Yes, you can have both Medicare and private insurance

Many people have Medicare and a private insurance policy at the same time. The private insurance works alongside Medicare — it does not replace it. How they work together depends on what type of private insurance you have and when you got it.

The most common setup is Medicare as your primary insurance and private insurance as a secondary payer. This means Medicare pays its share of your medical bills first, then your private insurance may pay part of what Medicare did not cover. Some people have private insurance that pays before Medicare does, though this is less common and has specific rules.

You do not lose Medicare coverage by having private insurance. Both policies stay active at the same time, and you keep your Medicare card and your private insurance card.

Key Takeaways

  • Private insurance can cover costs that Medicare does not pay, such as copayments, coinsurance, and deductibles.
  • Medigap policies are private insurance sold by insurance companies specifically to fill Medicare gaps, and you can buy one any time after you turn 65.
  • Medicare Advantage plans are an alternative to Original Medicare plus private insurance, and you cannot have both at the same time.
  • If you have employer health insurance when you turn 65, you may be able to keep it and delay Medicare without penalty.
  • Tell both your Medicare and private insurance provider about each other so they coordinate payments correctly.

The three types of private insurance that work with Medicare

Medigap (also called Supplemental insurance) is private insurance sold by insurance companies to pay the costs Medicare does not cover. These costs include your Part B deductible, copayments, and coinsurance. Medigap policies are standardized — Plan G from one company covers the same things as Plan G from another company, though the price differs. You buy Medigap directly from an insurance company, not through Medicare.

Employer health insurance is coverage through your current job or your spouse's current job. If you are still working or your spouse is, you may have group health insurance that covers you. This insurance can work with Medicare. Some employers offer retiree health plans that continue after you leave the job, and these also work alongside Medicare.

Individual or family private insurance is a policy you buy on your own, not through an employer or Medicare. This is less common for people on Medicare because Medigap is usually a better fit, but some people keep individual policies they had before turning 65. These policies work with Medicare the same way Medigap does — Medicare pays first, then the private policy pays its share of what remains.

How Medicare and private insurance coordinate payments

When you have both Medicare and private insurance, the two policies need to know about each other. This is called coordination of benefits. The process works like this: you go to the doctor, the doctor bills Medicare first, Medicare pays its share and sends an explanation of benefits to your private insurance, then your private insurance receives that information and pays its portion.

You do not usually pay anything out of pocket during this process if your private insurance is Medigap, because Medigap is designed to cover what Medicare leaves behind. If your private insurance is employer coverage or an individual policy, you may have a copayment or coinsurance that neither policy covers.

Tell both insurers about each other when you enroll. Give Medicare your private insurance information and give your private insurance company your Medicare information. This prevents billing delays and makes sure payments go through in the right order.

Medigap plans and how they fill Medicare gaps

Medigap comes in ten standardized plans labeled A through N. Each plan covers a different combination of costs. Plan G, for example, covers your Part B deductible, copayments, coinsurance, and some costs abroad. Plan N covers most of the same things but not the Part B deductible, so it costs less.

You can buy a Medigap policy from any insurance company licensed in your state. The price varies by company even though the coverage is the same. You can shop around and switch companies if you find a better rate, though switching may involve a new waiting period for pre-existing conditions depending on your state.

You do not need Medigap if you choose a Medicare Advantage plan instead. Medicare Advantage is a different way to get Medicare coverage — it replaces Original Medicare entirely. You cannot have both Original Medicare and Medicare Advantage at the same time, and you cannot have Medigap if you are on Medicare Advantage.

Employer insurance and Medicare coordination

If you are still working or your spouse is still working, you may have employer health insurance. You can keep this insurance and stay on Medicare at the same time. The two will coordinate: Medicare pays its share, then employer insurance pays its share. You will have both an employer insurance card and a Medicare card.

If your employer has 20 or more employees, the employer insurance is primary and Medicare is secondary for people over 65. This means the employer insurance pays first. If your employer has fewer than 20 employees, Medicare is primary and employer insurance is secondary.

Some employers offer retiree health plans that continue after you leave the job. These work the same way — they coordinate with Medicare. If you have a retiree plan, check whether it requires you to enroll in Medicare Part B when you turn 65. Some plans do, and some do not.

When you might delay Medicare to keep employer insurance

If you are still working and have employer health insurance, you may be able to delay enrolling in Medicare Part B without paying a penalty later. This is allowed if your employer has 20 or more employees. You must enroll in Part A (hospital insurance) when you turn 65, but you can delay Part B.

When you eventually leave your job or lose the employer insurance, you have a window to enroll in Part B without penalty. This window is called a Special Enrollment Period and usually lasts eight months after your coverage ends. If you miss this window, you will pay a permanent penalty on your Part B premium for as long as you have Medicare.

Talk to your employer's benefits office before you turn 65 to understand your options. Ask whether your plan requires you to enroll in Medicare Part B, whether you can delay Part B, and what happens to your coverage when you retire.

Medicare Advantage is different — you cannot have both

Medicare Advantage (also called Part C) is a way to get your Medicare benefits through a private insurance company instead of through Original Medicare. If you choose a Medicare Advantage plan, you do not have Original Medicare anymore. You cannot have both Original Medicare and Medicare Advantage at the same time.

You also cannot have Medigap if you have Medicare Advantage. Medicare Advantage plans include their own coverage for copayments and coinsurance, so Medigap would be redundant and is not sold to people on Medicare Advantage.

If you have Medicare Advantage and want to switch back to Original Medicare, you can do so during the Annual Enrollment Period (October 15 to December 7 each year). Once you switch back to Original Medicare, you can then buy a Medigap policy, though you may face waiting periods depending on your state.

What to ask your doctor and insurance company

When you have both Medicare and private insurance, make sure your providers know about both. Tell your doctor's office that you have Medicare and private insurance, and give them both insurance card numbers. This prevents billing confusion and makes sure claims are sent to the right place.

If you are buying Medigap, ask the insurance company whether there is a waiting period for pre-existing conditions in your state. Ask which doctors and hospitals are in-network, though Medigap does not have networks the way Medicare Advantage does — you can see any doctor who accepts Medicare.

If you have employer insurance, ask your benefits office whether your plan coordinates with Medicare or whether it is primary. Ask what happens to your coverage when you retire and whether you need to enroll in Medicare Part B while still employed.

Frequently Asked Questions

Do I have to buy Medigap when I turn 65?

No. Medigap is optional. You can have Original Medicare without it, though you will pay copayments and coinsurance out of pocket. Many people buy Medigap because the out-of-pocket costs add up, but it is your choice. If you decide later that you want Medigap, you can buy it, though you may face waiting periods depending on your state.

Can I have two Medigap policies at the same time?

You can buy two Medigap policies, but Medicare will only pay based on one. Having two policies does not give you double coverage — the second policy will not pay anything because Medicare has already paid its share. Most people have one Medigap policy or none.

What if my private insurance denies a claim that Medicare approved?

Contact your private insurance company and ask why they denied it. Explain that Medicare already approved and paid for the service. If the denial was a mistake, they will overturn it. If they deny it again, ask for an appeal process. You have the right to appeal any insurance denial.

Do I need to tell Medicare about my employer insurance?

Yes. When you enroll in Medicare, tell them about your employer insurance. This helps Medicare coordinate benefits correctly. You can update your information by calling Medicare at 1-800-MEDICARE or logging into your Medicare account online.

Can I switch from Medicare Advantage back to Original Medicare and buy Medigap?

Yes, but timing matters. You can switch during the Annual Enrollment Period (October 15 to December 7). Once you switch back to Original Medicare, you can buy Medigap. However, you may face waiting periods for pre-existing conditions depending on your state, so ask about this before you switch.