A company in PA has over 20 employees. Can they have a stated policy that if employee hits age 65 that they can no longer stay on the "regular" group health insurance and if they want to retain employer sponsored coverage that they MUST go onto the GROUP Medicare plan?
Group Medicare Plan
- Thread starter aheff
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I'm pretty sure they can, but I don't profess to know all the rules for the under 65 health market either.
Devin01
Guru
- 430
It is my understanding that the employer is NOT Allowed to force the employee off the Group and onto to Medicare .
It is my understanding that a Group Medicare Plan is typically only offered for groups under 20, it is a different situation if they are retired for Group Medicare Plans .
We have a handful of our brokers who offer Group Medicare in the less then 20 lives market and sometimes the employers incent the employee onto the Group Medicare plan (under 20 employees) and is allowed to pay for the premium. I know this is legal for under 20.
But I do not believe you are asking the under 20 Question. For over 20 I do not believe you can force someone off the plan.
If the company has 20 or more employees, it must offer the same coverage to those 65 years or older as it does to younger employees. The company cannot modify coverage or charge more. The employee can choose to keep the group health coverage or drop it and enroll in Medicare.
A company with fewer than 20 employees has two options:
It is my understanding that a Group Medicare Plan is typically only offered for groups under 20, it is a different situation if they are retired for Group Medicare Plans .
We have a handful of our brokers who offer Group Medicare in the less then 20 lives market and sometimes the employers incent the employee onto the Group Medicare plan (under 20 employees) and is allowed to pay for the premium. I know this is legal for under 20.
But I do not believe you are asking the under 20 Question. For over 20 I do not believe you can force someone off the plan.
If the company has 20 or more employees, it must offer the same coverage to those 65 years or older as it does to younger employees. The company cannot modify coverage or charge more. The employee can choose to keep the group health coverage or drop it and enroll in Medicare.
A company with fewer than 20 employees has two options:
- It can exclude those 65 and older from group coverage. Those employees would enroll in Medicare.
- It can let those 65 and older keep the coverage. In this case, the group plan generally becomes secondary to Medicare. The 65-year old employee would need to enroll in premium-free Medicare, Part A, during the Initial Enrollment Period. The group health plan would help pay for eligible expenses that Medicare didn’t cover. If the plan’s drug coverage was creditable (meaning paying at least the same as a Part D plan would), there would be no need to enroll in a Medicare prescription drug plan.
If they are over 20 employees they can't make them go onto medicare. If they have a Medicare carve out plan they may be able to , but don't quote me on that. (*Edit , Wrong ! )
If they are under 20 employees they still can't make them go onto medicare, but the group plan is within their rights to ONLY pay as a secondary.
If they are under 20 employees they still can't make them go onto medicare, but the group plan is within their rights to ONLY pay as a secondary.
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Devin01 is spot on. First, this is blatant age descrimination. The employer cannot treat anyone differently just because of their age. If I were there, I would get together the 65+ employees and march to the EEOC or a labor attorney. Second, TEFRA is Federal law that states that Medicare is the secondary payer to an employer group plan for EGHPs at companies of 20+. To force anyone to get Medicare Part B, and then force them into a plan designed to pay as Medicare primary is a deliberate attempt to circumvent Medicare Secondary Payer rules and stick Medicare with the claims. If the employer pays for Medicare Part B or a Medicare plan premium to incentivize people to move, that is also Medicare fraud, and CMS and Social Security would love to know about it.
I know it's not the same as forcing them to go into Medicare, but yet it is.
Thinking on this some more.
Get a copy of the SPD. See what it says. If you don't like it, call the DOL.
BUT if the SPD states that age 65, you move into their O65 plan, which requires Medicare A&B (you didn't specify if B is required) AND the employer O65 plan keeps the employee cost neutral, I don't think you've got a complaint.
BTW, for those screaming age discrimination, think about the people under 40. The insurance costs are a minimum of 5x higher when you compare age 30 to 60. Why are they subsidizing people over age 65 who are Medicare eligible?
(And no, I do NOT want to discuss the 3x rule in ACA, which is a huge issue.)
Get a copy of the SPD. See what it says. If you don't like it, call the DOL.
BUT if the SPD states that age 65, you move into their O65 plan, which requires Medicare A&B (you didn't specify if B is required) AND the employer O65 plan keeps the employee cost neutral, I don't think you've got a complaint.
BTW, for those screaming age discrimination, think about the people under 40. The insurance costs are a minimum of 5x higher when you compare age 30 to 60. Why are they subsidizing people over age 65 who are Medicare eligible?
(And no, I do NOT want to discuss the 3x rule in ACA, which is a huge issue.)
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are you speaking about "active" employees, or, "retired"?
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An employer of an actively working Medicare beneficiary or his/her spouse with 20 or more employees may not refuse to cover or offer different coverage to the Medicare beneficiary.
The employer can’t even offer another option. They can’t do anything that might in anyway try to persuade or incentivize a beneficiary to leave the same coverage everyone else at the company has. They can’t make them pay more for it, either.
Group Medicare may be a good option for employers with fewer than 20 employees or for retirees, but it’s a no go otherwise.
The employer can’t even offer another option. They can’t do anything that might in anyway try to persuade or incentivize a beneficiary to leave the same coverage everyone else at the company has. They can’t make them pay more for it, either.
Group Medicare may be a good option for employers with fewer than 20 employees or for retirees, but it’s a no go otherwise.
