Should you enroll in Medicare Part B if you have other insurance coverage?
Retirement looks different for everyone, and not everyone stops working at the age of 65. If you or your spouse still have employer coverage at 65, or health insurance in another way, you may be wondering if you need to enroll in Medicare Part B.
The answer depends on your situation. You don’t technically need to enroll in Medicare at all if you choose not to, or if you prefer private coverage. And if you’re still working, you may choose to keep your employer coverage. However, having Medicare Part B in addition to other insurance coverage can benefit you. Even if you have other insurance, you should compare your coverage with Original Medicare or keep both in certain situations.
We’ll discuss some other nuances with having Medicare Part B and another insurance in this post.
Key takeaways:
While you don’t need to enroll in Medicare Part B if you have other insurance, in some cases, it can benefit you to have both.
The only time you need to enroll in Medicare Part B if you have other insurance is if you work for a company with fewer than 20 employees. You can face penalties if you don’t enroll during your Initial Enrollment Period.
If you have both Medicare and other health insurance, you can have more comprehensive coverage.
What is Medicare Part B?
Medicare Part B is one part of Medicare, a government-sponsored health insurance program for people 65 and up and people with certain disabilities. Medicare Part A and Part B make up Original Medicare. Part B covers medically necessary services and supplies that are considered part of outpatient care. Outpatient care includes equipment and services not received during a hospital stay. Part A, on the other hand, covers care received during a hospital visit.
Common Care Part B covers:
Doctor's visits
Preventive care (like screenings and vaccinations)
Outpatient surgeries and procedures
Lab tests
Durable medical equipment (such as wheelchairs or supplies for diabetes)
Part B Costs: The costs for Part B include a monthly premium, annual deductible, and coinsurance. Here are the specific prices for 2024:
Monthly premium: $174.70
Deductible: $240
Coinsurance: 20%
After you meet the deductible, Medicare typically covers 80% of the Medicare-approved amount for services, and you’d be responsible for paying the remaining 20%. Many people choose to get a Medicare Supplement (also called Medigap) plan to reduce the costs not covered by Original Medicare.
Do you need Medicare Part B if you have other healthcare insurance?
To best answer this question, we need to address specific scenarios. Whether you fall into one of these scenarios or have something more unique, we’re always here to answer your questions and give you personalized advice. Call us at ___ or schedule an appointment to get help understanding when to enroll in Medicare and the best coverage options for you.
If you’re still working and have employer coverage
Your situation is different depending on if you’re working for a large group employer (more than 20 employees) or a small group employer (fewer than 20 employees).
If you’re 65 and have health insurance through an employer with 20 or more employees
You can choose to delay your Part B enrollment while you maintain your employer coverage. Once you retire, you’ll use the Part B Special Enrollment Period to enroll in Medicare and won’t incur any late enrollment penalties.
Even if you don’t need to enroll in Medicare Part B, we always advise that you compare your employer coverage with Part B because oftentimes, people are able to save by switching to Medicare.
If you’re 65 and have insurance through an employer with fewer than 20 employees
If you work for a company that has fewer than 20 employees, you should enroll in Medicare during your Initial Enrollment Period to avoid late penalties.
If you have military benefits from the VA or TRICARE
Veterans receive special healthcare benefits for their time served. Your situation will be more unique than a civilian’s.
If you receive VA benefits
The VA only covers services received in VA facilities. Furthermore, the VA encourages people to enroll in Medicare—both Part A and Part B—when you turn 65 for a few reasons. Enrolling in Medicare while receiving VA benefits will ensure you always have access to the healthcare you need.
If you have TRICARE
If you are eligible for premium-free Part A and have TRICARE, you must sign up for Part B to keep TRICARE. Active duty service members may delay Part B enrollment until their active duty status ends. Learn more on the TRICARE site.
If you have Medicaid
If you get Medicare, you likely won’t lose Medicaid coverage. However, Medicaid coverage does change when you turn 65. Usually, you’ll enroll in Medicare and receive Medicaid benefits through one of four Medicare Savings Programs. In this case, when you turn 65, you should enroll in Medicare Part B to receive benefits from a Medicare Savings Program and avoid late enrollment penalties and gaps in coverage.
If you have private insurance
Consider what your healthcare costs would be if you chose to sign up for Medicare Part B in addition to your private insurance. Depending on your insurance options, it may make sense to keep one over the other, or have both.
If I have Medicare and other insurance, how does payment work?
You can enroll in Medicare Part B if you have other insurance, but you don’t have to. However, depending on your other insurance, it may benefit you to have both. This depends on the cost of your other insurance and how it works with Medicare.
When you have both types of insurance, one will be a primary payer and one will be a secondary payer. The primary payer is the insurance that pays first. This insurance pays up to the limits of its coverage. Then, the secondary payer pays any costs that the first insurance didn’t cover. We’ll give you a few examples of how this works with popular types of health insurance and Medicare:
Employer coverage and Medicare:
If the company you work for has less than 20 employees:
Primary payer: Medicare
Secondary payer: employer health insurance
If the company you work for has more than 20 employees:
Primary payer: employer health insurance
Secondary payer: Medicare
These rules could be different depending on your specific circumstances. Check with your Medicare plan or your employer health insurance plan to be sure about who is responsible for coverage.
Important note: It’s the most beneficial for people who work for a small company to enroll in Medicare Part B. If you work for a company that has fewer than 20 employees, you’ll need to sign up for Part B during your Initial Enrollment Period or you’ll have to pay a monthly penalty.
TRICARE and Medicare:
If you’re on active duty:
Primary payer: TRICARE
Secondary payer: Medicare
If you’re not on active duty:
Primary payer: Medicare
Secondary payer: TRICARE (in certain situations)
If you receive care from a military hospital or federal health care provider, TRICARE pays first.
Veteran’s benefits and Medicare:
Depending on where you receive care, you’ll either use your Medicare benefits or VA benefits. If you receive care at a VA facility, your service will be covered by VA benefits. If you receive care at a non-VA facility, Medicare will cover your services. In general, you won’t be able to pay for the same services with Medicare and your VA benefits. If you need a VA-authorized service, your VA benefits will cover the service. Likewise, Medicare pays for Medicare-covered services.
Private insurance:
If you have private insurance and Medicare, you can check your policy and coverage information to see which insurance would pay first and which would pay second.
Medicaid:
Primary payer: Medicare
Secondary payer: Medicaid
Choosing between Medicare and other insurance
If you have private coverage, employer coverage, or coverage through other means, your Medicare decisions are a bit more complex. Should you keep your current insurance, enroll in Medicare, or receive benefits from both types of coverage? The answer will depend on your unique situation, and we encourage you to reach out to our licensed Medicare agents to get personalized advice. Call us today at 855-900-2427 to ensure you’re making the right Medicare decisions.