Medicare and Employer Insurance
Can I have both employer health insurance and Medicare?
Turning 65 or already on Medicare but still working, or considering going back to work? You might be wondering how Medicare fits in with the health insurance you get through your job, or your spouse’s job.
The good news is you can usually have both. It depends on your work status, the size of your employer, and the type of Medicare plan you choose.
Here’s how Medicare and insurance work together.
- You can usually have both Medicare and employer coverage.
- Which pays first depends on the size of your (or your spouse’s) employer.
- Don’t cancel coverage without comparing your costs and benefits.
- Be careful about delaying or dropping Part B—timing matters.
- When in doubt, talk to your Human Resources (HR) department, call 1-800-MEDICARE (1-800-633-4227) (TTY: 1-877-486-2048) 24/7, or visit Medicare.gov.
Are there instances where I should I drop my employer health plan once I get Medicare?
Not necessarily. Your employer plan might cover things Medicare doesn’t, and Medicare may help pay what your employer plan doesn’t cover. The two plans “coordinate,” meaning one pays first and the other pays second.
Before you decide to cancel, you should compare the costs, coverage, and provider networks. Also, check with your HR office—some employers actually require you to have Medicare once you’re eligible.
Who pays first—Medicare or my employer health plan?
Think of it this way: the “primary” plan pays the bill first, then the “secondary” plan helps cover what’s left.
- Employers with 20+ workers: Your job-based plan usually pays first, and Medicare is there as backup.
- Employers with fewer than 20 workers: Medicare usually pays first, and your job’s plan helps pick up the rest.
- Covered through your spouse’s job? The same rules apply based on that employer’s size.
- There are exceptions for workers’ comp, no-fault auto, liability, and end-stage renal disease (ESRD).
Tell all your providers if you have both Medicare and other coverage, so claims are submitted in the right order and you avoid possible billing delays.
What if I go back to work after starting Medicare?
If you’re already retired and choose to return to work and get employer coverage again, your job-based health insurance might take the lead. Some people consider dropping Medicare Part B in this situation to save money, but be careful—dropping Part B at the wrong time can lead to penalties or coverage gaps later. Always check with Medicare, Social Security Administration, and your benefits administrator before you cancel.
What if I have Medicare Advantage and my spouse’s health insurance?
It’s possible to have both, but it can get tricky. Medicare Advantage (MA) plans usually have their own provider networks and rules. Some employer plans coordinate with MA plans, but not all do.
Key considerations:
- Many MA plans require you to use the plan’s network. If the employer plan is primary, confirm with the MA plan and the employer how claims will be processed.
- Some employer plans won’t pay secondary to an MA plan the same way they would to Original Medicare. Check both plan documents and ask the benefits administrators.
The safest move is to call both your spouse’s HR office and your MA plan so you know exactly how claims will be handled.
Do I need Medicare Part B if I’m still working full-time?
Not always. If you’re actively working and your employer coverage is considered “creditable,” meaning it’s as good as or better than Medicare, you can delay Part B without penalty. Get written proof that the coverage was “creditable” or counted as adequate. That documentation matters when you enroll later.
Once you leave that job or lose that coverage, you’ll have 8 months to sign up for Part B without a late fee. Just make sure you keep proof of your employer coverage for when you do sign up.
Working with Medicare and your health plan: A quick checklist before you decide
- Ask HR/benefits whether your employer plan will be primary if you enroll in Medicare.
- Compare total costs (premiums + out-of-pocket) and networks for employer coverage vs. Medicare/Medicare Advantage.
- If delaying Part B, get written proof that you had employer coverage based on your current employment. Keep it.
- Call 1-800-MEDICARE or visit Medicare.gov for official guidance about coordination of benefits.
What if I qualify for a D-SNP and also have employer health insurance?
Most people who qualify for a Dual Eligible Special Needs Plan (D-SNP) have both Medicare and Medicaid. It’s not very common, but you can have a D-SNP and be covered under an employer plan (yours or a spouse’s).
Here’s how it works:
- Employer health plan usually pays first.
- Medicare (through your D-SNP) pays second.
- Medicaid pays last and may cover what’s left, like copays or deductibles.
Always let your employer plan, Medicare, and Medicaid know that you have multiple types of coverage so your bills get paid in the right order.
A Sentara Medicare Dual Eligible Special Needs Plan (D-SNP) offers extra benefits designed to make life a little easier. These include personalized care coordination to help manage appointments and medications, as well as transportation to get you to and from medical visits.
To learn about a Sentara Medicare D-SNP, call a Licensed Plan Advisor at 1-877-550-3285 (TTY: 711) or visit sentaramedicare.com/DSNP
October 1-March 31 | 7 days a week | 8 a.m.-8 p.m. or
April 1-September 30 | Monday-Friday | 8 a.m.-6 p.m.
Worth a look
Do you need a Medicare broker? Sources: medicare.gov, cms.gov, ssa.gov Y0174_1025_SHPME_310025_M