Enroll in Medicare Part B or delay it?

[WCMason]

Thanks to everyone for their responses.

The group health plan is with Blue Cross Blue Shield of Texas (BCBS-TX). It is a high-deductible HSA-qualified plan. (Joe realizes he will not be able to contribute to the HSA savings account come January).

This afternoon, Joe contacted BCBS-TX customer service, and was told the following: Joe needs to sign up for Medicare Part A, but not for Medicare Part B. BCBS-TX will be primary for the services normally covered by Part B, and Medicare will be primary for the services covered by Medicare Part A. Once he retires at age 70, he will not face a penalty when signing up for Part B. Also, the prescription drug coverage under his BCBS-TX plan is creditable coverage, so he does not need to sign up for Medicare Part D at this time.

Unfortunately, the BCBS-TX customer service representative could not give Joe this information in writing. So Joe has to trust that the BCBS-TX customer service representative is correct. He is not sure he wants to take that chance, and may sign up for Part B anyway.

If I gave advice that bad I wouldn't want to commit it to writing either. Medicare A and B are either primary or they're not. This is based on the number of employees on the payroll, regardless of whether they are full-time, part-time, on the health plan or not.

 

[kgmom219]

Thanks to everyone for their responses.

The group health plan is with Blue Cross Blue Shield of Texas (BCBS-TX). It is a high-deductible HSA-qualified plan. (Joe realizes he will not be able to contribute to the HSA savings account come January).

This afternoon, Joe contacted BCBS-TX customer service, and was told the following: Joe needs to sign up for Medicare Part A, but not for Medicare Part B. BCBS-TX will be primary for the services normally covered by Part B, and Medicare will be primary for the services covered by Medicare Part A. Once he retires at age 70, he will not face a penalty when signing up for Part B. Also, the prescription drug coverage under his BCBS-TX plan is creditable coverage, so he does not need to sign up for Medicare Part D at this time.

Unfortunately, the BCBS-TX customer service representative could not give Joe this information in writing. So Joe has to trust that the BCBS-TX customer service representative is correct. He is not sure he wants to take that chance, and may sign up for Part B anyway.

LD...STOP. You're killing me. Its a fully insured group in TX. Not a self-funded group in wherever. Rules are different.

OP...now I am 100% sure that he is fine. If he wants more info, then:

1. Have his employer email their broker, to get in writing (they can get it from their BCBS rep)
2. Call BCBSTX group customer service (on his card)and confirm that the group plan is primary over Medicare. The rep can give him that info and tell him to make sure he gets the reference number to the call
3. Call BCBSTX Medicare Customer service and get the info verified and again, the reference number to the call.

If he still wants to pay the $134, carpe diem! (As long as he calls you later for the Supplement!) Does he realize his wife and dependents can get 36 months of State Continuation? That small of group wants him off the plan.
Plus, unless its a small group paying a significant portion of the premium, its going to save him money (if 36 months is enough).

 

[kgmom219]

I have handled a number of clients where group health and Medicare were involved but have never come across a situation where the plan, or Medicare, was primary for one type of claim and secondary for another.

Seems to me it is one or the other but not both.

I love you and no

You can be on non-MSP group, Part A only and they do COB for anything that Part A covers. I could give you names and DOS, except that silly HIPAA law. I see this quite a bit, with people who own the company and are at max IRMAA or a drug cost issue. Or they just don't want to deal with Medicare. Or the wife is a lot younger and didn't work 40 quarters. Whatever. Sometimes staying on the group makes sense. But not usually.

 

[LostDollar]

Here is a page for links for some sample BCBSTX policies:

Policy Documents | Blue Cross and Blue Shield of Texas

Here is a policy out of that list:

https://www.bcbstx.com/static/tx/pdf/policy-forms/rsh2.pdf

Scrolling to doct page 76 (pdf page 88) there is a section called Medicare.

That suggests that BCBSTX is using an Active/Retired employee status (for this policy at least) to determine whether they will pay primary or secondary to Medicare.

Joe or OP could find Joe's specific policy in the lists and check the Medicare paragraph language in that policy.

 

[somarco]

Clarification for kgb. I should have noted my response was specific to the OP's situation.

Yes, if fewer than 20 then Medicare is primary but it is primary for A & B, not A only or B only.

Now if you know of a situation where, under or over 20 employees, where group is primary for A but not for B, please enlighten me. I just have not run across that situation.

From OP's post #8 . . .

Joe needs to sign up for Medicare Part A, but not for Medicare Part B. BCBS-TX will be primary for the services normally covered by Part B, and Medicare will be primary for the services covered by Medicare Part A.

I still call BS on this response.

 

[LostDollar]

1. LD....you are talking about an self-funded plan. The rules were laid out by the employer, not a carrier. You can't get carrier specific.

The self funding business is a wrinkle I do not understand, but I believe all of the sample plans one finds online for one of the nation's top five health insurors are written with language that says the insurance carrier pays second to Medicare if the insured employee is eligible for Medicare coverage. I got that message consistently from about 6 email and phone customer service contacts, a denied claim appeal letter and reading in 3-5 sample policies.

 

[FPin]

Thanks again for everyone's response. I have a feeling Joe will sign up for Part A and Part B, just to be safe.

 

[kgmom219]

You guys are going to LOVE this answer.

There's not a consensus. 5 people in various areas at the same carrier, all of whom should know. Its past the *** level. They are contradicting each other. Seriously. The group email finally came back with "I would enroll in Part B, but we can't give you a solid reason why".

So I called a client, group under 20, maxed out IRMAA, wife is 10 years younger. Had surgery last year. Told him what was going on, asked if there had been any claims issues. His response? "I don't know. I guess not. If I had any problems, you would have already known. So no?"

There ya go. Spend the $134.

 

[somarco]

The real answer is . . . "it depends" . . . . .

But the goofball that said Medicare was primary for A while the group was primary for B wins the prize.

 

[Carole Eleanor]

Joe needs to check with his Employer's Insurance Admin person. If the coverage he has is considered "credible" then he wouldn't be penalized. He needs to ask the employer plan admin person if he is required to enroll in his Part B Medicare. Just make sure that there is a clear understanding of what and how the employer plan was written. Good luck.