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How Medicare works with other insurance

If you have Medicare and other health insurance or coverage, each type of coverage is called a "payer." When there's more than one payer, "coordination of benefits" rules decide which one pays first. The "primary payer" pays what it owes on your bills first, and then sends the rest to the "secondary payer" to pay. In some cases, there may also be a third payer.

What it means to pay primary/secondary
  • The insurance that pays first (primary payer) pays up to the limits of its coverage.
  • The one that pays second (secondary payer) only pays if there are costs the primary insurer didn't cover.
  • The secondary payer (which may be Medicare) may not pay all the uncovered costs.
  • If your employer insurance is the secondary payer, you may need to enroll in Medicare Part B before your insurance will pay.
Medicare Advantage Plans cover all Medicare services

Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you're in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you're always covered for emergency and urgently needed care.

 

The plan can choose not to cover the costs of services that aren't medically necessary under Medicare. If you're not sure whether a service is covered, check with your provider before you get the service.

 

Medicare Advantage Plans may offer extra coverage, like vision, hearing, dental, and/or health and wellness programs. Most includeMedicare prescription drug coverage (Part D). In addition to your Part B premium of $144.60*, some plans charge a monthly premium for the Medicare Advantage Plan. There are also a selection of low cost or Zero Premium Medicare Advantage Plans. 

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