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Notice 2015-17 and Medicare Advantage (Part C)


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Question: Can an employer reimburse an employee's Part C (Medicare Advantage) premiums under the rule in IRS Notice 2015-17 or otherwise?

In IRS Notice 2015-17, the IRS allows an employer to reimburse an employee's Medicare Part B and D premiums under certain circumstances (i.e., the employer offers another group health plan, the actually enrolls in Medicare Part A and B/D instead, and the reimbursement is limited to reimbursement of Part B/D and Medigap premiums).

By its terms, 2015-17 is limited to Part B/D, not Part C. Is there any guidance about reimbursing Part C premiums pre-tax? Is it clear that 2015-17 does, or does NOT, apply to Part C premiums? Any help would be much appreciated.

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My gut tells me that ANY reimbursement of Medicare premiums when an employer group plan is also available is a prohibited incentive for the EE to choose Medicare and violates the Medicare secondary rules.

My recollection is IRS caveated it's statements in 2015-17 to say they weren't addressing other non tax rules (such as Medicare secondary).

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  • 1 month later...

As I understand it (according to IRS Notice 2015-17), this is true if certain conditions are met, namely:

1) The employer offers a group health plan to the employee that does not consist solely of excepted benefits and that provides minimum value;

2) The employee is enrolled in Medicare Parts A and B;

3) The reimbursement is available only to employees who are enrolled in Medicare Part A and Part B or Part D;

4) The EPP is limited to reimbursement of Medicare Part B or Part D premiums and excepted benefits, including Medigap premiums.

That said, what Jeff and I were wondering is how this affects Medicare Part C plans - since they are not really mentioned by the IRS.

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Medicare Part C is also known as Medicare Advantage Plan.

Medicare premiums are not reimbursable because Medicare is not a group health plan and if integrated with another employer group health plan raises the " Medicare secondary payer" problem which is noted in Notice 2015-17 Answer 3.

Also while "Medicare secondary payer" might only apply to employers with less than 20 employees, Notice 2013-54 and the EPP prohibition applies to employers with more than 2 employees, and state laws might also be applicable.

George D. Burns

Cost Reduction Strategies

Burns and Associates, Inc

www.costreductionstrategies.com(under construction)

www.employeebenefitsstrategies.com(under construction)

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Hi GBurns,

Thanks for your response, but I'm confused by the answer. It seems to me that Question 3, while prohibiting some Medicare reimbursement plans, also lays out a path for them to be acceptable. Can you explain more about what you mean by the "Medicare secondary payer" problem? For employer with fewer than 20 employees, Medicare is generally primary on the plan.

In the particular situation I am thinking of, a small non-profit has a fully insured high-deductible plan with 7 participants. They also have an HRA established to reimburse a portion of the high deductible levels, and they have a full medical FSA available for employees that wish to take part. If an employee turns 65, can the employer offer to pay/reimburse for the Medicare premiums (and if so, which parts)? It seems that if the employer meets the preconditions below, then they would be able to do so.

As a secondary question, could the 65+ employee still participate in any other elements of the HRA/FSA setup that is established?

For reference I have posted the entire Question 3 in IRS Notice 2015-17:

Question 3 (Integration of Medicare premium reimbursement arrangement and TRICARE-related HRA with a group health plan): If an employer offers to reimburse Medicare premiums for its active employees, does this arrangement create an employer payment plan under Notice 2013–54? If so, may the employer payment plan be integrated with another group health plan to satisfy the annual dollar limit and preventive services requirements? Similarly, does an arrangement under which an employer reimburses (or pays directly) some or all of medical expenses for employees covered by TRICARE constitute an HRA subject to the market reforms? If so, may the HRA be integrated with another group health plan to satisfy the annual dollar limit and preventive services requirements?

Answer 3:

Medicare premium reimbursement arrangements. An arrangement under which an employer reimburses (or pays directly) some or all of Medicare Part B or Part D premiums for employees constitutes an employer payment plan, as described in Notice 2013–54, and if such an arrangement covers two or more active employees, is a group health plan subject to the market reforms. An employer payment plan may not be integrated with Medicare coverage to satisfy the market reforms because Medicare coverage is not a group health plan. However, an employer payment plan that pays for or reimburses Medicare Part B or Part D premiums is integrated with another group health plan offered by the employer for purposes of the annual dollar limit prohibition and the preventive services requirements if (1) the employer offers a group health plan (other than the employer payment plan) to the employee that does not consist solely of excepted benefits and offers coverage providing minimum value; (2) the employee participating in the employer payment plan is actually enrolled in Medicare Parts A and B; (3) the employer payment plan is available only to employees who are enrolled in Medicare Part A and Part B or Part D; and (4) the employer payment plan is limited to reimbursement of Medicare Part B or Part D premiums and excepted benefits, including Medigap premiums. Note that to the extent such an arrangement is available to active employees, it may be subject to restrictions under other laws such as the Medicare secondary payer provisions. An employer payment plan that has fewer than two participants who are current employees (for example, a retiree-only plan) on the first day of the plan year is not subject to the market reforms and, therefore, integration is not necessary to satisfy the market reforms.

TRICARE-related HRAs. Similarly, an arrangement under which an employer reimburses (or pays directly) some or all of medical expenses for employees covered by TRICARE constitutes an HRA, and, as provided in Notice 2013–54, if such an arrangement covers two or more active employees, is a group health plan subject to the market reforms. An HRA may not be integrated with TRICARE to satisfy the market reforms because TRICARE is not a group health plan for integration purposes. However, an HRA that pays for or reimburses medical expenses for employees covered by TRICARE is integrated with another group health plan offered by the employer for purposes of the annual dollar limit prohibition and the preventive services requirements if (1) the employer offers a group health plan (other than the HRA) to the employee that does not consist solely of excepted benefits and offers coverage providing minimum value; (2) the employee participating in the HRA is actually enrolled in TRICARE; (3) the HRA is available only to employees who are enrolled in TRICARE; and (4) the HRA is limited to reimbursement of cost sharing and excepted benefits, including TRICARE supplemental premiums. Note that to the extent such an arrangement is available to active employees, employers should be aware of laws that prohibit offering financial or other incentives for TRICARE-eligible employees to decline employer-provided group health plan coverage, similar to the Medicare secondary payer rules.

Note that an employer may provide more than one type of healthcare arrangement for its employees (for example, a Medicare Part B employer payment plan and a TRICARE-related HRA), provided that each arrangement meets the applicable integration or other rules set forth in this notice or in related guidance.

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Take note of the "Note" at the end of your extract. The employer would have to have "more than one type of healthcare arrangement" partly because the part you highlighted in red states "and (4) the employer payment plan is limited to reimbursement of Medicare Part B or Part D premiums and excepted benefits, including Medigap premiums" (however the "and excepted benefits" does create confusion) and partly because each arrangement must meet "the applicable integration or other rules set forth in this notice or in related guidance." This means that Notice 2015-17 is not the only applicable guidance.

Regarding Medicare:

https://www.cms.gov/Medicare/Coordination-of-Benefits-and-Recovery/Coordination-of-Benefits-and-Recovery-Overview/Medicare-Secondary-Payer/Medicare-Secondary-Payer.html

Edit: Make sure you scroll to the end and see the section and downloads regarding Employer responsibility. In your case, it seems that the age 65+ employees would have Medicare and no GHP.

George D. Burns

Cost Reduction Strategies

Burns and Associates, Inc

www.costreductionstrategies.com(under construction)

www.employeebenefitsstrategies.com(under construction)

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George D. Burns

Cost Reduction Strategies

Burns and Associates, Inc

www.costreductionstrategies.com(under construction)

www.employeebenefitsstrategies.com(under construction)

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  • 10 months later...

An employer contracts with an insurer to provide a Medicare Advantage plan to its retirees (including retirees who have come back to work part-time and therefore are ineligible for the employers regular group health plan).

Is the Medicare Advantage plan in these circumstances an "individual" policy, such that the employer cannot reimburse the premiums for such plan (because, among other things, it doesn't meet the requirements of 2015-17) or is it a "group health plan" not subject to the prohibition?

Thanks.

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