Medicare is the primary insurance that many people aged 65 years and older use. Medicare consists of benefits offered by a federal health insurance program. There are exceptions to who may use Medicare, but the general census is for 65 and older. Medicare has several different parts to it as well. Part A is hospital insurance, Part B consists of medical insurance, Part C are the Medicare Advantage Plans, and Part D is prescription drug coverage. If you are unsure of which service you may have, check the Medicare card which will state what coverage you are protected under. Medicare is not always the primary insurance for an individual, but it can be depending on a few factors.
One of the largest influences of whether or not Medicare can be your primary insurance is if the individual is still working. Medicare can be secondary to employer insurance or it can be selected as the primary insurance. This depends on how large the employer is as well. If the company has less than 20 employees, than Medicare would be the secondary insurance. Also, primary insurance usually covers the bulk of the expenses, and secondary insurance may not pay anything if the primary insurance has not paid first.
If you work at a larger company with 100 employees or more and are eligible for Medicare due to a disability, Medicare will be your secondary insurance with your place of employment covering as primary care coverage. If there are less than 100 people at your place of employment with the same criteria mentioned, Medicare will now instead be your primary insurance provider. Individuals with disabilities that qualify for Medicare need to discover need to know how large their company is and then primary and secondary insurance coverage can be determined.
If you are not still working and are eligible for Medicare, then it will most likely be your main source for insurance. If you are still working, it is suggested that you speak with your employer and personnel that handle benefits to understand how your employer’s insurance and Medicare will work together as well as which will be the primary insurance used. Also, telling all your health care providers about any extra insurance or coverage you have from other insurance agencies will help get the bills sent to the right insurance and avoid billing and payment delays and penalties. Coordinating your benefits will ensure that the primary insurance pays first, meaning up to the limits of the coverage, with the designated secondary covering the remaining bills.
Other stipulations also affect whether or not Medicare is the primary provider. If you have ESRD and COBRA coverage, Medicare is the primary insurance coverage but only after 30 months. If you have been injured and work and fall under the workers’ compensation coverage, than Medicare will not be the primary. Talk to your Medicare agent and you other insurance coverage to determine who will be the primary coverage based on your unique, individual situation.