Med Supp Refund or no?

[somarco]

someone who had a med supp and part a only. The med supp would pay part a as usual and 20% of part b claims.

I had a client with Part A only, an employer group plan as secondary to Medicare, and no Part B.

Outpatient claims went to Medicare and were denied. Then they went to the group carrier, which paid the claim AS IF the person had Part B Medicare.

Then he had outpatient surgery.

He was not pleased.

 

[junkman]

I had a client with Part A only, an employer group plan as secondary to Medicare, and no Part B.

Outpatient claims went to Medicare and were denied. Then they went to the group carrier, which paid the claim AS IF the person had Part B Medicare.

Then he had outpatient surgery.

He was not pleased.

Was it small group ie without COBRA? That wouldbe accurate in that case. We had a large GA group with lots of older senior executives. They would decline Part B until they quit working becausethe employer plan was more comprehensive. They'd buy a Sup under open enrollment when they retired.

 

[atthewood]

I don't see how the co could keep the premium if the client didn't have Parts A & B, requirement to buy Med supp. Also, he should get a refund for the months from June to Jan because he had other coverage. Might be a quetion for your state insurance commissioner.

 

[junkman]

He had Part B when he enrolled. Unless Part B cancelled retro to start, he was eligible to buy it and owes at least 1 month premium.

He'd better check to make sure he can pass underwriting or have a SEP before canceling. He can have group and Medicare and a Sup at the same time so other (group) coverage is not a qualifying event.