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Over 65 employee medical plan options

Guest Pecos

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We have about 300 full time employees and many of our employees are over the age of 65 with Medicare coverage. From the laws I have read, we have to stay primary for full time employees and can not offer a "individual" supplemental Medicare program or financial incentives to waive group coverage.

My questions:

Could we offer a group supplemental medicare program for full time employees over 65? Would the employee have to be allowed to choose between the supplemental and group health plan?

Could we offer part-time employees over 65 supplemental Medicare coverage (do not meet the eligiblity rules for the group health plan)? If they are under 65 working part-time, is it discriminatory not to offer them some type coverage as well?

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First, there is no such thing as a group Medicare Supplement plan. Its not allowed, although many employers think they have them. What they actually have is a medical plan that is designed to wrap around the Medicare payment much in the same way as a Med Supp plan and pays secondary to Medicare because the individuals are not active employees.

If they are active employees, ADEA and the Medicare rules require that they be given the same benefit plan options that employees under age 65 are offered. You can distinguish by age or Medicare entitlement.

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  • 3 weeks later...
Guest Nate Ogden - OBA

We administered a group Medicare supp for the Hartford for 10 years. Covered retirees but was group sponsored. That being said you can't offer then secondary coverage if they decline the primary the law says;

"Medicare beneficiaries are free to reject employer plan coverage, in which case they retain Medicare as their primary coverage. When Medicare is primary payer, employers cannot offer such employees or their spouse’s secondary coverage of items and services covered by Medicare."

If you offer a cafeteria plan and individual premium reimbursement plan a retiree possibly could waive the GHP and use their cafeteria money to purchase their own Medicare supp. Their are open questions though if offering individual premium reimbursement creates scenario where those policies become group policies. Would have an attorney sign off before you did it

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