Medicare & Secondary Insurance

Medicare, a federally administered health insurance program for the elderly and disabled, is a comprehensive health care plan. However, that does not mean it is without its costs, and Medicare does not cover everything. Secondary insurance can help curb some of the costs of Parts A and B of Medicare, and it can give access to benefits that otherwise may not be covered by Medicare alone.

How It Works

• If you have more than one insurance plan, then one of those insurances pays primary, and the other pays secondary. That means that one insurance works as normal (primary), and the other insurance pays for whatever costs are left over, such as copayments and coinsurances (secondary). In most cases, Medicare is a primary insurance, and the many types of other insurances that that a consumer may have are secondary.

Employer Insurance

• If a beneficiary or his spouse is currently working, the employer insurance (or group health plan) works as a secondary insurance if it is a small company. In this case, a small company would be defined as 20 or fewer employees on the group health plan. However, if there are more than 20 employees, the group health plan is not a secondary insurance and works as the primary insurance instead.

Retiree Insurance

• Generally, all retiree insurance works as a secondary insurance to Medicare. Even if the beneficiary retired from a large company (more than 20 employees), after retiring, the health plan changes so that it is secondary rather than primary. Military retirees’ TRICARE for Life coverage is also secondary.

  There are rare, but few exceptions to this. One example is federal retirees who receive their benefits from the Federal Employee Health Benefits Program. In this case, their health insurance is primary, and Medicare is secondary.

Medicaid

• Medicaid is both a federal and state sponsored public health care program that offers free insurance to low-income individuals. If qualified, Medicaid works as a secondary insurance to Medicare, paying for coinsurances, copayments and often services that Medicare does not typically cover, such as dental, vision and long-term care.

Medigaps

• Medigaps are supplemental insurance plans that are specifically designed to work as secondary insurance to original Medicare. There are 12 types of Medigap plans that each cover different sets of services, and most Medigap plans cover coinsurances. Those with private health plans are not eligible for Medigaps, and Medigaps are not always available for purchase in all areas.