Do I Need Medicare Part B If I Have Other Insurance?

Remember, medicare is a U.S. Federal government Health insurance program that subsidizes healthcare services.

It depends on the type of insurance an individual has. If the insurance is a COBRA or individual policy or retiree coverage provided by a union or employer, enrollment in Medicare Part A: Hospital Insurance and Medicare Part B: Medical Insurance is necessary. These types of insurance are secondary to Medicare, paying for any covered care after Medicare has paid its share.

But suppose the insurance comes through the current employment of either the beneficiary or their spouse with a large employer (20 or more employees). In that case, medicare recommends enrollment in premium-free Medicare Part A. Part B enrollment is not necessary. When this coverage ends, medicare provides special periods to enroll in part b and obtain other coverage, such as a Medicare Part D Prescription Drug Plan, a Medigap policy, or a medicare advantage plan.
 

SO LET'S EXPLORE SOME OTHER SITUATIONS I help my clients with on a regular basis to determine "IF YOU NEED PART B OR NOT" AND "how to PREVENT A LIFETIME PENALTIES" ?

Do I Need Medicare Part B If I Have Retiree Insurance

The requirement for Medicare enrollment depends on the type of insurance an individual has. If an individual has COBRA, individual policy, or retiree coverage provided by a union or employer, they must enroll in both Part A (hospital insurance) and Part B (medical insurance). These types of insurance are secondary to Medicare, covering any eligible care after Medicare has paid its share.

However, if an individual or their spouse receives insurance through current employment with a large employer (20 or more employees), Medicare recommends only enrolling in premium-free Part A, and Part B enrollment is not necessary. When this coverage ends, Medicare offers special periods to enroll in Part B and obtain other coverage options, such as a Part D prescription drug plan, a Medigap policy, or a Medicare Advantage plan. (Learn more about these options.)

Do I Need Medicare Part B If I Am Still Working?

You are not required to have Medicare Part B coverage if you have employer coverage. You can drop Medicare Part B coverage and re-enroll when you need it.

Maybe you’re 65 but enjoying your career and want to work a few more years. You’re eligible for Medicare, but you also have employer coverage. Do you have to be dually covered with Medicare Part B coverage and employer health insurance?

If you’re a Medicare beneficiary and want to drop Medicare Part B coverage while you’re working and covered by your employer’s group health insurance, you may do so. You also may choose to defer enrollment in Medicare Part B coverage if you are employed at age 65 or older and eligible for Medicare.

 (LEARN MORE)

Do I Need Medicare Part B
If I Have Medicaid?

All states offer a variety of Medicaid programs, with eligibility and coverage specifics varying by state. If you qualify for a Medicaid program, it may help pay for costs and services that Medicare does not cover.

Here are a few examples of how Medicaid can work with Medicare.

Medicaid can provide secondary insurance for services covered by Medicare and Medicaid (such as doctors’ visits, hospital care, home care, and skilled nursing facility care). Medicare is the primary payer, and Medicaid is the payer of last resort, meaning it always pays last. When you visit a provider or facility that takes both forms of insurance, Medicare will pay first, and Medicaid may cover your Medicare cost-sharing, including co-insurances and co-pays.

Options to Lower Your Out-of-Pocket Costs

For many low-income Medicare beneficiaries, there’s no need for private supplemental coverage. More than one in five Medicare beneficiaries are dual eligible for both Medicare and Medicaid.

This includes Medicare enrollees (Original Medicare and Medicare Advantage) who are eligible for full Medicaid, as well as those who qualify for Medicare Savings Programs that help low-income seniors pay premiums and cost-sharing under Original Medicare.

For dual-eligible enrollees who qualify for full Medicaid, that coverage picks up where Medicare leaves off, covering coinsurance and deductibles, as well as services not covered at all by Medicare (such as dental, vision, and long-term care). For Medicare beneficiaries who qualify for Medicare Savings Programs but not full Medicaid, there are varying levels of assistance available depending on the enrollee’s income.

Those who receive the least assistance (Original Medicare premium assistance only, but no help with coinsurance or deductibles) might find a Medigap plan to be beneficial. Still, most Medicare Savings Program enrollees do not have additional coverage under a Medigap plan

 (LEARN MORE)

Can I Drop My Employer Health Insurance And Go On Medicare?

If you are turning 65 and still working, you might still be covered by your employer’s health insurance plan. Or, perhaps, you get benefits through a spouse’s employer coverage.

Before you apply for Medicare, be aware that you might have several insurance options. For example, you may be able to:

  • Drop your employer coverage and enroll in Original Medicare, Part A, and Part B. If you take this route, you might consider signing up for prescription drug coverage under Medicare Part D and/or buying a Medicare Supplement plan. Medicare Supplement insurance can help pay the out-of-pocket costs of Medicare Part A and Part B.

Alternatively, you may have the option to receive your Medicare benefits from a Medicare Advantage plan.

  • Have both Medicare and your employer coverage?. Medicare and employer coverage will need to coordinate benefits, which means that either Medicare or the employer plan pays first for covered care. The other insurance is “secondary” and may also pay a portion of the costs. More on who pays first below.
  • Stay with your employer coverage and apply for Medicare later. Keep in mind that being eligible for Medicare doesn’t mean you have to take it. However, you might want to enroll in Medicare Part A (hospital insurance) as soon as you’re eligible, especially if you qualify for premium-free Part A. You generally qualify for Part A without paying a premium if you’ve worked at least 10 years (40 quarters) while paying Medicare taxes.

Later, when your employer coverage ends, you can apply for Medicare Part B. To avoid a late enrollment penalty for enrolling in Medicare, make sure you apply for Medicare during your Special Enrollment Period.

It’s important that you contact your employer-based health plan administrator to find out how the plan works with Medicare.

To get the best value and health insurance coverage for your situation, learn about your employer coverage costs, and your costs if you apply for Medicare. You’ll need to do a little research to determine the best arrangement for you. An Independent licensed Medicare Insurance agent would be happy to help you figure this out. (Learn More)

Sign up for Medicare

Contact the Social Security Administration (SSA) to:

  • Sign up for Medicare Part A and/or Part B
  • Change your address
  • Apply for Extra Help with Medicare drug costs

Get help with costs

Contact your state to:

  • Find Medicare Savings Programs that can lower your Medicare costs
  • Get information about how to apply for Medicaid
  • Check if you’re eligible for other state programs that can help with health-related costs

Get personalized health insurance counseling

Trusted, unbiased, one-on-one counseling and assistance.

We help people and their families with Medicare:

  • Choose a plan
  • Review coverage
  • Understand costs
  • Apply for Extra Help
  • File a complaint or an appeal
  • Make informed Medicare decisions
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