Multiple coverages when on Medicare

[Helpico_Insure]

A couple reached Medicare status based on age etc. They also have their group coverage with BCBS through a small employer's group. I can offer them MA MSA, but am not sure how the high deductible will play. Will this coverage be beneficial for them (no health issues at all) because their group plan will cover whatever the high deductible will not, and will give the coverage for their medications, or better offer them an MAPD to be sure they are secured with all coverages they need and no penalty will apply? I can't make a right decision. Can someone help me with this?

 

[Mr Medicare]

Their group plan is only credible coverage if one spouse is still employed with the company. Depending on where they live would dictate what type of plan is best. MAPD's are great in certain areas, other areas not so much. There is also a high deductible Plan G with a Part D that could work. Also depending where they live you can add an indemnity plan to help cover the deductible. You could add a part D to the MSA, here is a link to CMS with more info on MSA plans. https://www.cms.gov/files/document/medicare-guide-medical-savings-account-plans.pdf You can send me a private message if you want to chat on the phone. I would be happy to help you out.

 

[Helpico_Insure]

Their group plan is only credible coverage if one spouse is still employed with the company. Depending on where they live would dictate what type of plan is best. MAPD's are great in certain areas, other areas not so much. There is also a high deductible Plan G with a Part D that could work. Also depending where they live you can add an indemnity plan to help cover the deductible. You could add a part D to the MSA, here is a link to CMS with more info on MSA plans. https://www.cms.gov/files/document/medicare-guide-medical-savings-account-plans.pdf You can send me a private message if you want to chat on the phone. I would be happy to help you out.

The credible coverage means they don't need Part D coverage. They both are employed with the same employer. If I offer them MA MSA it is because of the pay out they'll get from the plan. I just am not sure if the group plan will kick and pay the rest of the high deductible if they have a major health issue.

 

[Mr Medicare]

Good to know they are still employed, I learned that the hard way. The way I read the CMS guidelines from the link is that you can not have both a MSA and group plan I could be wrong though, wouldn't be the first time.

1. Who Can and Who Cannot Enroll? – Beneficiaries with both Medicare Part A and Part B can enroll in a MSA plan. The law provides that people who have other types of health insurance in addition to Medicare generally cannot enroll, and other groups as follows:
   
   • If the beneficiary has health insurance coverage that would cover some or all of the MSA plan deductible, including benefits under an employer or union group health plan; health care benefits from the Department of Defense (TRICARE) or the Department of Veterans Affairs; or is a retired Federal government employee and part of the Federal Employee Health Benefits Program (FEHBP).
     
     
   • If the beneficiary is eligible for Medicaid (a joint Federal and state program that helps with medical costs for some people with limited income and resources).
     
     
   • If the beneficiary has End-Stage Renal Disease.
     
     
   • If the beneficiary is currently getting hospice care.
     
     
   • Or if the beneficiary primarily lives outside the United States – 183+ days a year.
     
     Some plans may be sponsored by employers or unions and offered only to members.

 

[Helpico_Insure]

Good to know they are still employed, I learned that the hard way. The way I read the CMS guidelines from the link is that you can not have both a MSA and group plan I could be wrong though, wouldn't be the first time.

1. Who Can and Who Cannot Enroll? – Beneficiaries with both Medicare Part A and Part B can enroll in a MSA plan. The law provides that people who have other types of health insurance in addition to Medicare generally cannot enroll, and other groups as follows:
   • If the beneficiary has health insurance coverage that would cover some or all of the MSA plan deductible, including benefits under an employer or union group health plan; health care benefits from the Department of Defense (TRICARE) or the Department of Veterans Affairs; or is a retired Federal government employee and part of the Federal Employee Health Benefits Program (FEHBP).
     
     
   • If the beneficiary is eligible for Medicaid (a joint Federal and state program that helps with medical costs for some people with limited income and resources).
     
     
   • If the beneficiary has End-Stage Renal Disease.
     
     
   • If the beneficiary is currently getting hospice care.
     
     
   • Or if the beneficiary primarily lives outside the United States – 183+ days a year.
     
     Some plans may be sponsored by employers or unions and offered only to members.

Yes, you found the answer. Is the same valid for MAPD?

 

[Mr Medicare]

Yes, you found the answer. Is the same valid for MAPD?

Correct, same with MAPD. I believe it’s a question on most MAPD applications. If you want to fill the gap, cover the deductible and co-pays. A hospital indemnity plan might work. Depending on where they live. I don’t think there are many indemnity plans in California.

 

[somarco]

I could be reading this incorrectly, but it looks like both of you are looking for a way to generate a commission instead of trying to find a solution.

They also have their group coverage with BCBS through a small employer's group

How small? Legitimate question, not a joke.

their group plan will cover whatever the high deductible will not,

You are assuming Medicare is primary, which is not determined based on what is posted so far.

group plan is only credible coverage if one spouse is still employed

I am real curious where you came up with this gem. Please enlighten me.



The correct term is creditable coverage, not credible.

 

[somarco]

I could be reading this incorrectly, but it looks like both of you are looking for a way to generate a commission instead of trying to find a solution.

They also have their group coverage with BCBS through a small employer's group

How small? Legitimate question, not a joke.

their group plan will cover whatever the high deductible will not,

You are assuming Medicare is primary, which is not determined based on what is posted so far.

group plan is only credible coverage if one spouse is still employed

I am real curious where you came up with this gem. Please enlighten me.



The correct term is creditable coverage, not credible.

 

[Mr Medicare]

I could be reading this incorrectly, but it looks like both of you are looking for a way to generate a commission instead of trying to find a solution.



How small? Legitimate question, not a joke.



You are assuming Medicare is primary, which is not determined based on what is posted so far.



I am real curious where you came up with this gem. Please enlighten me.



The correct term is creditable coverage, not credible.

Hi somarco,

Thanks for correcting my spelling, I’m always looking to learn. Here is the link to information you need to enlighten yourself as requested. It also contains other useful information about delaying Medicare.

Have a great afternoon
https://www.cms.gov/Outreach-and-Ed...care-for-people-over-65-nearing-retirment.pdf

 

[somarco]

Hi somarco,

Thanks for correcting my spelling, I’m always looking to learn. Here is the link to information you need to enlighten yourself as requested. It also contains other useful information about delaying Medicare.

Have a great afternoon
https://www.cms.gov/Outreach-and-Ed...care-for-people-over-65-nearing-retirment.pdf

I was not correcting a spelling error . . . merely pointing out the correct term used by carriers and government when determining if your prior coverage is such that it can be CREDITED towards your new coverage.

CREDIBLE means the subject is believable . . . which has nothing to do with Part D or any other coverage where the carrier is looking to see if prior coverage could be credited towards the new coverage.

I looked at the 9 page document you linked and searched for references to CREDITABLE coverage . . . found 11 citations, all referring to creditable drug coverage . . . didn't see anything indicating credible/creditable coverage is determined by whether or not you have a working spouse covered under the group plan.

I need a bit more enlightenment . . .