Having quality medical insurance is extremely important. Living without healthcare may make you susceptible to substantial medical bills you can’t afford. There are several different healthcare options, including employer insurance and Medicare. So, you may wonder, “Can I have employer insurance and Medicare?”.
Employer coverage refers to health insurance purchased by your employer. This insurance is then offered to their employees as part of a benefits package. An employer health plan is considered private health insurance coverage.
Meanwhile, Medicare is a form of federal health insurance offered to people 65 or older, younger people with disabilities, and people with End-Stage Renal Disease. Since it is federal-based insurance, it is not considered private.
Additionally, in 2021, 7.9 percent of full-time, year-round workers had public health insurance, up 1.8 percentage points from 2020. Among less than full-time, year-round workers, the percentage with public coverage increased by 1.6 percentage points to 22.6 percent during this period.
Can you have Medicare and employer insurance at the same time? This article provides a comprehensive guide to navigating dual health insurance, with the purpose of helping individuals maximize the benefits of their coverage.
Understanding Dual Coverage: Is It Possible to Have Employee Insurance and Medicare?
Employer-based insurance was the most common of the subtypes of health insurance coverage. It covered over 54.3 percent of the population for some or all of the calendar year. Then, this was followed by:
Medicaid (18.9 percent)
Medicare (18.4 percent)
Direct-purchase coverage (10.2 percent)
TRICARE (2.5 percent)
VA and CHAMPVA coverage (1.0 percent).
As you can see, there are many different types of insurance. But can I have Medicare and insurance through my employer? The short answer is yes. Having multiple forms of medical insurance is known as dual coverage. While having multiple health insurance at once is possible, it is important to understand how the process works to maximize your benefits.
When you have employer coverage and Medicare, which pays first when medical support is needed? The primary payer will pay first, followed by the secondary payer. If there is a cost after the primary and secondary payers are maxed out, it is up to you, the patient, to pay out-of-pocket.
Sign up for Medicare coverage as soon as you turn 65. Otherwise, you may be susceptible to late enrollment penalties if your group coverage is not considered credible in the eyes of the IRS. Speak to your HR manager to find out. When enrolling for Medicare Part A or Part B, list any other insurance coverage you may have. This way, you can establish primary and secondary payers. This process is called “coordination of benefits.” Furthermore, if you are receiving Social Security, you will likely be automatically enrolled at age 65.
Who Pays First If I Have Both Employer Insurance and Medicare?
Enrolling for coverage can be confusing. Most people don’t understand the fine print and can easily miss out on benefits or get hit with unexpected bills at inopportune times. And having dual coverage can be even more challenging. When balancing employer insurance and Medicare, it’s vital to understand the details of each plan. Most importantly, you must understand the coordination of benefits (primary vs. secondary payers).
Primary Payer vs Secondary Payer
As mentioned, the primary payer pays first for medical costs (the amount they owe depends on your particular plan). Meanwhile, the secondary payer pays afterward. Who the primary and secondary payer is depends on the size of the company you work for. If your company has over 20 employees, your employer's health plan is the primary payer. Medicare is the primary payer if your company has less than 20 employees.
Concept of Coordination Of Benefits
Can I have both employer insurance and Medicare? We’ve learned that having dual coverage is possible, but what exactly does it look like? Here is an example of the coordination of benefits issue between employer coverage and Medicare:
For this example, imagine a 35-year-old woman named Susan. Susan needed consistent services from an obstetrician due to her high-risk pregnancy. The services rendered included multiple ultrasounds. After the birth of her baby, she received bills from her doctor that her insurance company already paid. She was confused by the situation. Upon further investigation, her insurer asked her physician for refunds for services that were not in effect. After several months of correcting the issue, Susan was unsuccessful and was stuck with more than $3,000 in charges.
Susan's issue was that her insurer incorrectly believed that her coverage ended because they believed that she had other insurance coverage at that time. Unfortunately, this situation occurs all too often. Having clear coordination of benefits between your employer's insurance company and Medicare can minimize this sort of issue.
Pros and Cons of Having Both Employer Insurance and Medicare
Health insurance can support a sense of safety and security for individuals. Knowing that surprising medical bills will be covered, even in unexpected occurrences, is a significant benefit. You may wonder, “Can I have worry-free Medicare and employer insurance?” While having two types of medical insurance may seem like a significant advantage, there are pros and cons. Here are some examples of both.
What Are the Pros Of Dual Healthcare Coverage?
What are the benefits of dual healthcare coverage? Can I have employer insurance and Medicare Part A? A significant advantage to having Medicare alongside your employer insurance is having access to more doctors. 99% of non-pediatric physicians accept Medicare. Medicare also does a great job of limiting out-of-pocket expenses, while employer insurance does not.
Medicare Part A greatly benefits those with dual healthcare coverage, especially regarding hospital stays and nursing care. These costs are premium-free to those who have worked at least 40 quarters in Medicare-covered employment.
What Are The Cons of Dual Healthcare Coverage?
Unfortunately, dual healthcare coverage can also come with complications. Can I have employer insurance and Medicare Part B? Is it worth it? Here are some of the details when it comes to employment insurance and Medicare Part B:
Medicare Part B is not free, unlike Part A. Part B requires a monthly premium of $164.90 or more. Dual coverage could force you to pay two separate premiums, which can add up quickly.
As mentioned earlier, billing complications can occur with dual coverage. It’s extremely important to understand which plan is primary and secondary to avoid complications. It is also possible that you are not eligible to have a health savings account with dual coverage. This depends on if you have a high-deductible health plan with your employer. In this case, it’s important to understand the ins and outs of your employer's health plan before asking, “Can I have Medicare and insurance through my employer?”
How to Enroll in Medicare When You Have Employer Coverage
Between 2020 and 2021, Medicare covered 18.4 percent of people. If you want to add Medicare to your current employer coverage, educate yourself on the rules, timing, and eligibility requirements for each type of Medicare. The answer to “Can I have employer insurance and Medicare?” may depend on your specific circumstances and needs.
Before opting into dual coverage, consider the cost, the coverage offered, and what you need from a plan. If you are a North Carolina resident, here are some options you can explore.
65 Years Old and Still Working
Can you have Medicare and insurance through work when you’re 65 years old and still working? Yes, this is quite common. Being eligible for Medicare depends on your age and/or disability status. Meanwhile, your work status does not impact it. Be sure to enroll as soon as you turn 65 to avoid penalties.
You can enroll for Part A during the Initial Enrollment Period (IEP), which begins three months before your 65th birthday and ends three months after. In addition, you can delay Part B if you have creditable coverage through your employer. If you receive Social Security, you will be automatically enrolled in Part A and Part B. The cost of Medicare may vary depending on your income level and which part of Medicare you enroll in.
Below 65 Years Old and Working
Can I have employer insurance and Medicare if I’m under 65 and still working? As previously mentioned, your work status does not factor into your ability to enroll in Medicare. If you are under 65 without a disability or End-Stage Renal Disease, you will not qualify for Medicare.
FAQs about Employer Insurance and Medicare
Can you have Medicare and work at the same time?
Yes, you can have Medicare and work at the same time. Your work status has no impact on your eligibility.
What is the best secondary insurance if you have Medicare?
The best option for secondary insurance will depend on your particular needs and financial availability.
Is Medicare the same as employer insurance?
No. Employer insurance is private insurance offered by your employer. On the other hand, Medicare is federal insurance.
Can I have Medicare and Employer Insurance at the Same Time?
Understanding the details of health insurance can be challenging. When considering insurance options, many wonder, “Can I have Medicare and Employer insurance?”
Medicare is a form of federal insurance available to people over the age of 65, who have disabilities, or who have End-Stage Renal Disease. Meanwhile, employer insurance is a form of private insurance offered directly by your employer. Dual healthcare coverage is when you have both at the same time.
But can you have Medicare and insurance through work? Moreover, what do you need to do to secure the perfect plans for you?
If you are interested in dual healthcare coverage, consulting an expert is helpful. Our team of insurance experts can help explain the fine print of your plans and get you enrolled in the perfect plan for you. Take a look at our agents and get the assistance you need today.