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Medicare eligibility vs entitlement vs enrollment


Guest Cgross
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Guest Cgross

I've searched the forum and can't find the answer to this question.

We are amending our COBRA notices and SPD and have reviewed the

DOL's model notices. In that notice, the term "enrolled" is used in relationship to Medicare and qualifying events. The law uses the term "entitled".

Can anyone explain the difference between enrolled, entitled and eligible?

If a person is on COBRA and becomes "eligible" for Medicare but does not

actually "enroll", can COBRA coverage be terminated? Or does the person

have to actually have the Medicare benefit?

Thanks for your help.

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IRS Reg. Sec. 54.4980B-7 Q&A 3 says you can cut someone off COBRA as a result of entitlement to Medicare, which is then defined as actual enrollment in Part A or Part B.

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This is a copy of that Q&A:

Q-3: When may a plan terminate a qualified beneficiary's COBRA continuation coverage due to the qualified beneficiary's entitlement to Medicare benefits?

A-3: (a) If a qualified beneficiary first becomes entitled to Medicare benefits under Title XVIII of the Social Security Act (42 U.S.C. 1395-1395ggg) after the date on which COBRA continuation coverage is elected for the qualified beneficiary, then the plan may terminate the qualified beneficiary's COBRA continuation coverage upon the date on which the qualified beneficiary becomes so entitled. By contrast, if a qualified beneficiary first becomes entitled to Medicare benefits on or before the date that COBRA continuation coverage is elected, then the qualified beneficiary's entitlement to Medicare benefits cannot be a basis for terminating the qualified beneficiary's COBRA continuation coverage.

(b) A qualified beneficiary becomes entitled to Medicare benefits upon the effective date of enrollment in either part A or B, whichever occurs earlier. Thus, merely being eligible to enroll in Medicare does not constitute being entitled to Medicare benefits.

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While the prior postings are correct as far as they go, in some cases determining exactly when Medicare entitlement does occur can require the analysis of some pretty technical rules and yield some surprising results.

However, 99% of the time the only thing that you need to know for COBRA purposes is that mere eligibility to enroll in Medicare is not the same thing as Medicare entitlement. (Which is the message of the prior postings.)

Kirk Maldonado

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