Is this Person Required to Take Part B at 65?

[kstein]

Here is an interesting one:

Woman works full time at a dental office. The office gives a High Deductible plan HSA type plan where she pays nothing for her portion.

The employer has:

27 total employees
28 full time
13 on the insurance

We are trying to find out if she is required to enroll into Part B or if her employer qualifies as credible coverage to correctly delay Part B until she quits. Anyone have an answer or a link to the correct cms document showing the definition of employer size?

 

[somarco]

https://www.medicare.gov/supplement...ance/who-pays-first/which-insurance-pays.html

If the employer has more than 20 employees, the group health plan generally pays first.

If the group health plan didn't pay all of your bill, the doctor or health care provider should send the bill to Medicare for secondary payment. Medicare will look at what your group health plan paid, and pay any additional costs up to the Medicare-approved amount. You'll have to pay whatever costs Medicare or the group health plan doesn't cover.

 

[wehotex]

https://www.medicare.gov/supplement...ance/who-pays-first/which-insurance-pays.html

if the employer has more than 20 employees, the group health plan generally pays first.

If the group health plan didn't pay all of your bill, the doctor or health care provider should send the bill to medicare for secondary payment. Medicare will look at what your group health plan paid, and pay any additional costs up to the medicare-approved amount. You'll have to pay whatever costs medicare or the group health plan doesn't cover.

call cob (coordin of benefits) @ 1-800-999-1118.

 

[kstein]

Thanks for the quick response. I wonder what the exact definition of 20 employees is? Total, full time, on insurance?

 

[WCMason]

Here is an interesting one:

Woman works full time at a dental office. The office gives a High Deductible plan HSA type plan where she pays nothing for her portion.

The employer has:

27 total employees
28 full time
13 on the insurance

We are trying to find out if she is required to enroll into Part B or if her employer qualifies as credible coverage to correctly delay Part B until she quits. Anyone have an answer or a link to the correct cms document showing the definition of employer size?

Medicare's 20 employee rule includes all employees. Non-covered and part-time employees are not excluded by Medicare Second Payer Act. 27 is the number, so she can defer Part B without a late enrollment penalty, and should not enroll in Part A if she wants to continue to contribute to the HSA.

 

[kgmom219]

Medicare's 20 employee rule includes all employees. Non-covered and part-time employees are not excluded by Medicare Second Payer Act. 27 is the number, so she can defer Part B without a late enrollment penalty, and should not enroll in Part A if she wants to continue to contribute to the HSA.

Ditto what WC said.

Its just like COBRA. Its not employees on the plan. Its the total head count, including part timers.

 

[DS4]

We are trying to find out if she is required to enroll into Part B

No

Employer plan primary, Medicare Part A secondary.

 

[bluediamond]

Is it credible coverage though for Part D?

 

[kstein]

I'm sure it is cc since its an employer plan but I haven't seen the specifics of her employer plan yet.

 

[somarco]

Is it credible coverage though for Part D?

I wondered about that but just posted the link and ran.

May not be since it is high deductible. Check with group carrier.

This ..................

A prescription drug plan is deemed to be creditable if it:

1) Provides coverage for brand and generic prescriptions;
2) Provides reasonable access to retail providers and, optionally, for mail order coverage;
3) The plan is designed to pay on average at least 60% of participants’ prescription drug expenses; and
4) Satisfies at least one of the following:

a. The prescription drug coverage has no annual benefit maximum benefit or a maximum annual benefit payable by the plan of at least $25,000, or
b. The prescription drug coverage has an actuarial expectation that the amount payable by the plan will be at least $2,000 per Medicare eligible individual in 2006.
c. For entities that have integrated health coverage, the integrated health plan has no more than a $250 deductible per year, has no annual benefit maximum or a maximum annual benefit payable by the plan of at least $25,000 and has no less than a $1,000,000 lifetime combined benefit maximum.

(Released May 23, 2005 in the Creditable Coverage Guidance.)

The maximum deductible can change each year. The 2015 maximum initial deductible is $320. Please see The 2015 Medicare Part D Model Plan Parameters for a comparison of changes each year.

What is meant by Creditable Coverage and How do I know if I have Creditable Coverage?