Tag: Medicare

Question: If a newly-benefits-eligible employee with a spouse on Medicare due to disability enrolls her spouse on the company group health plan, must her spouse terminate Medicare? If not, which plan would be primary? Answer: The employee’s spouse is not required to terminate Medicare coverage based upon becoming eligible (or enrolling) for coverage under a group health…

Question: Are employers required to offer benefits to employees eligible for Medicare (65 or older)? Answer: An employee who is entitled to Medicare may: Remain enrolled in a company’s group health plan and delay enrollment in Medicare; Elect enrollment in Medicare and remain enrolled in the group health plan at the same time; or Voluntarily revoke group…

Question: For the Medicare Part D notice of creditable coverage that employers need to provide each year, is it acceptable to post the notice on the benefit website to which all employees have access? If so, are there any specific guidelines that we must follow? Answer: Yes, posting the notice on the benefit website would…

Question: Does an employer count all employees in a controlled group when determining if the Medicare Secondary Payer (MSP) statute applies? Answer: The size of the employer is a factor in determining whether Medicare is a secondary or primary payer under the working aged provision and the disability provision of the law. For employers with under 20…

Question: Can we terminate an employee from our group plan when he becomes Medicare eligible? Answer: The federal Medicare Secondary Payer (MSP) rules prohibit some employers from terminating group coverage, providing financial or other incentives to encourage dropping group coverage, or purchasing a Medicare supplement policy for active employees (or their spouses) who are Medicare-eligible. Employers…

Question: Would a working (not retired) employee enrolled in Medicare be ineligible for enrollment in the company’s group health plan? Answer: The short answer to your question is that if the employee is still actively working and otherwise eligible for the employer’s group health plan, then the employee should be offered the same level of benefits as…

Question: Do Summaries of Benefits and Coverage (SBC) need to be provided to a new employee who is currently enrolled in Medicare and is electing to waive the group coverage. Small group under 50 employees. Answer: An SBC must be provided to all “participants and beneficiaries” without charge regardless of group size and/or the employee’s intent to…

Question:  Can an employer offer a group Medicare supplemental plan (employer paid) for employees enrolled in Medicare Parts A & B? Answer: Employer-sponsored group health plans are required to comply with the federal “Medicare Secondary Payer” provision.  The MSP rules determine whether the group plan or Medicare will be the primary payer with respect to ACTIVE…

Question: How does an employer group calculate the number of full time employees for the purpose of determining if Medicare is primary or secondary? Does the employer group use the calendar year or the medical plan year in running this calculation? Answer: According to the Centers for Medicare & Medicaid Services, the definition of employee coverage is…