Medicare

Have Medicare and Other Insurance? Here’s How to Coordinate Your Benefits for 2026

If you have Medicare along with other insurance coverage—like a retiree plan from your former employer, a spouse’s health plan, or Medicaid—you might be wondering how all these pieces fit together. Understanding “coordination of benefits” is crucial to maximizing your coverage and avoiding costly mistakes during AEP.

This guide will help you navigate how Medicare works with other coverage for 2026.

The Golden Rule: Who Pays First?

When you have multiple forms of health insurance, they don’t both pay full amounts. Instead, one acts as the “primary” payer, and the other as the “secondary.” The primary payer pays what it owes on your bills first, and then the secondary payer may cover some of the remaining costs.

Here’s how to determine which of your coverages is primary.

If you have Employer Coverage (from current work):

  • If your employer has 20 or more employees: Your employer plan is primary, and Medicare is secondary.
  • If your employer has fewer than 20 employees: Medicare is primary, and your employer plan is secondary.

AEP Tip: If you have creditable employer coverage, you may not need to enroll in a Medicare Part D plan. Check with your benefits administrator to avoid late enrollment penalties.

If you have Retiree Insurance or COBRA:

  • Medicare is primary.
  • Your retiree coverage or COBRA is secondary.

AEP Tip: During Open Enrollment, you can review your Medicare options (like a Medicare Advantage Plan) that might offer more comprehensive benefits than your retiree plan alone.

If you have Medicaid:

  • Medicare is primary for Medicare-covered services.
  • Medicaid is secondary and may help pay for costs that Medicare doesn’t cover, like copayments, coinsurance, and deductibles.

AEP Tip: If you have both Medicare and Medicaid (are “dual-eligible”), you may qualify for a Special Needs Plan (SNP) that is specifically designed to coordinate your benefits and often includes extra benefits.

3 Steps to Ensure Seamless Coverage for 2026

  1. Notify All Your Insurers
    Always make sure every one of your insurance companies knows about your other coverages. This ensures claims are correctly routed and paid.
  2. Review Your Current Coverage
    During AEP, look at how your primary and secondary plans worked together this past year. Were there still significant out-of-pocket costs? A different Medicare Advantage Plan might offer lower out-of-pocket maximums that work better with your secondary insurance.
  3. Ask the Experts
    Coordination of benefits is complex. A simple mistake could lead to denied claims or unexpected bills.

We Can Help You Navigate the Complexity

Figuring out how your Medicare plan coordinates with other insurance can be confusing. The licensed advisors at Medicare.social are experts in this area.

We can help you:

  • Understand exactly how your current plans work together.
  • Determine if your existing coverage is the most cost-effective combination.
  • Find a 2026 Medicare plan that optimally coordinates with your other insurance.

Don’t leave your coverage to chance. Schedule a free, no-obligation consultation with a Medicare.social expert today. We’ll ensure all your insurance pieces fit together perfectly for 2026.