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2-19 Employees |
In general, for
employers with fewer than 20
employees, Medicare is the primary
payor and the group coverage is
secondary.
Many carriers offer
substantially reduced premiums for
employees with Medicare as their
primary payor. Employers must
provide validation of small
group status (<20 ees) at each
renewal to qualify for reduced
rates.
When Medicare is primary, an
employee who turns 65 must sign
up for Medicare Part B as group
insurance will not cover
services that Medicare covers.
However, employees should only
consider Part D if their
employer plan coverage is not
creditable (currently all of
Shargel's clients have
creditable coverage).
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Employer Issues with Medicare
Primary |
Make sure you
receive the < 20 rate reduction:
If you are below the 20 employee
mark and you have employees turning
65, be sure to ask us about the rate
reduction and what documentation is
required to ensure that Medicare is
primary.
Be prepared: Be
sure to maintain DE-6 payroll
records for all years
that your company qualifies for
Medicare primary coverage.
If Medicare believes a group had
20 or more employees in a certain
year, they will back-bill the
employers for expenses the group
plan should have paid if Medicare
was secondary. They may do this
years later. You will need your
DE-6 records to confirm that
Medicare was primary.
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20+ Employees |
For employers with 20
or more employees the group plan is
the primary payor and Medicare is
secondary.
In general, we recommend that
employees in this category delay
enrollment in Part B Medical
Insurance and Part D Prescription
Drug Coverage as the group health
plan covers these services. (Our
clients have group plans that
count as Medicare "creditable
coverage.")
When employees retire, they can
enroll on Parts B & D without
penalty. After group coverage
ends, there is also a six-month
guaranteed issue period for
purchasing a Medicare Supplement
plan.
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