How Medicare affects your current coverage

It’s common for people who turn 65 to be covered by an employer or spouse’s plan. In this case, it may be in your best interest to combine your current coverage with a Medicare plan or switch over entirely to Medicare.

Employer coverage and Medicare

• If you work for a company with fewer than 20 employees, Medicare is considered your primary coverage. That means Medicare pays first, and your employer coverage pays second.
• If you work for a larger company, your employer-based coverage will be your primary coverage and Medicare your secondary coverage.
• Either way, after both insurers have paid their part of your medical bill, you only pay the balance.

Individual or Covered California health plans and Medicare

There is usually no reason to keep an individual or Covered California plan once you have Medicare. Once you have Medicare:

• It is illegal for someone to sell you a marketplace or individual market policy.
• You are not eligible for tax credits or other savings, which means you would pay full price for a marketplace plan.

Retiree insurance and Medicare

If you’re retired and receive health insurance through your former employer, you can still sign up for Medicare.

• Medicare pays first, and your former employer’s group health plan pays second.
• After both insurers pay, you pay the balance.

Coverage from your spouse’s employer and Medicare

• If your spouse’s employer has fewer than 20 employees, Medicare pays first.
• If it’s a larger company, the business’s health plan pays first.
• After both insurers pay, you pay the balance.

Military retiree and Veterans Affairs (VA) benefits and Medicare

Having both Medicare and VA coverage gives you the option to get care through VA or civilian doctors, depending on your healthcare needs.

• Medicare covers your civilian doctor visits for Medicare-covered services or items, and the VA covers your visits to VA facilities.
• Medicare may pay part of your copayment if you receive VA-authorized care from a civilian doctor or hospital.

TRICARE and Medicare

Active-duty military and enrolled in Medicare:

• TRICARE pays first for Medicare-covered services or items
• Medicare pays second
• TRICARE coverage may also help with some services not covered by Medicare.
• You pay for services that neither Medicare nor TRICARE covers.

Retired military:

• When you retire from the military, you must sign up for Medicare Part B (medical insurance) to maintain your TRICARE coverage.
• TRICARE for Life (TFL) is given to TRICARE-eligible individuals who carry Medicare Parts A and B. TFL benefits cover your Medicare deductible and coinsurance.

COBRA and Medicare

COBRA allows you to keep your employer’s group health insurance plan for a limited time after your employment ends. It protects you from losing your health insurance immediately after you lose a job.

• If you have Medicare, Medicare pays first, and COBRA acts as your secondary coverage. (The only exception is if you have End-Stage Renal Disease (ESRD). In that case, COBRA pays first.)
• In most instances, your COBRA coverage will end if you enroll in Medicare.
• You may be able to get an extension on your COBRA if Medicare doesn’t cover services offered on the COBRA plan, like dental insurance.
• You can enroll in COBRA if you become eligible and already have a Medicare plan. In that case, you’ll decide if the extra cost for COBRA is worth it for you.

Medicaid and Medicare

If you’re eligible, your best bet is to keep both Medicare and Medicaid coverage.

Get covered with Blue Shield

Blue Shield of California makes choosing the right health coverage easy. We offer Medicare Supplement plans and stand-alone Medicare Prescription Drug Plans statewide. We also offer Medicare Advantage Prescription drug plans in select counties. You have many options available to fit your needs and budget.