Your life’s been full of decisions up to this point, but brace yourself: If you’re turning 65 with existing healthcare coverage, you’ve got more decisions on the horizon! If you want to know whether you’ll be able to keep your coverage (and which health insurance plan will be the primary one), read on.

Are you nearing 65 while enrolled in a different healthcare plan? At 65, you become eligible for Medicare, and it’s not uncommon to reach eligibility while covered either by your employer’s plan or your spouse’s plan. If this is you, you’ll need to think about whether you should merge your current coverage with a Medicare plan or switch to Medicare completely.

The Relationship Between Medicare and Your Current Coverage

How does Medicare work with your current coverage? That depends on the type of insurance you have.

1. Medicare and Employer Coverage:

  • If you work at a company with fewer than 20 employees, Medicare becomes your primary coverage. Medicare covers expenses first, followed by your employer’s coverage.
  • If you work at a bigger company, your employer-based coverage will continue to be your primary coverage, with Medicare as your secondary coverage.
  • No matter what, after both insurers have paid their share toward your medical expenses, you are to pay the balance.

2. Medicare and Individual or Covered California Health Plans:

  • There’s typically no reason to keep individual or Covered California plans when you get Medicare.
  • Important:
    • It is illegal for anyone to sell you a marketplace or individual market policy once you have Medicare.
    • You would not be eligible for tax credits or savings, so you’d have to pay full price for a marketplace plan.

3. Medicare and Retiree Insurance:

  • Retirees who receive health insurance through their former employer need to sign up for Medicare.
  • Medicare is the primary payer, and your former employer’s group health plan acts as secondary coverage.
  • After both providers have paid their part, you pay the remaining balance.

4. Medicare and Coverage from Your Spouse’s Employer:

  • If your spouse works at a company with fewer than 20 employees, Medicare pays first for you.
  • If the spouse works at a larger company, their employer-provided health plan will be the primary coverage.
  • As with other plans, you are responsible for any balance remaining after both insurers have paid their part.

5. Medicare and Military Retiree and Veterans Affairs (VA) Benefits:

  • With Medicare and VA, you enjoy flexibility in choosing between VA and civilian doctors based on your healthcare needs.
  • The VA covers visits to VA facilities and Medicare covers visits to civilian doctors.
  • Medicare may contribute a portion of your copay if you receive VA-authorized care from civilian doctors or hospitals.

6. Medicare and TRICARE:

  • Active-duty:
      • Medicare is typically the primary payer.
      • TRICARE serves as secondary coverage (and could pay Medicare deductibles/coinsurance).
      • TRICARE could also pay for services that aren’t covered by Medicare.
      • You pay for anything that neither Medicare nor TRICARE covers.
  • Retired:
    • To keep TRICARE coverage, you have to sign up for Medicare Part B (medical insurance).
    • TRICARE for Life (TFL) is for those who qualify for TRICARE and have Medicare Parts A and B. TFL covers Medicare deductibles and coinsurance.

7. Medicare and COBRA:

  • COBRA lets you retain your employer’s group health insurance for a limited time after leaving your job, preventing immediate loss of health coverage.
  • If you have Medicare, it pays first, with COBRA as secondary coverage (except in cases of End-Stage Renal Disease).
  • In most cases, COBRA coverage will end upon Medicare enrollment.
  • If Medicare doesn’t cover specific services available through a COBRA plan (like dental insurance), you might be able to get an extension on your COBRA plan.
  • Enrolling in COBRA while already having a Medicare plan is possible, but you should carefully weigh the added costs and benefits first.

8. Medicare and Medi-Cal in California:

  • If you are eligible, the best option might be to keep Medi-Cal and Medicare. You will be assigned a Prescription Drug Plan (PDP), with the premiums fully or partially paid, and low or no copays for your drugs. The plan you are assigned to may not be the best plan for the drugs which you take. You may need help from a Medicare specialist to choose the most cost-effective plan.
  • Medicare Advantage Special Needs Plans are an option to Medicare and Medi-Cal. We can help you decide which is the best option for you and can take into consideration your health and the providers you need to see.

Still Not Sure How Your Current Coverage Interacts with Medicare?

Medicare coverage isn’t straightforward. There are many factors to consider and a limited amount of time to make a decision. Waiting too long can prevent you from getting the health benefits you need—but that’s why we’re here. At Susan Polk Insurance, we’ve been helping people understand their insurance options for decades, and we’d be honored to help you too. So get started today!

Don’t go a day without health insurance.

Since 1988, we’ve helped tens of thousands of people get the most out of their health insurance dollars, in SLO County and across California. Get a quote today and let us help you get the coverage you need at a price you can afford.