Can You Have Private Insurance and Medicare? AEP Answers

Around 60 million Americans depend on Medicare for their health insurance. This annual election period, which runs from October 15 to December 7, these Medicare beneficiaries will be making plan selections for the next year. If you are a Medicare enrollee, you may be wondering what other options you have. In some cases, it is possible to have both private insurance and Medicare, but there are restrictions and complications to consider.

Health Insurance Marketplace

You cannot enroll in both Medicare and a Marketplace plan.

The Health Insurance Marketplace was created as part of the ACA. It allows people to purchase private health insurance plans for themselves and their families, and possibly to receive a premium tax credit. However, if you are enrolled in a Medicare plan, you cannot use the Marketplace to purchase insurance.

Depending on your situation, you may be able to choose to enroll in a Marketplace plan instead of Medicare – but consider the consequences carefully.

For example, while most people qualify for premium-free Medicare Part A, some people do not, and they may not want to pay for Medicare coverage. In this situation, you may decide to enroll in a Marketplace plan instead of Medicare.

If you do this, however, you may run into problems if you ever decide to enroll in Medicare in the future. This is because you can be charged expensive late enrollment penalties. You may also need to wait for an enrollment period.

Employee, COBRA and Retiree Health Plans

Some people who have aged into Medicare also have access to job-based, COBRA or retiree health plans.

If you have a group health insurance plan through active employment, and if the employer has at least 20 employees, you may be delay enrollment in Medicare without facing a late enrollment penalty. However, coverage through COBRA or a retiree plan does not qualify you for penalty-free late enrollment or a special enrollment period.

You may be able to enroll in both Medicare and a job-based, COBRA or retiree plan. This may be expensive if you have to pay premiums for both, but you may find that the additional benefits make it worthwhile. If an employer is paying for benefits, this may be a very attractive option. However, it’s important to understand how Medicare coordinates with other insurance plans.

For example, if you are enrolled in both Medicare and COBRA, Medicare is typically the first payer. This means that the COBRA plan won’t pay until Medicare has. If you are enrolled in Medicare and a group health plan from active employment, and if the employer has at least 20 employees, the group health plan typically pays first. Additionally, some plans, such as retiree plans, may require you to enroll in Medicare if you are eligible.

Other Private Insurance Plans

Medicare enrollees have multiple plans to choose from, and some of these are private. For example, someone who is enrolled in Medicare Part A and Medicare Part B can also enroll in a private Medicare Part D plan for prescription coverage and a private Medicare Supplement Insurance plan to help with out-of-pocket costs. Alternatively, Medicare enrollees can enroll in a private Medicare Advantage plan.

Medicare Advantage plans often provide additional benefits, such as hearing, vision and dental. People who enroll in Original Medicare may decide to purchase coverage for these benefits through a separate standalone policy. Need assistance? Request a Medicare Insurance quote here.

Sources
  • https://www.healthcare.gov/medicare/medicare-and-the-marketplace/

  • https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods

  • https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/should-i-get-parts-a-b

  • https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance/which-insurance-pays-first

  • https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices

  • https://www.medicare.gov/index.php/supplements-other-insurance/retiree-insurance

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