Enroll in Medicare Part B or delay it?

[kgmom219]

Joe needs to check with his Employer's Insurance Admin person. If the coverage he has is considered "credible" then he wouldn't be penalized. He needs to ask the employer plan admin person if he is required to enroll in his Part B Medicare. Just make sure that there is a clear understanding of what and how the employer plan was written. Good luck.

I agree with you. And its a fully insured small group plan. If its ACA compliant (and it has to be at this point), then its creditable coverage.

The reason I went to the carrier was to get clarification for the board. And got the response above.

 

[WCMason]

Joe needs to check with his Employer's Insurance Admin person. If the coverage he has is considered "credible" then he wouldn't be penalized. He needs to ask the employer plan admin person if he is required to enroll in his Part B Medicare. Just make sure that there is a clear understanding of what and how the employer plan was written. Good luck.

Any penalty if the coverage is incredible?

The term you’re looking for is creditable. As in you get credit for having it. Not credible, as in believable or convincing.

 

[Todd King]

Any penalty if the coverage is incredible?

The term you’re looking for is creditable. As in you get credit for having it. Not credible, as in believable or convincing.

And you have to show creditable coverage in order to be credible....LOL

 

[TN_agent]

I imagine this is group, state, and carrier specific. We have this exact situation with a lawyer in a law firm we have group insurance on (but the rep was willing to put it in writing that they did not require him to take out B to pay claims in accordance with contract). 65+ founding partner, high income, IRMAA out the wazoo, younger wife who needed the insurance, expensive donut hole drugs, wanted the pre-tax cafeteria deductions for premiums, etc. He did not and does not need to take Medicare B as long as the firm stays with the carrier they are with. He took A and Medicare is primary on any claims that would typically be covered under Medicare A. The group plan is "primary" so to speak on the types of claims that would usually be paid under Medicare B (technically there is not a primary/secondary COB going on with outpatient claims, because he didn't take the Part B). Per contract, the group plan pays for things covered under Medicare B as if he had no other coverage in place if he does not elect B.

But, some contracts do not do this, and will only pay as if Medicare B has already paid (even if no Medicare B coverage is active), that is the trap you have to check on in small groups.

 

[junkman]

I had a large fully insured group covered with BCBST. A dependent spouse filed a claim with Medicare only. Medicare audited and kicked the claim back to the EMPLOYER. Per Federal law, the employer was liable not, the employee. Since this was fully insured there were no expired stop loss coverage and BCBST negotiated with Medicare to pay the claim.

The break point between employer/Medicare being primary is at the size that determines whether or not the group follows COBRA laws. It may be possible for a group to be cobra eligible during 1 period and not another. This is a Federal law and method of funding has nothing to do with it.

A small 3 life group in CA has 1 employee that has aged into Medicare. CA has a law that more than 50% must reside in CA. This employee is the determining one and had to elect Medicare because of how the carrier contract is written. Medicare is primary and without it, the carrier won't pay claims for this person. He could buy a supplement for much less but the employer doesn't care. They want to keep everyone off of ACA and eligibility requirements and thus pay 100% of the premium.

I had another large group of accountants. They were old with money and would frequently age into Medicare. Most never elected Part B since the group was had better coverage. This may have been before Part D came about. In this case, the group policy paid without regard to Medicare.

Bottom line: Medicare is primary when the employer is smaller than required to follow COBRA. The group contract determines whether or not the employee should elect Part B.

The OP should get anything in writing. Regardless of writing, you cannot force Medicare to do something just because you received and documented incorrect advice. You would have to sue the person that gave you the bad advice - and win. The 6 month period to buy a supplement begins when Part B is elected. The employee should elect part B if the carrier will not pay claims otherwise. He should buy a supplement when he elects Part B unless he is sure that he wants an Advantage Plan.