Part A penalty?

[Tom in RI]

I’m having trouble with the premise that a self employed person can get on a group plan. If you have access to a group plan (not through a spouse) how are you self employed?

 

[Bob G]

This answer pertains to Part B only. If the self employed person's company has 20 employees or more, that is considered a group plan for Part B and a person on that plan can stay on it and defer Part B. Self employed does not necessarily mean sole proprietor. A person can be self employed and have employees.

 

[LostDollar]

This answer pertains to Part B only. If the self employed person's company has 20 employees or more, that is considered a group plan for Part B and a person on that plan can stay on it and defer Part B. Self employed does not necessarily mean sole proprietor. A person can be self employed and have employees.

Caveat, not an insurance agent.

I would think any health insurance plan covering more than one person is a "group" plan.

And I believe that Part B regulations consider DO consider all multiple employee plans as group plans, regardless of covered employee counts. Co-ordination of benefit rules have to cover scenarios for groups of 2 up, not just groups of 20 up.

 

[Bob G]

Not referring to Group Plans in general, only with regards to Part B. Read it again.

 

[LostDollar]

Not referring to Group Plans in general, only with regards to Part B. Read it again.

Part B rules recognize and deal with ALL group plans, regardless of size. (That is the core problem I am having with your statement.)

Background from the SS POMS manual:

SSA - POMS: HI 00805.266 - Description of Terms Used in the Special Enrollment Period and Premium Surcharge Rollback Provisions - Group Health Plans

Description of Terms Used in the Special Enrollment Period and Premium Surcharge Rollback Provisions - Group Health Plans

secure.ssa.gov

The term GHP refers specifically to a group health plan based on the current employment status of the beneficiary or the beneficiary’s spouse. The GHP can be of any size, however when referring to a GHP for the disabled, the term refers to a plan of any size below 100 employees,

As posts here demonstrate time and time again, unless the employer group health plan has specific rules to the contrary, an employee of Medicare eligible age can remain on a group plan of any size AND defer Part B.

If you have a reference for a Federal rule that prohibits those actions, I would be interested in seeing it. I am not talking about rules that define the consequences of an action, I am talking about (Federal - not TPA) rules which prevent the action itself.

 

[Tom in RI]

This answer pertains to Part B only. If the self employed person's company has 20 employees or more, that is considered a group plan for Part B and a person on that plan can stay on it and defer Part B. Self employed does not necessarily mean sole proprietor. A person can be self employed and have employees.

If a “self employed” person’s company has 20 employees, that is not a self employed person.

 

[Bob G]

There is a distinction between a company that has coverage with less than 20 employees and 20 employees or more.
Less than 20 employees cannot defer Part B. Must sign up for Part B or be penalized later on.
20 employees or more can defer Part B without penalty.
Company Size matters, not whether it's a group plan or not.

 

[Bob G]

You can be self employed and have more than just yourself as an employee. Many self employed people have an assistant or secretary or 2. Those 2 or 3 might be part of a small group plan.

 

[somarco]

The definition of a "group" is fluid from state to state and carrier to carrier.

You can have a group of 1

Group of 2, husband and wife or 2 non-related individuals

Company can be SP, partnership, LLC, etc but there must be a business structure

Group master contract can be a trust, MEWA or association. In some cases the group can be boiler plate or tailor made for the situation.

With a "small group" (fewer than 20 eligible participants) regardless of how many are participants.

More . . .

Small Employer Exception | CMS

Small Employer Exception - This page describes the requirements for a Small Employer Exception (SEE) from the MSP working aged rules and the insurer’s role in those situations. It also explains the procedure for Small Employer Exception Requests and includes a link to the Small Employer...

www.cms.gov

SOME groups will also issue coverage to 1099 contractors, some will not.

To be self-employed means one conducts business on their own, as a partner or owner, rather than working for employers. According to the instruction of IRS (on page 2), the person who will “carry on a trade or business as a sole proprietor or an independent contractor” is a self-employed person.

self-employed

www.law.cornell.edu

 

[LostDollar]

Less than 20 employees cannot defer Part B.

This is not true.

Again, repeated posts over the 5 years I have been a member here confirm my statement.

You are attempting to use consequences of an action to say the action cannot be taken. Some agents and their clients have Medicare coverage challenges, exactly because the action can be, and IS, taken by some Medicare Beneficiaries.

This is just like a a PDP. A Medicare Beneficiary does not have to have a PDP.