LEARN ABOUT MEDICARE

Medicare serves specific groups of people, including:

People aged 65 or older

People under age 65 with certain disabilities

People of all ages with End-Stage Renal Disease

Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care

Helps cover services from doctors and other health care providers, outpatient care, medical equipment, and preventive services

Medicaid Parts A & B are often referred to as "Traditional Medicare" or “Original Medicare”.

To help pay out-of-pocket costs with traditional Medicare (typically a 20% coinsurance), you can also buy supplemental coverage, like Medicare Supplement Insurance Medigap, have secondary coverage from a former employer or union, or Medicaid.

If Medicare is primary with a secondary Medicaid, or Dual Medicare/Medicaid plan, the Medicaid benefits can only be used if the provider/treatment center also takes Medicare.

A Medicare-approved plan from a private insurance company that offers an alternative to traditional Medicare. These “bundled” plans include Part A, Part B, and usually Part D (drug coverage). These plans may have lower out-of-pocket costs than traditional Medicare.

Available to everyone with Medicare. To get Medicare prescription drug coverage, people must join a plan approved by Medicare that offers Medicare drug coverage. Most people pay a monthly premium for Part D.

Click here to learn how to apply for Medicare.

If you currently have Medicare, you can switch to Medicare Advantage (Part C) from Original Medicare (Parts A & B), or vice versa, during the Medicare Annual Enrollment Period.

You can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period (October 15 to December 7). Your coverage under traditional Medicare will begin January 1 of the following year. You can also make this change during the Medicare Advantage Open Enrollment period (January 1 through March 31).

**Switching from Original Medicare to Medicare Advantage DOES NOT reset the 190-day lifetime max for mental health inpatient services.

How does it work if I have Medicare and another health insurance plan? Who pays first?

Medicare.gov discusses how Medicare works with other plans as the primary or secondary payor:

Medicaid: Medicare pays first, and Medicaid pays second.

Group health plans:

• If the employer has 20 or more employees, then the group health plan pays first, and Medicare pays second.

•  If the employer has fewer than 20 employees and isn’t part of a multi-employer or multiple employer group health plan, then Medicare pays first, and the group health plan pays second.

• If the employer has fewer than 20 employees and is part of a multi-employer or multiple employer group health plan, then the group health plan pays first and Medicare pays second.

• I’m under 65, disabled, retired ,and have group health plan coverage based on my family member’s current employer. If the employer has 100 or more employees, then the large group health plan pays first, and Medicare pays second.

COBRA:

• When you’re eligible for or entitled to Medicare due to ESRD, COBRA pays first, and Medicare pays second during a coordination period that lasts up to 30 months after you’re first eligible for Medicare. After the coordination period ends, Medicare pays first.

• Deciding if and when you should elect COBRA coverage can be very complicated. When you lose employer coverage and you have Medicare, you need to be aware of your COBRA election period, your Medicare Part B (Medical Insurance) enrollment period, and your Medigap Open Enrollment Period. Each of these periods may have different deadlines, and those deadlines might overlap. You should be aware that what you decide about one coverage type (COBRA, Part B, and Medigap) might cause you to lose rights under another.

Indian Health Services or IHS provider:

• If you have non-tribal group health plan coverage through an employer who has 20 or more employees, the non-tribal group health plan pays first, and Medicare pays second.

• If you have non-tribal group health plan coverage through an employer who has fewer than 20 employees, Medicare pays first, and the non-tribal group health plan pays second.

• If you have a group health plan through tribal self-insurance, Medicare pays first, and the group health plan pays second.

Worker’s Comp:

• If you have Medicare and get injured on the job, workers’ compensation pays first on health care items or services you got because of your work-related illness or injury. There can be a delay between when a doctor or other provider bills for a work-related illness or injury and when the state workers’ compensation insurance decides if they should pay the bill.

• Medicare can’t pay for items or services that workers’ compensation will pay for promptly. Generally, these include items or services that workers’ compensation pays within 120 days of the date you received the service or the date of your inpatient hospital discharge (if applicable), whichever is earlier.

VA:

• If you have (or can get) both Medicare and Veterans’ benefits, you can get treatment under either program. However, Medicare is never the secondary payer after the Department of Veterans Affairs (VA). Each time you get health care or see a doctor, you must choose which benefits to use. Medicare can’t pay for the same service that your Veterans’ benefits covered, and your Veterans’ benefits can’t pay for the same service that Medicare covered.

• If the VA authorizes services in a non-VA hospital, but didn’t authorize all of the services you get during your hospital stay, then Medicare may pay for the Medicare covered services the VA didn’t authorize.

Tricare:

• Some people can have both Medicare and other types of TRICARE, including:

• Dependents of active-duty service members who have Medicare for any reason.

• People under 65 who have Part A because of a disability or End-Stage Renal Disease (ESRD) and who also have Part B

• People 65 or older who can get Part A and who also sign up for Part B

• If you’re on active duty, TRICARE pays first for Medicare-covered services. TRICARE will pay the Medicare deductible and coinsurance amounts and will also pay for any TRICARE-covered services that Medicare doesn’t cover. If you’re not on active duty, Medicare pays first. TRICARE may pay second if you have TRICARE For Life coverage. You pay the costs of any services Medicare or TRICARE doesn’t cover.

•  If you get services from a military hospital or any other federal health care provider, TRICARE pays the bills. Medicare usually doesn’t pay for services you get from a federal health care provider or other federal agency.