Group Medicare Plan

[LostDollar]

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.)

Wouldn't this violate the rules requiring over 65's to be offered the same coverage as under 65's? I'm thinking "same coverage" would go further than just cost.

 

[DS4]

Like WC Mason said, if the 65 yr old ee is still active, and, the employer has more than 20 ee’s, Medicare Data Match will come down on that employer like a ton of bricks

 

[Stephen]

I know it's not the same as forcing them to go into Medicare, but yet it is.

Pretty much. We have a carrier in our state that will still pay as primary on small groups, but will not put it in writing. Makes for an interesting conversation that I have about twice a year.

 

[LostDollar]

Pretty much. We have a carrier in our state that will still pay as primary on small groups, but will not put it in writing. Makes for an interesting conversation that I have about twice a year.

That sounds like an absolutely horrible situation for the employees to be in as far as making health insurance decisions.

 

[junkman]

Under 20 EEs (see COBRA defs) Medicare is primary. Over 20, the employer is primary. All small group carriers that I know of in TN require Parts A & B. Most employees opt for Medicare since they have the open enrollment when Part B starts and because most group plans these days are contributory HDHP plans and don't really benefit those on Medicare.

I've had a dependent spouse on a large employer plan file the claim ONLY with Medicare. Medicare audited and federal law says that the claim is the employer's responsibility. Fortunately, the group was fully insured and the carrier handled the claim only asking that they be given permission to negotiate with Medicare. Stop losses would have run out on any self-funded plan and the employer would have eaten the claim. It could have been large enough to bankrupt some employers.

 

[Stephen]

That sounds like an absolutely horrible situation for the employees to be in as far as making health insurance decisions.

It sure is , not much fun for the employer either.