Insurance Agent Forum

[Bob_The_Insurance_Guy]

Okay, here's the situation:

I have a client who's company consists of just him and his assistant. He is not Medicare eligible, but she is.

He has a condition which precludes him from getting individual coverage, but she does not.

They've had a group plan now for 8 years, five of which I've been the agent.

She is always the one complaining about meeting the deductible, and paying the coinsurance, he does not.

We are coming up on their group plan renewal, and she is thinking about going on to Medicare, of course, but also getting a Medicare Supplement or Medicare Advantage Plan. This would leave him out in the cold, since the group would no longer exist (in Georgia, you need 2 minimum to have a group).

Now, here's my thinking:

Even though she is Medicare eligible, she does not have to take on any Medicare Supplement or Medicare Advantage Plan, she can stay on the group plan with him, and opt for the Supplemental Coverage at a later date/year. This keeps the group in tact.

Their group plan is with the Evil Empire (BCBSGA). I was wondering if there was any way to provide a Blue Cross Med Supp plan as an option for the group. I haven't called BCBSGA yet to ask, I wanted your input first. You folks are better informed than they are.

The thrust here is to keep the group in tact, so that he can retain his health insurance. However, if there is any way to add on, as an option for her, the Medicare Supplement WITHIN the group, that would be gravy.

Am I smokin' dope, or is there any reason to my madness?

Any replies, no matter how harsh or critical, are gladly accepted.

[Dave020]

Check you state's rules on valid waivers for groups. In CA, one person can constitute 100% participation so long as the second employee is still working and is waiving for one of the following three valid waivers:

-Medicare
-MediCal (CA Medicaid)
-Spousal group coverage (other group)

It may be the same where you are.

Dave

[GreenSky]

Dave -

You've had the same avatar for quite a long time now. Ever think about changing it to a head of garlic?

Rick

[Dave020]

Not just a head of garlic, but a bobblehead of garlic

Happy now?

[somarco]

Seems like you had a beer stein a few months back when you were playing soldier with the RAF.

On a serious note, thanks for your service to our country.

[mking]

The question also related to what the carrier (B/C) will allow with regards to their underwriting requirements and state regulation on what constitutes a "group"........and acceptiable waviers...........Also keep in mind that with employers less than 20 ees........if a Medicare eligible employee stays in the group plan the carrier may require her to have Part-B also .......which also cost $96.40 per month
However some carrier may give you a Medicare eligible "rate' since the person is on Medicare (which is PRIMARY) some carrier do not give you "credit" for being on Medicare.......