Who MUST Enroll in Medicare at Age 65?

Mar 30, 2016

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  1. HeyMedicareMan
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    HeyMedicareMan New Member

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    I have a prospect in Colorado turning 65 in June 2016. He and his wife turning 65 in August 2016 are employee and spouse on their 4 employee group plan. MUST they enroll in Medicare because group is less than 20 employees? And, do the employee and spouse rates jump upon turning 65? If they MUST enroll in M/C A and B is that a federal requirement or a requirement imposed by the carrier and actually or usually in the group contract? Thanks for any guidance given.
     
  2. vic120
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    vic120 Guru

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    Medicare requirement. If they don't enroll in part B they will have late penalty
     
    vic120, Mar 30, 2016
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  3. HeyMedicareMan
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    HeyMedicareMan New Member

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    Thank you BUT they desire to stay in the employer group plan and I believe they can delay enrollment on M/C A&B until they leave the employer group plan. What I'm really looking for is when someone is working in a small under 20 employer situation MUST they take M/C A&B just because it is a small employer situation. I know there is no problem in delaying Medicare A&B when it is a large (greater than 20) employer .... there are no penalties assuming a timely enrollment in Medicare after leaving a larg employer's program. The clarification I need pertains to the rules concerning mandatory enrollment in M/C Aand B when the 65 year old wants to continue on the small employer's plan. I know they can enroll in Medicare but MUST they and if so is it a federal requirement or is it governed by the small group carrier and/or rules of the state?
     
  4. unic.consulting
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    unic.consulting Guru

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    Read pages 29 and 30 of Medicare and You. They can keep their employer plan, but Medicare is primary and the employer plan is secondary. Employer plans can (but don't always) require them to be on Medicare to keep their coverage. They should find out from their current plan if they're required to get Medicare or not.
     
  5. LAD
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    LAD New Member

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    If the employer has less than 20 employees, they will need to enroll in both A & B when they turn 65. If they don't, they will incur a 10% penalty on their part B payment.

    In addition, Medicare would be considered primary insurer at that point, and the employer plan could refuse to cover services that should have been covered by Medicare.
     
    LAD, Mar 30, 2016
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  6. vic120
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    vic120 Guru

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    I based my answer on the fact that YOU mentioned the group is below 20, If the group is over 20 Then they can delay
     
    vic120, Mar 30, 2016
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  7. sman
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    sman Guru

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    Your questions have been answered, but let me put it another way. He is not REQUIRED to enroll in Medicare. However, since the employer has less than 20 employees, most plans would automatically consider Medicare to be primary at that point (even if he didn't enroll in Medicare) and likely wouldn't pay anything that would have originally been covered by Medicare Part B. Additionally, if and when he finally did enroll in Part B he would have a penalty and only be allowed to enroll at a certain time each year.

    So to reiterate, there is nothing that is mandatory regarding enrolling in Medicare Part B. However, not doing so would be to his detriment.

    Since it's a small employer, he should ask them if they will consider paying for his Part B premium and possibly the Med Supp and Part D plan since they will no longer be covering the cost of him being on the group plan. At least provide him with the same amount of money they were spending on his group health plan. It's highly likely that his coverage with Medicare A & B and a Med Supp would be much better than his group plan.
     
    sman, Mar 30, 2016
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  8. DS4
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    DS4 Guru

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    No
    They do not need to enroll in Medicare.
    The employer plan will be secondary to nothing.
    Hence, Medicare doesn't pay, therefore, employer plan doesn't pay.
    This sounds like a good option?

    ----------

    How good is your E & O??
     
    DS4, Mar 30, 2016
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  9. somarco
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    somarco GA Medicare Expert

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    somarco, Mar 30, 2016
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  10. Mrs.A.Mann
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    Mrs.A.Mann Expert

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    AND, (in case new agents are reading) if it was in Texas they'd lose their guaranteed issue :0(
    Check your underwriting guidelines.
     
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