Can COBRA plan drop me if I chose not to accept Medicare?

[Guest Jtomiser]

I've looked everywhere but can't find an answer to predicament. Let me explain:

1. I am disabled and have never enrolled in Medicare because I've always been covered by my husband's insurance.

2. My husband lost his job and I enrolled in COBRA

3. That was 10 months ago. Now the COBRA administrator tells me that they're not going to cover me because I'm eligible for COBRA. Not "entitled", which I understand to mean receiving Medicare benefits, but "eligible".

4. I looked into enrolling in Medicare 10 months ago and Medicare said even if I were to enroll during the general enrollment period, I could not receive benefits until the following July.

My question is, can the COBRA administrator do this? Can I really be required to opt into Medicare rather than COBRA?

Thanks so much, I'm really confused on this.

[oriecat]

No, they are wrong.

Here is the law:

http://edocket.access.gpo.gov/cfr_2005/apr...r54.4980B-7.htm

26CFR 54.4980B-7

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.

[GMK]

Excellent reference, oriecat.

Most general literature and other documents say "eligible for Medicare," which to most people means or appears to mean old enough (or otherwise eligible) to enroll in Medicare. Causes big confusion.

[oriecat]

Yeah, it would be so easier if everything would forget that confusing "entitled" word and just use "enrolled".

[Guest Jtomiser]

Sorry I actually said eligible for "COBRA" when I meant to say Medicare, but it looks like you all got the picture.

New info: It seems that since I collect SSI I was automatically enrolled in Medicare Part A 15 years ago. That was news to me. Anyway, Aetna now says they'll only pay secondary COBRA benefits even though I'm not enrolled in Part B. They only recently became aware when I tried to get coverage for a wheelchair. I guess that expense raised a red flag for them. No they say they're going to go back and collect money from all the providers because Medicare should have been primary (even though I'm not now, nor have ever been enrolled in Medicare Part B).

But shouldn't the COBRA administrator notified me of this provision in the plan? When I enrolled a year ago I received nothing that referenced it. They were still happy to take the money for 12 months. Do they not have any responsibility here?

[oriecat]

If you had the Medicare prior to the COBRA, they still can't kick you off of COBRA, you can have both (as explained in the Q-A I posted already). Which one is primary becomes a whole new question that we probably don't have enough information to answer.

[Guest Jtomiser]

Thanks for the replies by the way. Oriecat - that's exactly right, they have not kicked me off COBRA though I thought they had after speaking to the manager. What they're really saying is there's a provision in the plan that says they can make Medicare Part B primary even if I don't have it and even though I'm not required to have it by law. Essentially, the plan reserves the right to assume I have the Part B coverage and not pay primary. In other words, they can just pretend I have it. Essentially, the law can't require me to buy Medicare but Aetna can (or else they'll slash the benefits I paid them for). Doesn't seem like it should be legal but I guess it is.

The big question for me now is whether I'll be permitted to read that plan provision and whether the COBRA administrator had any obligation to notify me of that provision when I signed up. My understanding is that they have a fidiciary duty to communicate the terms of the plan to the beneficiaries. After all, the plan is not out there for the reading, and even so the sponsor appears unwilling to make it available.

[oriecat]

You might want to review this booklet and call the Medicare Coordination of Benefits people and see what they have to say:

http://www.medicare.gov/publications/pubs/pdf/02179.pdf

From page 32 of the booklet

If you have questions about Medicare and COBRA, call the Medicare Coordination of Benefits Contractor at 1-800-999-1118.

[Guest Jtomiser]

I will look at that. Thanks again!

[Mary C]

The provisions of the plan are in the Plan summary plan description - the plan provisions do not change from active employee coverage to COBRA coverage - and since COBRA coverage must be identical to that you had while your spouse was employed, it has probably been in place since you signed up for coverage. Your COBRA administration may not have the information you are looking for, but your husband's former employer would. And no, COBRA administrators are NOT required and do not have a fiduciary duty to inform you of the plan provisions - that's the previous employer's job.

I do question how the coordination of coverage provisions under an active plan can state they presume you are enrolled in Part B if eligible. I would assume that goes against the Medicare Secondary Payer regulations for active employee coverage. Once the coverage provided is under COBRA though, MSP provisions state Medicare is primary.

[LRDG]

Mary C, worth pointing out that COBRA in no way changes coverage received while an actively at work EE.

The fiduciary duty of the ER includes providing Plan Docs to participants with in 15? business days from receipt of written request, under penalty for failing to do so. DOL penalty is $150? per day?

Here is a link to DOL site for COBRA and health plans:

http://www.dol.gov/dol/topic/health-plans/cobra.htm

In addition to the link provided by oriecat:

http://edocket.access.gpo.gov/cfr_2005/apr...r54.4980B-7.htm

[Guest lisa4165]

I just came across this discussion and it seems like I am in an almost IDENTICAL situation:

1. I am disabled and didn't enroll in Medicare Part B because I had insurance through my husband.

2. He was terminated and we went on COBRA as of 5/1/09.

3. Aetna has been paying all my claims through the group insurance.

4. Yesterday I called Aetna because one of my claims had been flagged as needing "more information." After the rep asked me questions about my Medicare eligibility, she announced that Medicare should have been primary all along and that Aetna will pay secondary as if I had been paid my Medicare, even though I haven't. She said they'll need to go back into my past claims to "correct" them.

I was never told anything about coordination of benefits with Medicare when I enrolled in COBRA. I declined to enroll in Medicare Part B because I thought that the COBRA plan (at $500/mo. individual) gave me better coverage and made the other coverage redundant.

My question is: was the COBRA administrator responsible for informing me that Aetna would pay as if I'm receiving Medicare benefits, whether or not I do? I never received an SPD when the company switched to Aetna (from Anthem Blue Cross) as of 4/1/09. I was given a brochure about the Aetna plan, but no SPD or anythiing that had information about coordination of Medicare benefits.

Any help would be appreciated.

[masteff]

Lisa - this is probably the best to start with:

You might want to review this booklet and call the Medicare Coordination of Benefits people and see what they have to say:

http://www.medicare.gov/publications/pubs/pdf/02179.pdf

From page 32 of the booklet

If you have questions about Medicare and COBRA, call the Medicare Coordination of Benefits Contractor at 1-800-999-1118.

[Chaz]

The Medicare regulations state that Medicare is primary to COBRA continuation coverage when Medicare coverage is based on age or disability. Aetna can't cut off the COBRA coverage but it appears from the facts you present that they are correct that Medicare pays first.

[oriecat]

But how can Medicare pay first if she is not enrolled? Or did I misunderstand something?

EDIT: Unless she was also automatically enrolled in Part A, like the first poster. I forgot about that part.

[GMK]

You got it, oriecat.

People enroll in Part A. It doesn't cost anything and doesn't pay anything while you have employer plan coverage, but if an emergency creates the need for Part B, you don't have to wait 3 months to complete your enrollment. You're already in the system and just add the coverage(s) you need. Or so I'm told.

[Guest lisa4165]

Thanks for the responses. I reached out to the COBRA administrator (my husband's previous employer's HR dept.), who contacted the broker and then the Aetna liason. Now everything has been resolved! I'm still not completely clear on what happened--apparently the Aetna rep I talked to on the phone was misinformed and Aetna cannot be secondary when I am not enrolled in Medicare Part B. The Aetna account manager has now assured me of the following:

Medicare Part A is secondary, and Aetna is Primary

All the claims were originally paid correctyl and the advice from member services should be disregarded.

A manager will "re-educate" the Member Service rep that spoke with me.

Needless to say I am relieved. And I hope that the individual who initially posted this thread had her situation similarly resolved.

[Guest mschwab67]

Please someone help this is the same thing that is happening to me, and I can not get the Employer to admit that medicare cannot be primary if I do not have Part B. I have Part A and was insured through my husbands employer since 2002 he lost his job and I elected cobra. They are now saying they do not want to cover part b services because medicare is primary not cobra. I am wondering how to straighten this out!! PLEASE HELP I see lisa4165 finally got some results, can anyone point me in the right direction before it is too late! Cobra is telling me I must sign up for medicare partB or they will not cover my services they want to cover as if I did have partB. I agree with Oriecat how can medicare be primary for partb services when I do not have part b!!!

[GBurns]

Have you called Medicare/SSA ? Or done as lisa did, call the insurance company itself?