Can you have Medicare and BCBS at the same time? A comprehensive guide to your coverage options

According to the Centers for Medicare & Medicaid Services, millions of Americans coordinate their Medicare with other health coverage, including private insurance. This can lead many seniors to ask: Can you have Medicare and BCBS at the same time? The answer depends on your specific plan types and how you choose to structure your benefits.

Quick Summary

Many individuals can have Medicare and Blue Cross Blue Shield (BCBS) coverage simultaneously through several common scenarios, such as enrolling in a Medigap plan or coordinating with an employer-sponsored plan. The specific arrangement determines which insurer pays first and what your out-of-pocket costs will be.

Key Points

• Three Main Scenarios: You can have Original Medicare plus a BCBS Medigap policy, a BCBS Medicare Advantage plan (which replaces Original Medicare), or Original Medicare combined with an employer-sponsored BCBS plan.

• Coordination of Benefits: When you have more than one plan, a process called coordination of benefits determines which insurer pays first and which pays second.

• Medigap vs. Advantage: A BCBS Medigap plan works with Original Medicare to cover out-of-pocket costs, while a BCBS Medicare Advantage plan is an all-in-one alternative that replaces Original Medicare.

• Employer Coverage: If you have an employer-sponsored BCBS plan, the size of the employer determines if Medicare is the primary or secondary payer.

• No Medigap with Advantage: You cannot use a Medigap policy to cover costs if you are enrolled in a Medicare Advantage plan; these are mutually exclusive options.

Yes, You Can Have Medicare and BCBS: Here’s How

Navigating your healthcare options can be confusing, but understanding how Medicare works with private insurance, like a Blue Cross Blue Shield (BCBS) plan, is a key step toward making informed decisions. It is indeed possible to have both, but the way your coverage works depends on the type of BCBS plan you have.

Scenario 1: Original Medicare and a BCBS Medigap Policy

One of the most common ways to combine these coverages is to have Original Medicare (Part A and Part B) along with a Medicare Supplement Insurance (Medigap) policy from BCBS. Medigap policies are sold by private insurance companies to help pay for some of the costs that Original Medicare doesn't cover, such as deductibles, copayments, and coinsurance.

How a Medigap plan works with Original Medicare:

• Medicare Pays First: When you receive care, Original Medicare pays its share of the Medicare-approved amount for covered health services.
• Medigap Pays Second: Your BCBS Medigap policy then pays its share of the remaining costs, up to the limits of your specific plan.
• No Double-Dipping: It’s important to remember that a Medigap policy only works with Original Medicare and cannot be used with a Medicare Advantage (Part C) plan.

Scenario 2: A BCBS Medicare Advantage (Part C) Plan

Another option is to get your Medicare benefits through a private insurer like BCBS, via a Medicare Advantage plan. These are all-in-one alternatives to Original Medicare and are sold by BCBS on behalf of the federal government. When you enroll in a Medicare Advantage plan, you are no longer in Original Medicare.

How a Medicare Advantage plan works:

• Replaces Original Medicare: A BCBS Medicare Advantage plan must cover everything that Original Medicare does, but it can also offer additional benefits like vision, dental, hearing, and wellness programs.
• Single Plan: All your Medicare-covered services are provided through the private BCBS plan, which may operate as an HMO or PPO.
• Network Restrictions: Unlike Original Medicare, which allows you to see any provider who accepts it, Medicare Advantage plans often have specific provider networks.

Scenario 3: Original Medicare and Employer-Sponsored BCBS Coverage

If you or your spouse is still working and you are enrolled in Medicare, you can have an employer-sponsored BCBS plan simultaneously. In this case, a process called coordination of benefits determines which plan pays first.

How employer coverage coordinates with Medicare:

• Company Size Matters: The size of the employer determines the payment order. If the employer has 20 or more employees, the employer-sponsored plan generally pays first. If the employer has fewer than 20 employees, Medicare typically pays first.
• Secondary Payer: The plan that pays second may cover some or all of the costs not covered by the primary payer.
• Consider Your Needs: You must weigh the costs and benefits of keeping your employer plan versus moving to a Medicare-only or Medigap-based option. Some people might find that their retiree coverage works much like a Medigap policy, offering additional benefits that fill in Medicare's gaps.

Comparison Table: Medicare and BCBS Scenarios

Feature	Original Medicare + BCBS Medigap	BCBS Medicare Advantage (Part C)	Original Medicare + Employer BCBS
Number of Cards	Two (Medicare & BCBS)	One (BCBS)	Two (Medicare & BCBS)
Primary Payer	Medicare	BCBS	Varies by employer size
Coverage Type	Original + Supplemental	All-in-one alternative	Original + Employer Group Health
Network	National (any provider accepting Medicare)	Often restricted (HMO/PPO)	Dependent on employer plan
Extra Benefits	Some plans offer foreign travel coverage	Often includes vision, dental, etc.	Dependent on employer plan
Cost Structure	Premiums for both plans, fixed copays	Often includes premiums, copays, out-of-pocket maximum	Premiums for both plans (varies)

Choosing the Right Combination for You

Your decision should be based on your personal health needs, financial situation, and lifestyle. Consider these factors:

• Your healthcare usage: Do you prefer the freedom to see any doctor, or are you comfortable with a network? Those who travel frequently might prefer Original Medicare with a Medigap policy due to its nationwide coverage.
• Your budget: Compare the premiums for a Medigap policy versus a Medicare Advantage plan. Also, consider the potential for out-of-pocket costs, as Original Medicare has no maximum, while Advantage plans do.
• Your desired benefits: Do you need extra benefits like dental, vision, and hearing coverage? If so, a Medicare Advantage plan might be a better fit.
• Your coordination of benefits: If you're on an employer plan, talk to your benefits administrator to understand how your coverage works with Medicare before making any decisions.

Making Your Decision

Understanding the interplay between Medicare and BCBS is crucial for securing the best possible health coverage. Once you've assessed your needs and weighed the pros and cons of each scenario, you can make an informed choice. It is always recommended to compare the specific plans available in your area and consider all aspects of your health and financial picture. For a detailed guide on coordinating benefits, the official Medicare website is an excellent resource.

Frequently Asked Questions

Can I have a Blue Cross Blue Shield Medicare Advantage plan and a Medigap plan at the same time?

No, you cannot. A Medicare Advantage plan is an alternative to Original Medicare. Medigap policies are designed specifically to work alongside Original Medicare to cover its out-of-pocket costs. You must choose one path or the other.

If I have an employer-sponsored BCBS plan, do I need to sign up for Medicare?

Not always. It depends on your employer and the size of the company. If the employer has 20 or more employees, your employer plan typically pays first. If fewer than 20, Medicare usually pays first. You should contact your employer's benefits administrator to understand their specific rules.

How do I know if my employer's BCBS plan or Medicare pays first?

This is determined by coordination of benefits rules. The general rule is that for employers with 20+ employees, the employer plan is primary. For those with fewer, Medicare is usually primary. It's best to contact your employer's benefits administrator or the Medicare Coordination of Benefits Contractor for certainty.

What is the primary benefit of choosing a Medigap plan from BCBS?

A Medigap policy helps fill the 'gaps' in Original Medicare by covering costs like deductibles and copayments. This can significantly reduce your out-of-pocket expenses and provides greater predictability in your healthcare spending.

Why would someone choose a BCBS Medicare Advantage plan over Original Medicare and a Medigap policy?

Medicare Advantage plans often bundle additional benefits not included in Original Medicare, such as dental, vision, hearing, and prescription drug coverage, into a single, comprehensive plan. Many plans also have an annual out-of-pocket maximum, which Original Medicare does not.

Can I use my BCBS plan's provider network with my Medicare coverage?

This depends on the type of plan. If you have Original Medicare with a BCBS Medigap plan, you can see any doctor or visit any hospital in the U.S. that accepts Medicare. If you have a BCBS Medicare Advantage plan, you may be restricted to a specific network of providers.

What is the first step I should take if I want to combine Medicare and BCBS?

Your first step should be to assess your current and future healthcare needs, including your budget and whether you need benefits beyond what Original Medicare offers. From there, you can compare the different plan options—Medigap or Medicare Advantage—and check with your employer if that's a factor.