Can my employer force me to drop out of group health plan at age 65 and take only medicare?
Total Comments: 3
Posted: Tue Aug 31, 2010 10:36 pm Post Subject:
Absolutely! If the group contract states that coverage is available to all employees and dependents under age 65, then at age 65 you would no longer be eligible for the plan. Your under age 65 spouse and dependents who are under 18, 19, 23, or 26 (depending on the policy language) would be eligible to continue the group coverage at the full cost of the group insurance for 36 months under the provisions of COBRA. (Employers currently are required to subsidize 65% of the COBRA continuation coverage, but that is always subject to change.)
Posted: Mon Mar 25, 2013 11:47 pm Post Subject: Commercial insurance is denying claims
My husband is a township trustee that has full coverage medical insurance through the township at no cost to him or the employees. Medicare premiums would cost him over $100.00 a month so he chose not to sign up for Medicare. Our insurance recently denied a claim stating that since my husband did not go on Medicare they will no longer pay his claims but the township is still paying his premiums. Is that legal?
Posted: Tue Mar 26, 2013 04:35 am Post Subject:
Our insurance recently denied a claim stating that since my husband did not go on Medicare they will no longer pay his claims but the township is still paying his premiums. Is that legal?
Probably. You have to look at the controlling document, either a copy of the Master Contract or the Summary Plan Description to see what it says about Medicare. However, if the insurance company is not going to pay any of your husband's claims, then it needs to terminate his coverage and refund the premiums to the township.
It is entirely lawful to state that beginning at age 65, the plan will be secondary to Medicare.
Now, the problem your husband has caused is that by rejecting enrollment in Medicare Part B, unless he is still within his 7 month window of first opportunity (three months prior to age 65, the month he turned age 65, and three months following age 65), he will likely be subject to a lifetime premium penalty of 10% for every 12 months he has gone without being enrolled in Part B. The only saving grace would be if Social Security considers his continuing coverage after age 65 to be "creditable".. If they do, then he has a new 8-month window of opportunity to enroll in Part B. If the insurance company refunds premiums back to the time it no longer provided coverage, that could expose your husband to the premium penalty again.
Posted: Tue Aug 31, 2010 10:36 pm Post Subject:
Absolutely! If the group contract states that coverage is available to all employees and dependents under age 65, then at age 65 you would no longer be eligible for the plan. Your under age 65 spouse and dependents who are under 18, 19, 23, or 26 (depending on the policy language) would be eligible to continue the group coverage at the full cost of the group insurance for 36 months under the provisions of COBRA. (Employers currently are required to subsidize 65% of the COBRA continuation coverage, but that is always subject to change.)
Posted: Mon Mar 25, 2013 11:47 pm Post Subject: Commercial insurance is denying claims
My husband is a township trustee that has full coverage medical insurance through the township at no cost to him or the employees. Medicare premiums would cost him over $100.00 a month so he chose not to sign up for Medicare. Our insurance recently denied a claim stating that since my husband did not go on Medicare they will no longer pay his claims but the township is still paying his premiums. Is that legal?
Posted: Tue Mar 26, 2013 04:35 am Post Subject:
Our insurance recently denied a claim stating that since my husband did not go on Medicare they will no longer pay his claims but the township is still paying his premiums. Is that legal?
Probably. You have to look at the controlling document, either a copy of the Master Contract or the Summary Plan Description to see what it says about Medicare. However, if the insurance company is not going to pay any of your husband's claims, then it needs to terminate his coverage and refund the premiums to the township.It is entirely lawful to state that beginning at age 65, the plan will be secondary to Medicare.
Now, the problem your husband has caused is that by rejecting enrollment in Medicare Part B, unless he is still within his 7 month window of first opportunity (three months prior to age 65, the month he turned age 65, and three months following age 65), he will likely be subject to a lifetime premium penalty of 10% for every 12 months he has gone without being enrolled in Part B. The only saving grace would be if Social Security considers his continuing coverage after age 65 to be "creditable".. If they do, then he has a new 8-month window of opportunity to enroll in Part B. If the insurance company refunds premiums back to the time it no longer provided coverage, that could expose your husband to the premium penalty again.
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