Medicare Secondary Payor Rules -- "coverage by virtue of current employment status"

[Guest steelejared]

Under the Medicare rules Medicare must be the secondary coverage for employees of an employer who has at least 20 employees and that covers Medicare beneficiaries who are age 65 or older and who have coverage under their employer's group health plan "by virtue of an individual's current employment status." The regs at Section 411.104© state that coverage by virtue of current employment status is coverage by the ghp based on employment including coverage based on a certain number of hours worked. My questions deals with the following: If the plan document defines an eligible employee as an employee who works greater than a certain number of hours ("x hours") and defines a retiree so that the retiree may still work part time but must have fewer than x hours so that they are not an eligible employee, but the retiree is covered not as an employee but only as a retiree, do the Medicare MSP rules still prohibit the ghp from providing secondary coverage for the retiree. I have not been able to find anything which says that this does or does not work. Any tips?

[jsb]

If the coverage is "by virtue of CURRENT employment", then Medicare is secondary. I think you described a situation where the coverage is by virtue of PRIOR employment, that is, retiree status. In this case, Medicare should be primary.

We have the same situation. Retirees who return to work on a part-time or limited term basis. They are not eligible for any of our employment benefits. However, they may be covered by one of our group (fully insured) health plans as a result of their status as a pension-drawing retiree. But for their retiree status, they would not be receiving any health insurance from us. If they have it, Medicare is primary.