Do I Need Health Insurance if I Have Medicare?

Almost a fifth of the population in the US are enrolled with Medicare scheme. This represents about 50 million people who are either 65 of age and above or have any form of physical disability. Medicare provides a cushion for the elderly in the event they seek medical treatment.

The scheme was meant for people above 65 years old with the assumption that most of them will have retired by then. However, we see that more people above this age still continuing to work. Some have their employer’s cover and don’t want to forfeit this for Medicare.

Do I Need health insurance if I have a Medicare? Is Medicare considered health insurance? In this article, we help you weigh your options.

What Is Medicare?

Medicare is a federal government social insurance scheme that targets US citizens or legal US citizens. It targets people who have reached the age of 65 years but can enroll younger citizens who have any form of disability.

Over the years, the program has been improved to cater for more needs of the elderly. It’s a comprehensive cover that is divided into several Medicare health plans.

The most basic ones are Part A and B. Part A covers mostly hospitalization and the procedures while Class B will cover some outpatient costs.

Part C and D of the Medicare health plans are advanced and would require payment of a monthly premium. Part A works just fine for many, but sometimes, you might want to consider to drop your employers’ cover and seek Medicare only.

Do I Need Health Insurance If I Have A Medicare?

If you have been holding a cover either from your employer or your spouse’s employer, you might ask yourself what you will lose by subscribing for Medicare Part A. Most people prefer to enroll in Part B and maintain a private cover to ensure that the private insurance can cover areas not covered by Medicare.

People have different lifestyles and sometimes, an employer’s cover might be advanced than the basic Medicare. You might be seeking very expensive procedures that Part A or B don’t cover and your private medical health insurance can help.

You should consider keeping your private cover if you evaluate that you might need more coverage above what Medicare plans to pay. If you are still contributing to your employer’s cover through premiums, you can weigh which payment is higher. This is a comparison between Part B of Medicare and your private cover.

But, it’s good to know that there are restrictions on the levels of reimbursements. For example, if your employer employs 20 people and above, his cover becomes the primary cover and Medicare becomes secondary. In case your employer has 20 people or less in their payroll, then Medicare becomes your primary cover.

There has also been a debate going on whether Medicare is as comprehensive as needed. For example, research has shown that Medicare only covers half of all medical needs of a patient.

Can I Get A Medical Cover In The Health Insurance Marketplace?

Health Insurance Marketplace is a central information hub for people without medical insurance coverage. Here, people can seek information and even buy a medical cover. This hub is organized by the federal government although there are state-organized marketplaces.

It’s a federal offence for anyone to sell you a private medical cover at the Health Insurance Marketplace knowing that you already have a Medicare scheme.

There are other organizations dedicated to ensuring you get information on better health care. You can check out and learn more about Accountable Care Organization (ACO). This organization pushes for quality care regardless of your insurance cover.

If I Have An Existing Medical Insurance, How Does Medicare Work With Them?
As explained earlier, Medicare becomes the primary payer if your employer’s cover caters for 20 people and below. This will mean that Medicare will cover up to the limits of the cover. The secondary payer will then cover anything above this limit.

If Medicare is the secondary payer, it will only cover to the limit it has set. If there is a delay in making payments by your primary payer, Medicare can opt to pay on the condition that it can recover the paid amount from your insurer.

What Options Do I Have With Medicare?

Medicare has been introducing various improvements to the cover over the years. One of the ways to help meet some medical needs other Medicare parts might not cover is called Medigap.

These options which are sold by private companies entrusted and vetted by Medicare provide you with advanced coverage. For example, if you are a frequent traveler outside of the US, you might be forced to purchase a cover that can bail you out in case you get sick while abroad.

Does Medicare Count As Health Insurance?

Affordable Care Act stipulates that citizens should have a medical cover that meets a set of basic requirements. These are known as minimum essential coverage. This means that your Medicare health insurance cover should be able to offer some services that will give you basic relief.

Based on these conditions, Medicare meets the qualification of being a health insurance. Given that Medicare has more advanced parts and Medigap options, it beats the benefits of some of the private health insurance covers.

After Hitting 65, Private Medical Insurance Covers Are Secondary

The scheme was established to take care of senior citizens who might not have the same energy and zeal to pay for private cover. Many of these are automatically enrolled to the scheme when they hit 65 but some still ask – Do I need health insurance if I Have a Medicare?

The answer is not direct, rather, it is a case of yes and no. ‘Yes’ if you feel that the options offered are limiting you and you want a broader coverage. The answer could also be ‘No’ if you enroll in all parts of Medicare including the Medigap.

However, based on an improvement to Medicare, choosing to retain private insurance might be seen to be a luxury.

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