Questions about Medicare and HSAs

[LostDollar]

A number of companies require those turning 65 to sign up for medicare and their insurance with the company changes at that age. Regardless of what you think it is legal to do that. Yes there are likely guidelines they have to follow, but that does not change it is legal to require that.

Note - I am not required to answer all your questions. I'd suggest talk to your HR office if you have questions about this and how it works. There are many variations about what companies do when employees turn 65, are fully retired...

Caveat, not an agent.

No, you are not required to answer my questions. However your comments indicate you do not fully understand Medicare Coordination of Benefits rules and Employer Health coverage requirements for Large (over 20) companies.

In relation to OP's original post, if the large group employer is requiring over 65 employees, or their family members over 65, to go on Parts A and B of Medicare in order to retain health care coverage from active employment, there is a significant potential problem there. The employer is treating over 65 and under 65 employees differently. The stage is also possibly being set for an insurance carrier to attempt to treat Medicare as primary, rather than secondary, for claims.

OP's post did not indicate they were asking about Employer Retiree Health coverage, but if they were, then yes, the employer could probably require Medicare enrollment because Medicare would be primary to the Employer Retiree Health Plan.

There are probably some specialized situations where those general rules would not apply, but those are the general rules expressed in CMS documents, and by agents, in recurring discussions on site about this issue.

There also used to be HHS documents covering this, I am no longer able to relocate them with searches.

 

[annon123]

Caveat, not an agent.

OP's post did not indicate they were asking about Employer Retiree Health coverage, but if they were, then yes, the employer could probably require Medicare enrollment because Medicare would be primary to the Employer Retiree Health Plan.

And they didn't indicate they weren't either. I had responded only as if they were and did not bring up any other context/circumstances. That was the only context I was talking about and had indicated in my post that their HR dept would best know the rules particular to their insurance and their state. You then expanded my comment into a criticism of me when I didn't answer outside of that context and presumed I knew little about a context I wasn't even talking about.

As posting on these forums appear to be how you spend much of your time/is a hobby I'd suggest you are more careful in how to respond to people and stick to just what they said rather than presume they are also talking about something they are not when you want to show off your knowledge/criticize them. And, of course, you don't need to be an agent to know a lot/be informed.

What you could have done instead of accusing me of not knowing something/was wrong about I wasn't even talking about is instead just add to the information posted. You could have, instead, stated that if the context wasn't employer insurance with someone who turned 65 (which was the only context I was talking about) here is additional information you might find helpful. That would have added information without making an incorrect assumption about something I wasn't even addressing and then putting me down for it in the process.

 

[LostDollar]

And they didn't indicate they weren't either. I had responded only as if they were and did not bring up any other context/circumstances. That was the only context I was talking about and had indicated in my post that their HR dept would best know the rules particular to their insurance and their state. You then expanded my comment into a criticism of me when I didn't answer outside of that context and presumed I knew little about a context I wasn't even talking about.

As posting on these forums appear to be how you spend much of your time/is a hobby I'd suggest you are more careful in how to respond to people and stick to just what they said rather than presume they are also talking about something they are not when you want to show off your knowledge/criticize them. And, of course, you don't need to be an agent to know a lot/be informed.

What you could have done instead of accusing me of not knowing something/was wrong about I wasn't even talking about is instead just add to the information posted. You could have, instead, stated that if the context wasn't employer insurance with someone who turned 65 (which was the only context I was talking about) here is additional information you might find helpful. That would have added information without making an incorrect assumption about something I wasn't even addressing and then putting me down for it in the process.

Caveat, not an agent.

Unfortunately HR departments do not always know the answers either and there may be little they can do in the face of possibly inappropriate "set in stone" actions of an insurance carrier over claims decisions, regardless of whether or not the carrier's claims actions follow CMS coordination of benefits actions.

OP and client need to have a very clear understanding of WHY the employer is requiring that action by their 65 and over active employees (and over 65 covered family members of those employees) so they at least know the possible ramifications of having "health events" as an active employee, or dependent of the active employee, under that coverage.

Neither an active employee of a large company, or their agent, should want to be in a situation where the Primary insurance carrier will want to treat themselves as secondary to Medicare when Medicare will be processing the claim saying Medicare is Secondary to that carrier for claims payment. Neither the employee or the company's HR department can fight that with at least some large health plan carriers.

I don't know what power CMS might be able to exert in this situation. Or if they can do so, how long it would take in light of current turmoil relating to government department staffing decisions.

(Insurance carriers' internal claims appeal processes also do not always work well for the insured.)

(All of that is just personal opinion of a non-agent Medicare Beneficiary)

 

[annon123]

Caveat, not an agent.

Unfortunately HR departments do not always know the answers either and there may be little they can do in the face of possibly inappropriate "set in stone" actions of an insurance carrier over claims decisions, regardless of whether or not the carrier's claims actions follow CMS coordination of benefits actions.

OP and client need to have a very clear understanding of WHY the employer is requiring that action by their 65 and over active employees (and over 65 covered family members of those employees) so they at least know the possible ramifications of having "health events" as an active employee, or dependent of the active employee, under that coverage.

Neither an active employee of a large company, or their agent, should want to be in a situation where the Primary insurance carrier will want to treat themselves as secondary to Medicare when Medicare will be processing the claim saying Medicare is Secondary to that carrier for claims payment. Neither the employee or the company's HR department can fight that with at least some large health plan carriers.

I don't know what power CMS might be able to exert in this situation. Or if they can do so, how long it would take in light of current turmoil relating to government department staffing decisions.

(Insurance carriers' internal claims appeal processes also do not always work well for the insured.)

(All of that is just personal opinion of a non-agent Medicare Beneficiary)

As employees you are stuck with what the company chooses to do. And companies can and do negotiate plans. More than once I have had a plan, in the same state, with the same insurer but a different employer and the plans are different. Starting with the HR department and looking at benefits book they have for employees with the details of the plan is a good start. Calling the insurer is also prudent. If what they say matches. Great. If not. Then there is an issue that needs sorted out.

 

[LostDollar]

As employees you are stuck with what the company chooses to do.

Or you are stuck with how the carrier chooses to process the claims and the HR department may be able to do nothing.

 

[annon123]

Or you are stuck with how the carrier chooses to process the claims and the HR department may be able to do nothing.

But they won't know until they ask will they.

If the problem is with wrong claim processing then the person's state insurance commission may be able to help if the insurance company refuses to budge. Also if it is a system where all the doctors are also employees usually they have a patient advocacy/experience office who sometimes can help with issues. Escalating the complaint within the health system can work on occasion too. All of this is a crap shoot but giving up for the person even tries anything guarantees they won't "win".

 

[LostDollar]

But they won't know until they ask will they.

If the problem is with wrong claim processing then the person's state insurance commission may be able to help if the insurance company refuses to budge. Also if it is a system where all the doctors are also employees usually they have a patient advocacy/experience office who sometimes can help with issues. Escalating the complaint within the health system can work on occasion too. All of this is a crap shoot but giving up for the person even tries anything guarantees they won't "win".

The time to solve the concern is before any claims are filed by finding out WHY the carrier and the company require a T65 employee of a large company to file for Medicare Part A and B, denying their ability to contribute to an HSA.

I will let you help OP and client when OP posts back in a year or two about how to deal with an insurance carrier who will not process claims according to CMS COB guidelines.

 

[annon123]

The time to solve the concern is before any claims are filed by finding out WHY the carrier and the company require a T65 employee of a large company to file for Medicare Part A and B, denying their ability to contribute to an HSA.

I will let you help OP and client when OP posts back in a year or two about how to deal with an insurance carrier who will not process claims according to CMS COB guidelines.

Well since you apparently know all there is to know, you can help them. Sheesh. I am now beginning to understand why people block you.

 

[LostDollar]

Denying the the ability to contribute to an HSA, requiring payment of Part B premiums, and starting the clock running on the no underwriting enrollment period for a Medigap plan which is not going to pay anything in the presence of an employee plan and Part B.

A situation which totally sucks, and based on the little information OP provided, does not seem right to me.

 

[LostDollar]

Well since you apparently know all there is to know, you can help them.

Not in this lifetime.