T65 Still Working, Covered Thru Employer Group W/ No Rx Coverage

[beachbum2012]

I posted this situation in the Health Care Reform forum, but need to ask questions here a different way for those more familiar with the senior market.

Situation: potential client turning 65 and small employer of < 20 pays for his whole health care premium. Because of < 20, I imagine he does have to sign up for Part B. His employer coverage is good (low deductible, MOOP) but it includes no Rx coverage. Can he sign up for a standalone PDP to prevent him from getting the Part D LEP? Will this affect his group coverage at work and cause him to lose coverage there? I just wondered how the two insurances would mesh.

 

[WCMason]

I posted this situation in the Health Care Reform forum, but need to ask questions here a different way for those more familiar with the senior market. Situation: potential client turning 65 and small employer of < 20 pays for his whole health care premium. Because of < 20, I imagine he does have to sign up for Part B. His employer coverage is good (low deductible, MOOP) but it includes no Rx coverage. Can he sign up for a standalone PDP to prevent him from getting the Part D LEP? Will this affect his group coverage at work and cause him to lose coverage there? I just wondered how the two insurances would mesh.

He does need Parts A and B and at minimum D to avoid the LEP. Part D will not affect EGHP as it has no Rx coverage. He may find a med supp will be better than staying with EGHP given he has to pay Part B premium plus the payroll deduction for the EGHP. That's a cost/coverage comparison you'd want to help him with.

 

[somarco]

includes no Rx coverage.

Sounds like a non-compliant plan. Possibly a mini-med, indemnity type (junk) plan.

If so, he probably wants to kick that plan to the curb and go with Medigap + D or MA.

 

[Russ]

He does need Parts A and B and at minimum D to avoid the LEP. Part D will not affect EGHP as it has no Rx coverage. He may find a med supp will be better than staying with EGHP given he has to pay Part B premium plus the payroll deduction for the EGHP. That's a cost/coverage comparison you'd want to help him with.

You don't have to have part B to get a Medicare part D plan. Part A only will work.

 

[WCMason]

You don't have to have part B to get a Medicare part D plan. Part A only will work.

That is correct. The reason to get Part B is because the employer has less than 20 employees. Without Part B the employer plan can pay after what Medicare should have paid even if the person did not enroll in Medicare Part B, leaving the employee exposed to huge medical expenses.

 

[yogooglethis]

That is correct. The reason to get Part B is because the employer has less than 20 employees. Without Part B the employer plan can pay after what Medicare should have paid even if the person did not enroll in Medicare Part B, leaving the employee exposed to huge medical expenses.

What he said.Also late enrollment for part B will apply since it's not a EGHP that's primary and the employee needs to time their retirement date to dovetail with the 7/1 GEP if they do not want a lapse in coverage.

 

[G.Gordon]

I'm seeing this move by smaller employer groups and even one large utility for it's retirees as a way to force them to look outside the group.

Turn off the Rx coverage and they look outside and get exposed to the marketplace of non-group/retiree benefits and most will end up completely moving off the group. My experience anyway.

For this situation, I echo: Part B and D are needed.

If they company is paying 100% of his premium, he might ask them for re-imbursement if he exits the group. I have several locally that are getting their B, D and Medigap premium paid back by the employer for exiting the group therefore saving premium dollars and lowering the overall age of the group.