Medicare and COBRA 20 Characters

Oct 31, 2015

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  1. somarco
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    somarco GA Medicare Expert

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    Age 67 female, out on disability (work), COBRA eligible 11/15/15, has Medicare Part A.

    She has a lot of medical issues (but not ESRD) and needs to keep current plan/COBRA as long as possible. If she is not able to return to work by 3/15/16 she will be medically retired and can continue COBRA but probably can't afford it.

    Employer funding her COBRA until 3/15/16

    If she takes Part B while on COBRA my understanding is Medicare is primary, COBRA secondary.

    If she delays Part B until the employer stops funding COBRA she does not get an SEP (at least that is the way I read it) and has to wait until the 2017 GEP to sign up then wait until July 2017 for B to be effective.

    That situation won't work either. She will be dead, or broke, or both by then.

    What have I missed? What would you suggest?
     
    somarco, Oct 31, 2015
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  2. LAD
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    LAD New Member

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    Here is what CMS has to say on the matter:

    1. Working Aged (Medicare beneficiaries age 65 or older) and Employer Group Health Plan (GHP):

    1)Individual is age 65 or older, is covered by a GHP through current employment or spouse’s current employment AND the employer has less than 20 employees:
    Medicare pays Primary, GHP pays secondary
    2) Individual is age 65 or older, is covered by a GHP through current employment or spouse’s current employment AND the employer has 20 or more employees (or at least one employer is a multi-employer group that employs 20 or more individuals):
    GHP pays Primary, Medicare pays secondary
    3) Individual is age 65 or older, is self-employed and covered by a GHP through current employment or spouse’s current employment AND the employer has 20 or more employees (or at least one employer is a multi-employer group that employs 20 or more individuals):
    GHP pays Primary, Medicare pays secondary
     
    LAD, Oct 31, 2015
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  3. kgmom219
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    kgmom219 What's Next?

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    You are reading it the same way I would.

    Never use COBRA past age 65.

    Put her on G or N. You can always suspend Part B (and the supp) if she goes back to work. And when she returns to Part B, she gets another GI. See if the employer will pay the Part B and Med Supp?

    Why COBRA over a Supp? Just wondering
     
    kgmom219, Oct 31, 2015
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  4. WCMason
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    WCMason Guru

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    Her SEP to get Part B is eight months from the date her active employment ended, so so long as 3/15/16 is within that eight months she should be able to take the subsidized COBRA benefits and get Part B to start in March.
     
    WCMason, Oct 31, 2015
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  5. LAD
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    LAD New Member

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    As far as I know for 2015/2016 rules, the SEP would be end of employer coverage, and she would have 2 months prior to the end of the employer paid COBRA coverage, the month of, and 2 months after in order to get the delayed part B SEP.
     
    LAD, Oct 31, 2015
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  6. kgmom219
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    kgmom219 What's Next?

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    Employer coverage and employer paid COBRA coverage are not the same thing
     
    kgmom219, Oct 31, 2015
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  7. somarco
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    somarco GA Medicare Expert

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    She has Crohn's. Drugs are expensive on PDP.

    Wes, the part that is confusing (to me at least) is her employment status. She has been disabled for almost a year. They are continuing her on the group plan but she it not technically on the payroll. She is receiving disability and that will continue (how long I don't know).

    HR will terminate her group coverage 11/15 and pay for COBRA through 12/31. If she is able to return to work by 3/15 they will reinstate her as an active employee. She may not know if her doc will allow her to return to work until mid Feb which is going to be a crunch to get B set up for March.

    Because of high medical bills, and even higher Rx costs, she doesn't want a gap in coverage.

    Her income is/will be too high to qualify for Extra Help and her drugs under a PDP are considerably higher than on the group plan.

    She wants/needs to milk the group/COBRA as long as possible for the Rx benefit.

    ----------

    Thanks for your input lady and gentlemen. The more I look at this the more convinced this is above my pay grade. Decided to have her get the information from SS. If they screw it up it's off my plate.

    My email to her.

    ..................

    The more I look into your situation I want to make sure you get advice from the source. You need to call a local Social Security office
    and ask them specific questions.

    Even better is to go in person and get a response in writing if possible.

    Explain your situation and get answers to these specific questions.

    When should you sign up for Medicare Part B? Before or after you go on COBRA? If you can wait until you go on COBRA, what is the latest date to sign up for Medicare Part B without penalty or delay?

    If you have Medicare A and B, as well as COBRA, which pays first?

    If you sign up for Medicare B while on COBRA does your COBRA terminate?

    Can you have Part D (drug) and COBRA or does signing up for D cause your COBRA to terminate? When should you sign up for Medicare Part D in order to avoid a late enrollment penalty?

    Ask Social Security if there is anything you else you need to know and anything you have overlooked.

    Take very good notes. There won't be any do-overs.

    Which pieces you enroll in, which you drop, which you postpone and the timing of each is crucial. I found answers to each of these questions but they are not in one place and in each situation the examples used do not exactly match your situation.

    A lot of it depends on when your employer terminates your employment. Some of the Medicare rules apply when your employment terminates, others apply when you lose your group insurance. And still others act differently if you have COBRA and Medicare.
     
    somarco, Nov 1, 2015
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