Medicare Secondary Payer

[Guest Rellio]

I have a client that is hovering right around the 100 employee mark. Sometimes the size of the group dips below 100 employees, and sometimes they are above 100 employees.

As you may know, the 100 employee mark is crucial to determining if medicare is primary for disabled individuals on a group health plan. Over 100, employer plan primary, under 100 medicare primary.

Does anyone know how to determine the size of the group so we can decide if the group plan should be paying or medicare should be paying? Is it month to month? Year to year average? Other?

Thanks.

[Guest erinf]

I believe it is determined the same way COBRA application is determined - looking back at the previous calendar year, were there 100 or more employees on 50% or more working days during the year.

[Larry M]

I believe the threshhold is 20 employees.

from Medicare web site:

"In most cases, Medicare is primary. Some of the most common situations where Medicare can pay secondary are:

-The individual or his/her spouse is currently employed/working and covered under an employer group health plan as a result of current employment.

The company has 20 or more employees or participates in a multiple-employer or multi-employer group health plan where at least one employer has 20 or more employees.

-Individual in question is entitled to Medicare as a result of a disability, the company has 100 or more employees, or participates in a multi-employer/multiple-employer group health plan where one employer has 100 or more employees.

-The individual in question is Medicare entitled due to end-stage renal disease. Medicare is the secondary payer to a group health plan until a 30-month coordination period has ended."

In the latter two cases, this is for individuals who are under age 65.