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Health Benefits for Seniors
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Health Benefits for Seniors
Discuss workforce management, performance management, retention, communication, motivation, contributing to business results and other topics.
Our agency pays 80% of the insurance premiums for our administrators. One worker will be turning 65 next month. Her premiums will be increasing from $700 to $725 a month at that time. We were hoping s
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Forums » Topic Forums » General Forum » Health Benefits for Seniors
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Health Benefits for Seniors
posted at 6/22/2010 5:33 AM EDT
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Posts: 2
First: 6/22/2010 Last: 7/23/2010 |
Our agency pays 80% of the insurance premiums for our administrators. One worker will be turning 65 next month. Her premiums will be increasing from $700 to $725 a month at that time. We were hoping she would apply for Medicare and opt for a much less expensive supplemental policy with our insurer, but she says she is not interested in changing anything. Do we have the right to drop her current coverage when she becomes eligible for Medicare? |
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Health Benefits for Seniors
posted at 6/22/2010 5:51 AM EDT
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Posts: 2146
First: 2/15/2006 Last: 9/14/2011 |
My understanding from research a few years ago is NO, you can not force her out of your plan. Nor can you incentivize her for doing so. She can opt out voluntarily though. And if you have an opt out bonus for ALL employees, she would be eligible for that.
If you have less than 20 employees, Medicare would be the primary payor, otherwise the employee will still be as long as she is on the plan. https://www.cms.gov/ProviderServices/06_grouphealthinsurance.asp You can search under Medicare "working aged" rules to get more information but I found that link to be good. |
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Health Benefits for Seniors
posted at 7/23/2010 5:00 AM EDT
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Posts: 1047
First: 4/11/2002 Last: 9/14/2011 |
Sorry for chiming in late here, but ruppert is correct. Most employees that turn 65 won't drop their employer-sponsored health benefits for Medicare. Medicare benefits tend to be worse, not to mention more complex. |
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Health Benefits for Seniors
posted at 7/27/2010 6:36 AM EDT
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Posts: 2442
First: 2/12/2000 Last: 9/14/2011 |
Why can't you change your primary plan to state that when an active employee is eligible for Medicare that your primary plan will integrate with (or assume integration with) Medicare A/B?
In addition it is my understanding that any person working or not that becomes eligble for Medicare A, B and drug plan will pay a high penalty if they do not enroll when first eligible since they will need to join at some point. |
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Health Benefits for Seniors
posted at 7/27/2010 10:08 AM EDT
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Posts: 2146
First: 2/15/2006 Last: 9/14/2011 |
Howard, actually the late entry is waived as long as they do it within 63 days of losing the employer's coverage. They are not charged any extra than had they joined the day they originally became eligible.
However, I do agree you want to integrate with Medicare if the employee chooses to have both coverages. Your insurance carrier should already be doing so. If you have less than a certain # employees ( I think the magic # is 20), Medicare would be primary...otherwise they are secondary. I just had to do a data survey about employees at Medicare age. I forget the exact purpose, but definitely check with your carrier on this. |
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Health Benefits for Seniors
posted at 7/28/2010 6:52 AM EDT
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Posts: 2146
First: 2/15/2006 Last: 9/14/2011 |
From their own words at http://aging.senate.gov/crs/medicare11.pdf
See the part between the ***'s since we can't bold or underline here... "Medicare is the nationâs health insurance program for qualifying individuals who are 65 and older, disabled, and those with End Stage Renal Disease (ESRD). Generally, Medicare is the âprimary payerâ â that is, it pays health claims first, and if a beneficiary has other insurance, that insurance may fill in all or some of Medicareâs gaps. However, in some situations the ***Medicare Secondary Payer (MSP) rules prohibit Medicare from making payments for any item or service when payment has been made or can reasonably be expected to be made by a third-party payer. Under certain conditions, the law makes Medicare the secondary payer to insurance plans and programs for beneficiaries covered through (1) a group health plan based on either their own or a spouseâs current employment***; (2) auto and other liability insurance; (3) no-fault liability insurance; and (4) workersâ compensation situations, including the Black Lung program. ***The purpose of the MSP program is to shift costs from Medicare to private sources of payment, thus reducing Medicare expenditures***. Additionally, the Medicare statutes exclude Medicare coverage for items and services paid for directly or indirectly by a government entity, subject to certain limitations"...."Subject to certain conditions, Medicare payments are secondary to employer-sponsored health insurance offered to employees. An employer with 20 or more employees3 must offer workers aged 65 and over the same group health insurance coverage offered to other employees. In fact, the statutes prohibit a group health plan from taking into account that an individual or his/her spouse who is covered by the plan, by virtue of the individualâs current employment status, is entitled to Medicare benefits. Any individual age 65 or older (and his/her spouse age 65 or older) who has current employment status is entitled to the same benefits under the employerâs group health plan, under the same conditions as any such individual (or his/her spouse) under age 65." The article also talks about the 20 employee limitation. |
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