Mid-year change Medicare enrollment

[JJRetirement]

Under Section 1.125-4(e) a mid year change is permitted when an employee or spouse "Becomes entitled to coverage (i.e. becomes enrolled)" in Medicare Part A or Part B.

If an employee does not actually enroll in Medicare when first eligible, does the actual enrollment in a mid-year in a later year (say beyond age 70) qualify as a change permitting him to drop health care under the employer plan? Premiums are paid pre-tax under the cafeteria plan.

I am wondering what the purpose of the parenthetical in the regs is and will it help this employee who has now decided he wants to enroll in Medicare, but he won't be covered in time for start of the plan year.

[jsb]

Yes, I would consider the first-time acquisition of Medicare (that is, "entitled to" or "enrolled in" as evidenced by receipt of a Medicare card) to be a qualifying event that would allow the employee to drop coverage mid-year, provided, however, that the employee made the request to drop their coverage within the time frame specified by your plan.

In Benefits world, we tend to consider "entitled to coverage" to mean "eligible for coverage", but someone is not actually enrolled until they fill out the forms and enroll.

In Medicare world, "entitled to coverage" means "enrolled", not just eligible; that is, you've taken the steps, filled out the papers, and CMS sent you your Medicare card, so now you are "entitled" to have Medicare pay some of your medical bills.