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If you have Medicare and other insurance, the good news is you can generally use both types of insurance to cover your health care costs. Each type of coverage is called a payer. When there is more than one payer, coordination of benefits rules decides which payer pays first. The primary payer will pay first and send the remainder of the bill to the secondary payer. Even with two types of health insurance you may still be responsible for some out-of-pocket costs.
Medicare and employer health coverage
If you’re 65 or older, you may still be working and covered by a group health plan through your employer. You can still get Medicare as soon as you turn 65 and have double coverage. If your employer has 20 or more employees, the group health plan generally pays first before Medicare pays for your medical bills. If the group health plan doesn’t cover all of your medical bill, they should send the bill to Medicare for a secondary payment. You will have to pay whatever your group health plan and Medicare doesn’t cover.
If your employer has fewer than 20 employees, Medicare generally pays your medical bill first.
Learn more about Medicare and employer health insurance.
Medicare and your domestic partner’s health plan
You may have health care coverage through your domestic partner’s employer. Medicare will pay first if the domestic partner is entitled to Medicare on the basis of age and the partner has a group health plan coverage based on the current employment status of a partner.
Medicare and COBRA continuation coverage
COBRA stands for the “Consolidated Omnibus Budget Reconciliation Act” according to the U.S. Department of Labor. COBRA allows workers who lose their health benefits the right to continue group health benefits for a limited period of time under certain circumstances.
Generally if you have Medicare because you are 65 or older or have a disability, Medicare will pay before COBRA. However, if you have Medicare because of end-stage renal disease (ESRD), COBRA continuation coverage will generally pay your medical bills first.
Medicare and TRICARE
TRICARE is a health program for uniformed service members and their families, including retired service members and their families. If you are enrolled in Medicare and still active-duty in the military, TRICARE will generally pay for Medicare-covered services and items. TRICARE may also pay for Medicare deductibles and coinsurance amounts for any service not covered by Medicare that TRICARE covers. If neither Medicare nor TRICARE pays for a service, you will have to pay out-of-pocket.
If you are inactive military, Medicare pays first before TRICARE for medical services that Medicare covers.
Medicare and Veteran’s benefits
If you have both Medicare and Veteran’s benefits, you can get medical treatment under both programs. However, Medicare will not pay for the same service that is covered by Veteran’s benefits and vice versa. Medicare may pay all or part of your copayment if you’re billed for VA-authorized care by a doctor who isn’t part of the VA.
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