Still working at age 65 & on employer group health plan: Is Medicare Primary?

sgeertsen

[font size="1" color="#FF0000"]LAST EDITED ON 05-12-03 AT 08:26AM (CST)[/font][p]Here are the facts: The employee is still working at age 65, has been participating in the employers group health plan and will start social security and medicare benefits.
Questions:
If the employee stays in the employers group health plan, which is primary - Medicare or the group plan?
Does the employer have any rights to terminate or change the ee's coverage or decide which plan is primary?
Can the employer change any other insurance coverage because of age (like dental)?

Hunter1

I'll be the first to try to answer:

Your group plan will be primary as long as you continue to work
The employer cannot determine which is primary
The employer can change your plan, just like other employees
I'm more uncertain about the answer to changes in other benefit plans, but I would hazard a guess that those benefits would have to be continued or it would be age discrimination.
My opinions

lorrie

Does your health insurance Master Plan Document outline how coverage for your plan is coordinated with Medicare? According to our plan document, "Federal legislation requires that active employees age 65 and over be given the option to elect either the employer's plan or medicare as primary coverage."

I am not familiar with how the employee goes about choosing one or the other, or what the benefits to the employee or the employer are for either option.

E Wart

E Wart
It is my understanding that the law changed probably 20 years ago (shows how old I am) where group insurance stays primary for someone over 65 who has group coverage and becomes eligible for Medicare. However, I can't remember the exact date (shows how old I am.) This was put in place to attempt to "save money and the Medicare program." Anyway, I understand that you can't make the decision which is primary. Nor would I get into designing different programs for different age groups, I think you call that discrimination. (Do you have different insurance for someone under 20?)
You should talk with your TPA or Insurance carrier on this and make sure you document reads properly and meets any legal requirements.
There are a couple of things you can do, once you iron this out. First educate your employees. We have the hardest problem with the hosptial and doctors who when they hear Medicare or Medicad, write it down as the primary carrier. Make sure your employees understand and that they insist any time they give their cards to a provider to educate and insist to those providers to bill your carrier first. (Can get to be a big mess if they don't.) We have had to go back and repay Medicare for thousands of dollars in bills from several years ago that the doctor billed incorrectly and we didn't know about. I assure you Medicare will find you and the people they contract with to process these are extremely hard to deal with.
The next thing to do is have any and all of your employees who have anyone on Medicare who is also covered under your plan to call 800-999-1118 and let Medicare Coordination of Benefits section know they have other coverage. (The covered person has to call. Medicare won't talk with you.) They will need to know the Employer's name and address and your insurance companies name and address, phone, no. employees covered under your plan (more or less than 100) and policy no. (I have a sheet thatI give to employees as soon as I learn someone is eligible for Medicare. It giving them all this info so that they will have it and take care of it as soon as possible.) What this does is ear mark any Medicare claim so it won't be paid without your companies EOB. Then you don't get into the problem of "repaying" Medicare two years later.
The last thing you can do is in your insurance policy, if you have an "out of pocket maximum", state that if an "employee has other health coverage from any other source where coordination is allowable, including Medicare, Medicaid, and CHAMPUS coverage, the coinsurance limit does not apply." This way you still share the bills with the other carrier and don't pay 100% after a certain out of pocket is reached.
One more thing, if an employee is on your group coverage and has Medicare and then terminates. They can elect COBRA. However, if an employee terminates and elects COBRA and then becomes eligible for Medicare, they can no longer be covered under COBRA (whether or not they take the Medicare) since they now have an option for another insurance.
Sorry this is so long. Hope it helps.

lorrie

We hire an independent benefit services group to administer our health plan, as well as keep our plan document updated, which is done every year. I appreciate the information you have given here. I will be checking with our group to correct our information!

I did not post the original question here, but I am certainly learning from the other responses. Thank you!

Tarri Akerman

AS AN INSURANCE BROKER WITH BELLGROUP FINANCIAL IN TEXAS, IF YOU EMPLOY LESS THAN 20 LIVES OR OVER 100, MEDICARE IS PRIMARY WITH THE GROUP PLAN PAYING SECONDARY.

njjel

Not being familiar with this at all I am going to assume that what the above post says is not state specific?

Hunter1

Please tell us where this information comes from, administrative rules, or whatever. I'd love to have my group pay secondary!

Hunter1

This answer bothered me a great deal, so I did some research, and here's what I found: Federal law requires that employers offer employees over age 65 the same coverage as under 65. The employee is free to reject employer coverage and retain Medicare as primary. If the employee retains employer coverage, it is primary. There are some exceptions. More info can be found at: [url]http://cms.hhs.gov/medicare/cob/providers/pro_egh.asp[/url]
This is a particular page in the Centers for Medicare and Medicaid Services web site. More information than you wanted to know!