Can You Have Both Private Insurance and Medicare?

Key takeaways:

If you have Medicare and another health insurance plan, Medicare may be the primary or secondary payer. You may not have any cost-sharing responsibility when you receive care.
If Medicare is your primary payer, it will pay first and your other plan may cover remaining expenses. If Medicare is secondary, the other plan pays first and Medicare may cover all, part, or none of the remaining cost.
Even with a primary payer and a secondary payer, you may still have out-of-pocket costs for your healthcare.

If you have private insurance through an employer or a union when you become eligible for Medicare, your existing plan may be the primary payer. That means it may cover your healthcare costs before Medicare does. But depending on your coverage, the other plan may be secondary to Medicare.

Various factors may affect your decision to keep or drop your employer health insurance when you have Medicare. These factors include whether you or your spouse has certain employer coverage and whether you have creditable drug coverage — a prescription medication plan that meets Medicare’s minimum standards.

Here’s what you need to know about how Medicare can work with private insurance plans and Tricare, and how to get the most out of a combination of insurance payers.

Can you use Medicare with private health insurance?

You can, but it’s not required. Medicare (including Medicare Advantage) can be combined with other types of health plans, including Tricare military health insurance.

Your 7-month, first-time Medicare enrollment period begins 3 months before your 65th birthday, includes your birth month, and ends 3 months later. Most people should enroll in Part A during that initial enrollment period even if you also have employer coverage or another plan, unless you want to continue contributing to a health savings account (HSA).

You can join Medicare Part B after that period ends — without late enrollment penalties — if you have other coverage similar in value to Medicare, such as an employer-sponsored plan, and that plan is the primary payer. But you must sign up for Part B during a special enrollment period up to 8 months after you or your spouse’s employment ends or your coverage ends (whichever happens first).

Even if you or your spouse is working, Medicare requires that you have creditable drug coverage. If your existing plan does not qualify, you must buy a Part D plan, or you’ll owe a Part D late enrollment penalty. You’ll have to pay this premium upcharge every month you have Medicare Part D.

What is primary and secondary insurance?

If you have more than one health insurance plan, one plan will pay first and the other plan typically pays second — if the care provided is covered. The plan that pays first is known as your primary insurance or primary payer. The other plan is known as your secondary insurance or secondary payer.

Typically, the first plan pays up to the limits of its coverage. The second plan pays only if there are costs the first plan didn’t cover, but it may not pay all the remaining expenses.

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Medicare Part D prescription plan prices: Hefty price tags for specialty medications and weight-loss drugs approved to treat other conditions are reasons for higher Part D premiums and out-of-pocket costs.
Medicare and prior authorization: Advance approval is common for Medicare Advantage, but a prior authorization pilot program begins in 2026 for some original Medicare Part B services in six states.
Tricare with Medicare: If you have original Medicare and Tricare for Life, Medicare is your primary payer and Tricare for Life will pick up out-of-pocket costs for your Medicare-covered services.

How does Medicare work with other insurance?

Medicare and your other insurance plan coordinate their benefits to avoid duplicate payments. Whether Medicare is primary or secondary typically depends on the other insurance plan.

Here are examples of when Medicare is the primary or secondary payer.

Your situation and type of insurance in addition to Medicare	How Medicare pays
You are working at age 65 and older and are covered by your or your spouse’s employer group health plan (GHP) and the employer has fewer than 20 employees.	Primary
You are working at age 65 or older and are covered by your or your spouse’s GHP and at least one employer has 20 or more employees.	Secondary
You are self-employed at age 65 or older and are covered by your or your spouse’s GHP and at least one employer has 20 or more employees.	Secondary
You are disabled and are covered by your or your family member’s GHP and at least one employer has 100 or more employees.	Secondary
You have end-stage renal disease (ESRD) and are covered by a GHP or COBRA in the first 30 months of Medicare eligibility or entitlement (eligibility through means other than age).	Secondary during the 30-month coordination period for ESRD
You are 65 and older and covered by Medicare and COBRA.	Primary
You are disabled and covered by Medicare and COBRA.	Primary
You are 65 and older with an employer retirement health plan.	Primary
You are entitled to Medicare and are covered under workers’ compensation because of a job-related illness or injury.	Medicare typically doesn’t pay for injury, illness, or disease covered by workers’ compensation. But it may make a conditional payment when there is evidence that the workers’ compensation or insurer won’t pay promptly.

Can you choose your primary payer depending on the care you need?

You do not get to choose which health plan (Medicare or private insurance) pays for your services. Your primary and secondary coverage depends on how you get insurance — not on the type of healthcare that you need. That said, you can make Medicare your primary insurer by dropping the other insurance. Or Medicare is typically the secondary payer if you have group health insurance from an employer with 20 or more workers.

Are there exceptions that affect whether Medicare can be your primary or secondary coverage?

There are a few special situations to keep in mind:

If you have employer health insurance and Medicare but get services outside your insurance network(s), it’s possible that neither Medicare nor your insurance plan will pay for the care.
If you get healthcare services from the Indian Health Service and have a tribal group health plan, Medicare pays first.
If you get veterans health benefits, the location of your treatment determines the primary insurance payer. If you go to a Veterans Affairs (VA) location (or get preauthorization for care elsewhere), your VA benefits will cover the expenses. If you go to a non-VA facility for services that the VA has not authorized, your Medicare coverage will kick in only if the care is authorized by your Medicare plan.
Medicare does not pay for treatment covered under the Federal Black Lung Program.

Where can I get help finding out whether Medicare is primary or secondary to my other insurance?

If you’re not sure whether Medicare is your primary or secondary policy, you can check with your employer or private insurer or call Medicare’s Benefits Coordination & Recovery Center at 1-855-798-2627 (TTY: 1-855-797-2627). You can also get free help with questions and benefits coordination from the State Health Insurance Assistance Program (SHIP) in your state, Washington, D.C., Guam, Puerto Rico, or the U.S. Virgin Islands.

How to get the most out of your combination of health insurance plans

To make the most of your health insurance plans, you’ll need to understand their rules, benefits, and costs. Typically, it makes sense to enroll in Medicare Part A (hospital insurance) when you’re first eligible, since most enrollees don’t pay premiums.

As for Medicare Part B (medical insurance): In some cases, you’re better off delaying your enrollment until after your employer coverage has ended and you are eligible for a special enrollment period. That way, you can avoid paying Part B premiums and you aren’t subject to the late-enrollment penalty.

But some employers require workers who are eligible for Medicare to sign up for it and will refuse to pay for any claims until they enroll. It’s also important to tell your healthcare professionals if you have multiple insurance plans so that they know your care could have primary and secondary payers.

Which factors affect how you build your health coverage?

Several factors will determine the best structure for your health insurance coverage, including:

Whether you have health insurance other than Medicare
Whether your spouse has health insurance other than Medicare (and whether you’re covered by that plan)
Whether you are satisfied with the health professionals or hospitals in your private plan’s network
Whether you have creditable drug coverage without buying a Part D plan
The out-of-pocket costs of both the primary and secondary insurance

Here are some potential financial responsibilities to consider if you have Medicare and another insurance plan:

Part D out-of-pocket costs, which depend on your plan’s formulary
Vaccine out-of-pocket costs
Telehealth out-of-pocket costs
Other out-of-pocket costs of having healthcare coverage and accessing services, including premiums, deductibles, copayments, and coinsurance

Frequently asked questions

Not necessarily. If you can afford the premiums (or have no premium for Part A only), it may be worth your while to maintain both plans and have them work together. That way, one will be the primary payer and the other may be able to help you cover out-of-pocket costs related to your healthcare services.

Yes, if you or your spouse is still working at age 65, you can have private insurance such as a group health plan. If you are not eligible for premium-free Part A and you are 65 or older, you can buy private insurance instead of enrolling in Medicare. If you are not receiving Social Security benefits and you turn 65, you can also buy a private plan. One caveat: If you ever change your mind, you can face late-enrollment penalties.

You may be able to realize tax savings depending on the two health insurance plans you have. For instance, if you have Medicare and a private health plan with an HSA, you can use tax-advantaged funds from the HSA to pay for your Medicare premiums. But once you have Medicare, you can’t make new contributions to the HSA.

The bottom line

Sorting out how Medicare works with other types of insurance can feel overwhelming. But understanding how your health plans work together can help you make the most of what’s available to you.

Generally, if you get health insurance coverage through a large employer, that insurance will be your primary payer and Medicare will be your secondary payer. If your insurance is provided by an employer with fewer than 20 employees or you get retiree healthcare benefits from a former job, Medicare is your primary payer.

It’s also important to make sure you have enough healthcare and prescription coverage to delay Part A, Part B, and Part D enrollment without penalties. These penalties will be ongoing premium upcharges when you switch to Medicare coverage.

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Written by:

Beth Braverman

Beth Braverman is a freelance writer who has covered health care, personal finance, and parenting for more than a decade. A former Money magazine staffer, Beth has worked as a B2B magazine editor and a newspaper reporter.

Edited by:

Cindy George, MPH

Cindy George, MPH, is the senior personal finance editor at GoodRx. She is an endlessly curious health journalist and digital storyteller.

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