Lawful cancellation of medical/dental coverage for Medicare eligibles

[Guest Louie]

Is it lawful to terminate an active employee's or former employee on Pre-65 retiree or Cobra medical and dental insurance if they are Medicare eligible? I know that coverage CAN BE terminated, but if it hasn't for whatever reason can be at any time? Our company utilization and experience is getting worse and worse with each year and is devastating to our rising premiums. We have a few totally disabled and post-65 employees who are covered under our insurance plans. Can workers have both Medicare and Employer-sponsored medical and dental insurance? Thanks for any feedback!

[Linda]

I think you have to look at each group under the law and your plan documents (and consider potential amendments to your plan documents).

You are not going to be able to unilaterally take an active employee (or the family member of an active employee) out of the employer’s group health plan when he or she becomes eligible for Medicare. Of course, that person might voluntarily decide to drop employer coverage when he or she enrolls in Medicare.

Retirees and COBRA beneficiaries are a different story. A retiree health plan could be designed to simply bridge to Medicare eligibility. And the requirement to offer COBRA ends when a COBRA beneficiary enrolls in Medicare.

I don’t have enough facts to comment on the people you mention who have coverage which should have been but wasn’t cancelled.

In all situations where an individual has both Medicare and employer provided coverage, the Medicare secondary payer rules determine which program is primary.