Key Takeaways

• Enrolling in both Medicare Part C and a PSHB plan may seem like you’re doubling your coverage, but it often results in higher costs and reduced coordination of benefits.

• PSHB plans already provide comprehensive health coverage. Adding a Medicare Advantage (Part C) plan could lead to unnecessary premium payments and complications in claims processing.

Understanding What Medicare Part C Covers

Medicare Part C, also known as Medicare Advantage, is a private alternative to Original Medicare. These plans are approved by Medicare and include Part A (hospital insurance) and Part B (medical insurance), often bundled with additional benefits such as prescription drug coverage, vision, hearing, and dental services.

Unlike Original Medicare, Part C is administered by private insurers. That means benefits, provider networks, and out-of-pocket costs can vary widely between plans. Although these plans cap annual out-of-pocket expenses, you must still pay your Part B premium and, in most cases, an additional premium to the Part C plan.

PSHB Plans Are Not Supplements

It’s important to clarify that PSHB plans are not designed to work like Medicare Supplement (Medigap) policies. In fact, PSHB coverage already provides robust benefits that often mirror or exceed what’s offered under many Medicare Advantage plans.

When you enroll in a PSHB plan as a retiree, your plan coordinates with Medicare if you are enrolled in both Part A and Part B. This integration allows your PSHB plan to cover what Medicare does not, reducing your overall out-of-pocket costs.

However, when you add a Medicare Part C plan to the mix, you are essentially enrolling in a second comprehensive coverage option—and both cannot operate as primary insurers simultaneously. This creates overlap, and the plan that gets billed first depends on a hierarchy that can be confusing and prone to delays.

What Happens When You Combine PSHB and Medicare Part C

When you enroll in Medicare Part C, Medicare automatically redirects your coverage to that private Part C plan. In this case:

• Medicare itself no longer pays claims.

• Your PSHB plan may not coordinate benefits with the Part C plan.

• The providers you see may be limited to those in the Part C network, which can exclude providers who accept PSHB.

The result? You may be paying premiums for both plans while only getting the benefit of one. And if you try to use both, billing disputes can arise.

1. You Might Pay for Redundant Coverage

PSHB plans offer comprehensive health insurance, including hospital, medical, and prescription coverage. Adding a Part C plan means you’re now paying premiums for two full coverage systems.

Most Part C plans also require you to keep paying your Part B premium. So instead of supplementing your existing benefits, you’re overlapping them—which often means higher total costs without proportional value.

2. Coordination of Benefits May Not Exist

One of the biggest issues with combining PSHB and Medicare Part C is the lack of coordination. PSHB plans typically coordinate with Original Medicare (Parts A and B), not with private Medicare Advantage plans.

This lack of coordination means:

• Providers may not know how to bill both plans.

• You could receive bills that neither plan wants to cover.

• You may be stuck paying for services you thought were covered.

The billing confusion can take months to resolve and may require you to file paperwork manually or make repeated phone calls to both insurers.

3. Your Provider Access Could Be Limited

Medicare Advantage plans have specific provider networks, which may not include providers who are in-network with your PSHB plan. This restricts your freedom to choose doctors and hospitals.

If you’re used to the nationwide access that PSHB plans offer, enrolling in a Medicare Advantage plan may unexpectedly reduce your access to care. Even if your preferred provider accepts both plans, the billing process could become tangled.

4. You Could Miss Out on PSHB Integration Benefits

Many PSHB plans offer integration features when you enroll in Medicare Part B:

• Waived deductibles

• Lower copayments

• Reduced coinsurance

• Better prescription drug pricing through the Part D EGWP (Employer Group Waiver Plan)

These cost-saving features typically do not apply if you enroll in a Medicare Advantage plan instead. You could lose access to these benefits, even while continuing to pay PSHB premiums.

5. Enrollment Timing Matters

If you’re already enrolled in Medicare Part C, you can disenroll during:

• The Medicare Advantage Open Enrollment Period (January 1 to March 31)

• The Annual Election Period (October 15 to December 7)

Disenrolling from Part C allows you to revert to Original Medicare and reestablish coordination with your PSHB plan. Timing is essential—you may need to act quickly to avoid unwanted overlap in the next coverage year.

6. PSHB Prescription Drug Coverage Is Integrated

Retirees enrolled in PSHB and Medicare will automatically receive prescription drug coverage through a Part D Employer Group Waiver Plan (EGWP). This coverage is typically more robust and offers:

• A $2,000 annual out-of-pocket cap on drug costs

• Access to nationwide pharmacy networks

• Favorable drug pricing agreements

If you enroll in a Medicare Advantage plan with prescription drug coverage (MAPD), you may be forced to give up your PSHB-integrated Part D EGWP benefits. Worse, opting out of the EGWP could permanently limit your future access to drug coverage through PSHB.

7. No Reimbursement for Part C Costs

Some PSHB plans offer Part B premium reimbursements or incentives when you enroll in Medicare Part B. These reimbursements are generally not available for costs associated with Medicare Part C.

If you switch to a Medicare Advantage plan, you could lose these reimbursements. That means you’re no longer receiving the full financial value of your PSHB plan, despite continuing to pay for it.

8. You Could Complicate Your Claims Processing

With Medicare Part C, your claims go directly to the private insurer managing the Advantage plan. If you try to use your PSHB plan in tandem, you might run into issues like:

• Denied claims due to conflicting plan information

• Claims bouncing between insurers

• Out-of-network denials

This not only delays your reimbursements but can also lead to out-of-pocket payments you weren’t prepared for.

What You Should Consider Before Overlapping Coverage

Before enrolling in a Medicare Advantage plan while keeping your PSHB plan, ask yourself:

• Am I gaining any meaningful benefit that PSHB doesn’t already provide?

• Will my providers still be in-network with both plans?

• Do the cost savings of the Advantage plan outweigh the loss of PSHB coordination?

• Am I giving up any reimbursements or integration benefits from PSHB?

Understanding these trade-offs helps ensure you’re not paying for overlapping coverage that provides little extra value.

Better Outcomes Come from Strategic Choices

Your PSHB coverage is designed to integrate with Medicare Parts A and B—not Part C. While the idea of adding Medicare Advantage might seem attractive at first glance, the reality is that it often creates more complications than it solves.

Before making any changes to your current setup, take time to review how your PSHB plan coordinates with Medicare and what specific benefits you might lose or gain. If you’re unsure, speak to a licensed agent listed on this website who can help clarify how these pieces work together in your situation.