Medicare Eligibility

[DTH]

When active employees turn age 65, are group health plans required to have them elect to either stay in the group health plan (with Medicare as secondary payer) or opt out of the group health plan and enroll in Medicare?

Also, I recall that if an individual who is eligible for Medicare but does not enroll in it that they are assessed a Medicare premium penalty (10%??) once they actually enroll. Becuase of this penalty, are there any disclosure rules that apply?

Thanks!

[Mary C]

The Medicare penalty is applicable to the Part B premium only. However, the regs do specify that an individual does not need to enroll in Part B if they are covered by an active group health care plan after they turn 65 and gives the individual a grace period of 7 months after they lose the active employer group health care coverage in which they can enroll in Part B without incurring the penalty.

[DTH]

Is the group health plan required to disclose this?

[Guest chloe]

Under the Medicare Secondary Payor rules, coverage for an active employee is primary to Medicare if the employer has more than 20 employees. The only exception would be for disabled, under 65 individuals or for individuals with ESRD after 30 months.

[Mary C]

To the best of my knowlege, nothing requires a group health care plan to disclose any Medicare regulations.

[Guest fritzreb]

The only disclosure now required by Medicare under the new MMA regs for an effective date 1/1/06 is that employers offering prescription drug coverage must disclose to all plan participants if the group coverage will count for credible coverage under MMA. This rule is for all group prescription drug plans, even for employers who do not offer retiree benefits.