Individual Insurance Coverage and Medicare Benefits

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Individual Insurance Coverage and Medicare Benefits

Individuals who are eligible to receive Medicare benefits may already have individual insurance coverage. It may be beneficial for the individual to retain this private insurance when they elect to take Medicare.

Here are a few helpful facts about Medicare benefits and individual insurance coverage:
• Not all private individual insurance coverage allows the policy holder to be covered under Medicare while retaining the individual insurance. This information should be contained in Evidence of Coverage or Explanation of Benefits.

• Medicare will be the primary insurer if Medicare coverage and individual insurance coverage is allowed. A primary insurer is the insurer that pays a claim first.

• One reason to keep an individual insurance policy is that it may provide better coverage for prescription drugs than Medicare does. If one does not enroll in Medicare Part D, which is the prescription drug coverage under Medicare, there is not a penalty to enroll if one can prove they have an individual policy that is superior to Medicare coverage. If one chooses to terminate the individual policy they must enroll in Part D at least within a 63 day period after the individual prescription policy ends.

• Other reasons to keep individual insurance coverage are if the policy has other benefits greater or more extensive than Medicare.

If individual insurance coverage will allow the policyholder to maintain coverage while receiving Medicare benefits it can be a wise choice to retain the individual policy.



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