Question on Part B Enrollment

[LostDollar]

But aren't there always exceptions to that such as documented divorce, death, retirement, getting fired, quitting, etc?

http://www.aetna.com/employer/middle_market/data/67404w.pdf

Admittedly a sample from only one carrier, but here is an employer to carrier reporting form that shows medicare as the reason the employee is being removed from the group plan coverage. The employer would have had some kind of in house signed document from the employee to support their name going on this form.

While possible I suppose, I would be hard pressed to believe that an employer could force a Medicare eligible employee to remain on the group plan. It would, in fact, be to the employer's financial advantage to have them gone. (Re discussions in other threads somewhere where some employers are forcing dual job couples to each get coverage from their own employer.)

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(While high 401K participation accrues to the advantage of highly paid executives in the company, high health plan participation, particularly from older employees, accrues to the cost disadvantage of the company.)

 

[somarco]

aren't there always exceptions

"Always"? No, not always, but many times.

An employee can voluntarily cancel coverage at any time only if the company is not having employee premium contributions deducted pre-tax. If they are, they are de facto enrolled in a Section 125 Plan and cannot change that election until Open Enrollment (OE) or Qualified Life Event (QLEs).

https://www.zenefits.com/answers/wh...e-an-employee-to-keep-their-health-insurance/

Vic made no mention of a QLE, only that the person wanted to drop group health and enroll in Medicare.

 

[LostDollar]

Ok, I see the reason for your comment and your experience and knowledge has gone beyond what I know about benefits.

 

[WCMason]

My experience with many clients in a similar situation over the years has been that the Medicare eligible employee can disenroll from the employer plan anytime, as Medicare eligibilty is a QLE and it doesn't stop being a QLE after OE ends. Some employers have required a copy of the Medicare ID card, but none has refused to allow the mid-year departure.

 

[LostDollar]

You gave me some search terms which led me to this:

https://www.law.cornell.edu/cfr/text/26/1.125-4

Paragraph (e) seems to me to suggest that if an employee actually goes ahead and enrolls in Part B, that becomes a QLE which the employer must then honor by allowing the employee to drop coverage.

If the employee also has dependents in the group health plan, that course of action probably creates some issues for them.

(And some health insurance carriers go further than actual enrollment when applying coordination of benefits with Medicare, they say that even eligibility for Medicare, regardless of actual enrollment, permits them to use Medicare coordination of benefits rules.)

(Cross posted with WCMason)

 

[somarco]

I have no reason to doubt you, Wes, but the plan administrator is the one who ultimately decides to accept Medicare enrollment as a QLE or not. I have seen it go both ways.

I had prospects who worked for very large employers that wanted to opt out of group insurance mid-year when they turned 65 only to be told they had to wait until OE. Have one now that works for a small employer (5 employees) and her employer told her she could drop the group plan at any time. She is 66 but wants off the plan.

So the answer is, "It depends".

 

[LostDollar]

I have no reason to doubt you, Wes, but the plan administrator is the one who ultimately decides to accept Medicare enrollment as a QLE or not. I have seen it go both ways.

I had prospects who worked for very large employers that wanted to opt out of group insurance mid-year when they turned 65 only to be told they had to wait until OE. Have one now that works for a small employer (5 employees) and her employer told her she could drop the group plan at any time. She is 66 but wants off the plan.

So the answer is, "It depends".

I went back and looked at that link again (because I wanted to be argumentative). I discovered that I had missed the word "MAY" and also that paragraph A supports precisely what you are saying.

(And it seems almost criminal to think that a small group employer's plan could force an employee to be in both the group plan and Medicare in order to have coverage.)

 

[DS4]

Most all employers would be ecstatic to have an active, age 65 and older ee request to waive off. It is also illegal for that employer to financially induce that ee to waive off too.

 

[LostDollar]

Most all employers would be ecstatic to have an active, age 65 and older ee request to waive off.

I agree, but for a plan administrator, the terms of the plan document take precedence over feelings of ecstacy experienced by senior management of the employer.