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The Coordination of Medicare Advantage & Medicare Benefits

Medicare is the national, federally funded health care program for the elderly and disabled in the United States. Enrollees may also decide to get their health care through the Medicare private health plans known as Medicare Advantage plans. Both Medicare Advantage and traditional Medicare benefits may coordinate with any other sources of insurance a beneficiary may have.

  1. Employer Benefits for Those 65+

    • Both traditional Medicare benefits and Medicare Advantage will coordinate with employer benefits. How it coordinates depends on the company that a beneficiary or his spouse works for. If there are 20 or more people on an employer's group health plan, then the employer insurance is primary. This means that doctors and hospitals bill the employer insurance first. Medicare is secondary, meaning it is billed second and pays for most leftover costs like co-payments. If the employer has less than 20 people on the group health plan, then Medicare is primary and the group health plan is secondary.

    Disabled, ALS and End-Stage Renal Disease

    • Employer benefits coordinate with traditional Medicare and Medicare Advantage differently if a beneficiary is Medicare-eligible due to disability, amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD). In order for the employer's group health plan to pay primary, the disabled and those with ALS must work at a company with over 100 employees on the plan.

      An individual with end-stage renal disease's employer coverage is primary for 30 months (called a "coordination period"). After this period, the employer coverage becomes secondary, and Medicare pays primary.

    Federal Retiree Benefits

    • Federal retirees who receive their health insurance through the Federal Employee Health Benefits Program (FEHBP) have several options. If they decided to take Medicare, Medicare will always pay primary. If they don't, their benefits will not be affected.

      How coordination works depends on what type of an FEHBP plan the beneficiary has. If she has an HMO, original Medicare coordination opens up the limited HMO network because original Medicare does not have a network. Those in fee-for-service FEHBP plans may have many of their Medicare costs waived.

    Military Benefits

    • Military retirees who opt-in to the TRICARE for Life program are required to take Medicare. Medicare is primary, and TRICARE for Life works as a supplemental insurance. It pays for such items as deductibles and co-insurances.

    COBRA

    • How COBRA coordinates with Medicare and Medicare Advantage benefits depends on which the beneficiary had first. If the beneficiary had COBRA before he became Medicare-eligible, typically, COBRA will end once he enrolls in Medicare. A spouse and children can stay on the plan, and the beneficiary may be able to keep COBRA for costs that Medicare does not cover.

      If the beneficiary became COBRA-eligible after he already had Medicare, he is allowed to have both. Medicare is primary, and COBRA pays secondary.

      Those with ESRD can have COBRA during the 30-month coordination period if they lose their employer plan. If COBRA ends, then Medicare pays primary.

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