Hello! I came across this discussion when researching about Medicare with COBRA online. My situation is not the exact same as Guest Jtomiser and Guest Lisa4165 and Guest mschwab67 because I am not disabled, but otherwise I am in a similar predicament.
I realize this discussion is from 04/2010 through 03/2011 and I have not received the same positive results that 'Guest Lisa4165' had in 2010. However, I've received so many different responses from everyone I've contacted about my current dilemma that I'm posting here to possibly acquire more concrete information and/or how to proceed (or) if I’m just screwed.
I’m also posting this ‘mini novel’ because I don’t want anyone else to go through this and if even 1 person reads my story on this website and they are 65 or older when choosing COBRA, hopefully, they will know they must sign up for Medicare Part B if they choose COBRA.
Here is my story in detail…
I turned 67 in April 2024 - my husband is 64. We had health insurance through my husband's employer when I turned 65 in April 2022, so I only enrolled in Medicare Part A. I was told by both Medicare and Social Security since I was covered under my husband's employer’s medical insurance, I could delay Medicare Part B enrollment without penalty, which I did.
My husband left his job in July of 2023, and we accepted his former employer's COBRA insurance. Thankfully, I am a very healthy 67-year-old, and rarely get sick - I use food and exercise as medicine – no drugs – not even Tylenol. Hence, I had not even used our COBRA Medical insurance (Cigna Platinum Plus) since we initially enrolled in COBRA in August 2023.
Since enrolling in COBRA in August, I’d only used our Delta Dental for bi-annual teeth cleaning and for my Orthodontist (Invisalign). In early March 2024, my husband and I set up our eye exam appointments to see the Ophthalmologist on March 21st. We both did the routine comprehensive eye exam & routine refraction, but I also had a Posterior: Retina test and we both got new reader prescription glasses.
We have EyeMed for Vision Insurance and receive their EOBs electronically. For Cigna Medical & Delta Dental, we receive paper EOBs, but can also look at them online. About a month after our 3/21 eye exam appointments, I received a paper EOB from Cigna Medical in the mail, which was strange because I’d only had the eye exam & glasses appointments. The Cigna Medical EOB was for my eye exam/ophthalmologist appointment on March 21st, so I immediately looked at our EyeMed (Vision) online accounts. My EyeMed account only had (1) EOB for the new glasses. My husband’s EyeMed account had (2) EOBs – one for his new glasses and one for his comprehensive eye exam/routine refraction. Also, on my EyeMed online account, it was boldly stated that I was due for a comprehensive eye exam, which I’d just had on 3/21.
I called EyeMed, and confirmed EyeMed had no claim for me for my eye exam/ophthalmologist appointment on March 21st - they did not – EyeMed only had the claim for my new glasses. The EyeMed rep said to call the eye doctor’s insurance/claims department and have them send the eye exam claim to EyeMed.
I called my eye doctor’s claim/insurance department and they said because I also had the Posterior Retina test that made my full eye exam claim a medical insurance claim, not a vision insurance claim. I asked her to resend the claim to EyeMed and to change the code. She said she would resend it manually through fax with notes, but that she could not change the ‘code’- she also said, with the medical code, if she resent the claim to EyeMed electronically, the system would automatically deny it again due to the medical code.
I called Cigna that same day – the agent I spoke to was not in a US call center and I had trouble understanding him, but I wanted to make sure Cigna knew and noted on my account that I had enrolled in Medicare Part A on 4/01/2022. The Cigna agent seemed as confused as I was, and I didn’t receive any additional information or help from him about my situation. But he also thought my eye exam claim should have been paid through our vision insurance (EyeMed) and not through our medical insurance (Cigna).
On Saturday, May 4th, I received a bill in the mail from the Ophthalmologist’s office. On the bill, it also showed that I owed the $140.40 and the doctor’s office added the note that was on my Cigna EOE (my doctor’s bill stated: “Cigna’s records show you have not signed up for Medicare. You are responsible for paying the amount Medicare would have paid.”).
On Monday, May 6th, I called my husband’s former company’s Cobra administrator (I don’t want to mention the name of my husband’s former company or its benefit’s administrator company because his former company is a huge international company that everyone knows – same with the benefit’s company). After several days and many hours on the phone with both the Cobra administrator and Cigna (3-way calls included), is when I learned (literally felt like I’d been punched in the gut) all about the ‘primary and secondary’ insurance if you’re 65 or over and go on COBRA.
Call me ignorant if you please (I’m not, but certainly feel that way now after this situation), but we’ve always just had company sponsored medical benefits – we’d never had (2) medical insurance policies at the same time or Cobra. Yes, I’ve heard the terms, ‘primary & secondary’ insurance before, but I obviously didn’t understand what that meant. In my mind, it just meant the primary insurance is billed 1st and what isn’t paid by it, the secondary kicks in and pays remainder up to our policy limits (less our deductibles, co-pays, and OOP max). I had no idea that it meant the primary was responsible for 80% and the secondary was responsible for 20%, and because I did not have Medicare Part B, that I’m responsible for the full 80%. Obviously, had I understood this, I’d have immediately signed up for Medicare Part B. Who would pay as much money as we are paying monthly to only have 20% coverage (?!?!) when for an additional $175, I’d have proper coverage?
We pay $2,658.15 monthly for COBRA (with my share as spouse being the bulk at $1,544.73), and I only had this (1) claim/payment by Cigna for $35.10 since our COBRA started on 08/01/2023.
My husband’s former employer only allowed us to “Call” to enroll in COBRA in August 2023 - we couldn’t enroll online like we did when active, but still have access to the company’s benefits’ website and we can do all other benefits related actions online like pay for COBRA, etc. My husband’s former company uses the same benefit’s administrator for active employees as it does for COBRA administration. When calling to enroll, we were told that the company had stopped allowing their retired/terminated employees to enroll in COBRA online because they wanted to make sure Cobra eligible employees/dependents understood everything.
However, when enrolling in August 2023 (I did it on my home phone line with CSA on speaker and my husband also in the room) – I had to give the CSA both our birthdays, etc., so the agent knew I had just recently turned 65; however, knowing I was 65, the agent never explained that COBRA insurance for me would not work the same as when my husband was actively employed. The CSA did not tell me that my coverage now would be secondary and would only pay 20% - period. The CSA did not ask if I was enrolled in Medicare Part B and did not tell me if I wanted our insurance to work as it did when husband was employed that I needed to enroll in Medicare Part B. Quite the opposite – I asked a bunch of questions, and we were assured our health insurance on COBRA was the exact same as when my husband was employed and would work (exactly) the same for both of us.
For 2024 Open Enrollment that opened in October 2023, again we were only allowed to enroll/make any changes to employers’ many other medical, dental and vision plans on the phone with the benefit administrator’s Customer Service Agent. Since we were able to make any changes to the former employers’ many, many other medical, dental, and vision plans for 2024, I had a lot of questions; hence, I requested a skilled ‘COBRA’ Supervisor only to enroll us.
We were transferred to a supervisor that was supposedly a ‘COBRA’ expert and she enrolled us for 2024. After the supervisor answered all our questions about the company’s different and less expensive options, I immediately told the supervisor/agent that we want the exact same Medical, Dental and Vision plans that we’d had – no changes from the prior year. My husband and I have always chosen to pay for the more expensive options with more coverage/less OOP when actively employed and when on COBRA because we prefer to pay higher monthly premiums vs paying higher deductibles, copays, and OOP maximums throughout the year.
Before the supervisor would even begin the conversation, I was asked to give her our birthdates, and other personal information to proceed. I asked the benefit’s Supervisor if our COBRA insurance was the exact insurance (coverage, deductibles, copays, OOP maximums, etc.) that both my husband and I had while he was employed and she responded, “Yes”.
I didn’t stop there – I gave our COBRA administrator’s Supervisor scenarios and asked her if all the %’s paid by Cigna were the same, if all our deductibles, copays and OOP maximums were the same for both of us as they were when my husband was an active employee (?) – again, she responded, “Yes”. I asked if we needed to let any doctors, clinics, hospitals, etc. know that our insurance now was COBRA insurance and was no longer active employee group insurance? The Supervisor told us “No” - we did not have to tell anyone that our insurance was now COBRA insurance because our insurance worked exactly as it did when my husband was actively employed. I had also asked her if our insurance would cover less or if providers would be hesitant to service either of us since the insurance was now COBRA? Her response again was, “No, you don’t need to tell providers your insurance is COBRA and, no, your insurance coverage is exactly as when actively employed and pays exactly the same as when actively employed”.
I have this supervisor’s name and the date we enrolled. Supposedly, all phone calls are recorded, and I’m still waiting on the company’s ‘health pro advocate’ to call me – ha – this all happened 2 months ago. I had been conversing with another benefit’s administrator Supervisor. This supervisor finally admitted to me that because I don’t have Medicare Part B, that if I ever use this Cigna medical insurance that Cigna will only pay up to 20% and I will be responsible for the 80% that Medicare would have possibly paid. For days, I had been asking this question to everyone I’d spoken to at the benefit’s administration company and at Cigna (BTW – I put in a formal request over 2-months ago with a Cigna CSA to have a Cigna Manager call me – nobody from Cigna has ever called me). Why would my husband’s former employer’s COBRA Administrator and Cigna not want to immediately answer this question?
This same benefit’s administrator supervisor also told me that the supervisor that did enroll us in October 2023 should have informed me that because I was 65 and entitled to Medicare that my COBRA medical insurance would not work the same unless I enrolled in Medicare Part B (again, supposedly all calls are recorded so I was surprised that she did admit this).
Additionally, this supervisor has already called us to offer 3 months reimbursement for our last 3-months of my portion of COBRA payments (when we asked why not reimburse all the months’ payments for my portion since August 2023 due to the inaccurate information given, less the $35.10 amount CIGNA has paid for me since we started COBRA in Aug 2023, her answer was because all those business quarters had already closed their books. Currently our COBRA is paid through the end of July 2024. We are surprised they offered to reimburse us for anything though - is this even normal? We’re wondering if they do record all phone calls and if they reviewed the recordings? Should we pursue this and/or hire an attorney?
March 31, 2024, was my 8-month SEP deadline to enroll in Medicare Part B. I called Medicare and they suggested that I call the national SS phone to set up an appointment with my local SS office so I could try to plead for an exception. My appointment is Friday, June 28th – it took 7-weeks to even be able to get an appointment at our local SS office (the national agent said they’re short staffed nationwide). The agent said because I missed my SEP, I can’t enroll in Medicare Part B until January - March 2025 and that my Medicare Part B won’t activate until July of 2025. I still have not received a firm answer from Social Security or Medicare if I will be penalized from August 2023-July 2025 (or) from August 2023-July 2025 when my Medicare Part B would commence? Would any of you know the answer to this?
Even more disheartening is my husband decided to take a job with a local family-owned business in mid-January (he was commuting over an hour to/from at his former job and we’d already planned he’d retire next year at 65). His current employer offers benefits, but we had to enroll by March 31, 2024! It’s ironic that this deadline is also my 8-month SEP deadline for Medicare Part B enrollment.
Since we were unaware of my current situation with the COBRA insurance & not being enrolled in Medicare Part B, we waived his current employer’s insurance for 2024. If we had realized all of this, we’d have either enrolled me in Medicare Part B with our current COBRA (or) we would have dropped COBRA and enrolled in my husband’s current employer’s health insurance. With either of these options, I’d now have proper health insurance coverage and I would not be penalized for life for Medicare Part B.
After this mini novel, I guess I’m still confused as to why Guest Lisa4165’s insurance company (Aetna) ended up switching her primary/secondary insurance payments to her COBRA insurance (Aetna) being/paying as Primary, and her Medicare (Part A only) paying as Secondary? Is this because she was on Disability (she too was 65 or over)?
If being on Disability was not the reason Guest Lisa4165’s husband’s former employer ended up keeping their COBRA insurance as Primary, and they did reconsider due to her not being enrolled in Medicare Part B, should we call my husband’s former employer and use the same argument as she used?
Is this a company’s decision on which pays primary/secondary? Or is this current federal law in all situations?
Lastly, I kept every single piece of paper received from hubby’s former employer and even after rereading all of it when becoming aware of my situation, I still think the DOL approved language isn’t enough – there are just too many words used that can still make a person think it doesn’t pertain to them if they are enrolled in Medicare Part A (words like: ‘or’, ‘and’, ‘generally’, ‘may’).
Below is the DOL language that is in our COBRA paperwork from my husband’s former employer…I still don’t think it is clear enough. I feel companies and/or their benefit’s administrators should be mandated to inform any former employees and their dependents (65 or over) that the insurance they are paying full cost + administration fees for is not the same and does not work/pay the same if they are 65 or over. They should also be mandated to inform that any former employees & employee’s dependents 65 or over that they must purchase Medicare Part B, and if they don’t purchase it, they will be responsible for the remaining 80%. They should be mandated to disclose/use language that clearly informs that without purchasing Medicare Part B too that purchasing COBRA insurance means they are purchasing insurance that will now only be responsible for paying up to 20%. Bottom line – IT’S JUST NOT CLEAR ENOUGH!
Here is the exact DOL language in our COBRA paperwork:
“When does COBRA coverage become effective?
Once you enroll in COBRA coverage and make your first payment, coverage is effective retroactive to the date your active group health coverage ended. A number of factors can impact how quickly your COBRA enrollment is completed, as the following chart shows.
Other Coverage Options
When you lose group health coverage, there may be other, more affordable coverage options for you and your family through the Health Insurance Marketplace, Medicare, Medicaid, Children's Health Insurance Program (CHIP), or other group health plancoverage options (such as a spouse's plan) through what is called a "special enrollment period." By enrolling in coverage through the Marketplace, you may qualify for lower costs on your monthly premiums and lower out-of-pocket costs. Additionally, you may qualify for a 30-day special enrollment period for another group health plan for which you are eligible (such as a spouse's plan), even if that plan generally doesn't accept late enrollees. Some of these options may cost less than COBRA continuation coverage.You can learn more about many of these options at www.HealthCare.gov.
Can I enroll in Medicare instead of COBRA continuation coverage after my group health plan coverage ends?
In general, if you don't enroll in Medicare Part A or B when you are first eligible because you are still employed, after the Medicare initial enrollment period, you have an 8-month special enrollment period111 to sign up for Medicare Part A or B, beginning on the earlier of
■ The month after your employment ends; or
■ The month after group health plan coverage based on current employment ends.
If you don't enroll in Medicare and elect COBRA continuation coverage instead, you may have to pay a Part B late enrollment penalty and you may have a gap in coverage if you decide you want Part B later. If you elect COBRA continuation coverage and later enroll in Medicare Part A or B before the COBRA continuation coverage ends, the Plan may terminate your continuation coverage. However, if Medicare Part A or B is effective on or before the date of the COBRA election, COBRA coverage may not be discontinued on account of Medicare entitlement, even if you enroll in the other part of Medicare after the date of the election of COBRA coverage. If you are enrolled in both COBRA continuation coverage and Medicare, Medicare will generally pay first (primary payer) and COBRA continuation coverage will pay second. Certain plans may pay as if secondary to Medicare, even if you are not enrolled in Medicare.
For more information visit https://www.medicare.gov/medicare-and-you.
111https://www.medicare.gov/sign-up-change-plans/how-do-i-get-parts-a-b/part-a-part-b-sign-up-periods. These rules are different for people with End Stage Renal Disease (ESRD).”
