Medicare and groups over 20 employees

[Guest billlehnertz]

I have a CPA group which has 19 employees, and will have 19 employees when it renews January 1. The carrier will charge the 67-year-old employee enrolled in Medicare $286 instead of $576 if the group was over 20 employees. They will charge that amount until the next renewal. We know that the employee number will be over 20 before tax season is over and drop to 19 in May. Has anyone had any experience or know how Medicare would treat claims for this 67-year-old if the claims were incurred when there were more than 20 employees? Thank you.

Bill Lehnertz

[Guest taylorjeff]

Here's the MSP wording...

"The "20 or more employee" threshold is met when an employer has 20 or more full and/or part-time employees for each working day in each of 20 or more calendar weeks in the current calendar year or the preceding calendar year. The 20 calendar weeks do not have to be consecutive. The requirements of the MSP law are based on the number of employees, not the number of people covered under the plan. EGHPs assure correct application of the "20 or more employees" rule by taking the following steps:

At the beginning of a calendar year, employers should examine their records to determine whether they had 20 or more employees for each working day in each of 20 or more calendar weeks during the preceding calendar. If so, the threshold has been met, and Medicare is secondary payer for working aged people covered by the EGHP for the entire calendar year that has just begun. Once employers have met the requirement in a particular year, they must provide primary coverage for the remainder of the year and throughout the following year.

If employers have not satisfied the threshold during the previous calendar year, it is still possible that they will meet it at some point during the new calendar year. Once employers reach the threshold, Medicare becomes secondary payer from that point on through the remainder of that year and throughout the next year. Medicare does not become secondary payer retroactively for the part of the year before the threshold is reached."

If the employer goes less than 20 weeks with 20 or more ees, they have nothing to worry about. However, if sometime later that year they go back up to 20 or more ees, those weeks will need to be added to the previous weeks earlier in the year. If the total weeks exceed 20, the the threshold is met and they should by law begin paying the "employer primary" premium. Any claims incurred prior to the threshold date are "medicare primary".

I have a CPA group which has 19 employees, and will have 19 employees when it renews January 1. The carrier will charge the 67-year-old employee enrolled in Medicare $286 instead of $576 if the group was over 20 employees. They will charge that amount until the next renewal. We know that the employee number will be over 20 before tax season is over and drop to 19 in May. Has anyone had any experience or know how Medicare would treat claims for this 67-year-old if the claims were incurred when there were more than 20 employees? Thank you.

Bill Lehnertz