rules can be confusing. Here are three common situations many Allsup customers face:

Most people don’t pay a premium for Medicare Part A, which helps cover hospital stays. There’s usually no reason not to sign up for this coverage as soon as you’re eligible. With Part B, which covers doctor visits and other outpatient care, you’ll pay a monthly premium. If you like your current plan, it may make sense to keep it and wait to sign up for Part B when you retire.

If you decide to delay Part B, contact Social Security to find out how to avoid a late-enrollment penalty. Also, be aware that Medicare’s rules are different if you work for a very small employer. If your employer has fewer than 20 employees, your employer may require you to sign up for Medicare Parts A and B when you’re eligible.

I receive Social Security Disability Insurance benefits and will soon be eligible for Medicare. I currently have health insurance through my spouse’s employer. Should I sign up for Medicare?

This situation is similar to the first one. In most cases, it makes sense to go ahead and enroll in Part A if you’re not paying a monthly premium. But if your spouse’s insurance provides excellent coverage with low out-of-pocket costs, then you might consider staying on this plan and waiting to enroll in Part B.

One important thing to note, though, is that Medicare defines a “small employer” differently for people who are eligible for Medicare based on disability. If your spouse’s employer has fewer than 100 employees, the employer may require that Medicare pay first on your claims. In this case, you’ll need to take Medicare Parts A and B as your primary insurance.

I am eligible for a retiree plan with my former employer. Do I need Medicare too?

Retiree plans typically require you to sign up for Medicare plans as soon as you’re eligible. Then, Medicare pays first on your claims, with your retiree plan picking up only those costs that Medicare does not cover.

In any of these situations, be sure to speak with the administrator of your health plan to confirm how your benefits will work with Medicare. If you have questions about Medicare’s rules for delaying coverage or coordinating benefits, you also can contact a Medicare plan expert at the Allsup Medicare Advisor® at (866) 521-7655.

Paula Morgan
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Paula Morgan