Medicare

Regarding our group health plan, if we have active employees who have spouses who are on Medicare, is there any LEGAL way to get them off the plan or at least have Medicare pay primary?

Our rates have gone up an average of 25% per year for the past 4 years and it appears that "spouse claims" have played a large part in those increases.

The owners of the company are not interested in raising the EE contribution for spouse coverage. Currently, the cost for all of our coverage tiers (EE, EE+Child, EE + Spouse, Family) is split about 80% to ER and 20% to EE. The company keeps absorbing the increases each year, but I don't know how much longer they can do this. And even though the company absorbs the increase, it definitely impacts EE raises. No raises are given until the health insurance renewal is completed!

FWIW, we are a rural factory with a little over a hundred insured EE's. Our average insured EE age is about 48. We do NOT have a wellness program.

If anyone has any suggestions, I'm all ears.

Comments

  • 2 Comments sorted by Votes Date Added
  • Sorry, if your plan has over 20 covered, you must be primary. Any attempt to exclude spouses over 65 will be seen as age discrimination. I believe you are stuck.

    Your best bet is to begin a wellness program ASAP. We have found we save at least $2 for every $1 spent. We are going to begin a more directed desease management program in 2013 for diabetics and chronic asthmatics which we expect to greatly reduce these costs in our self-funded plan.

    If you are fully insured you should talk to your agent about how to reduce your costs. Your insurer probably has something to offer. If you are self-insured, your agent should still be able to help you. You should probably also do a poll among your local HR people or on this or other similar forums. You might also check with some associations in your industry.

    Good luck!
    Nae
  • If you're up for renewal soon, another idea (if you're not already doing it) is to introduce some sort of HDHP with HSA or HRA. We have found that consumers are much more careful with their claims (and health) on the HDHP plans, as they have much more skin in the game.

    As the others have pointed out, active disease management, as well as offering incentives for annual wellness screens and healthy lifestyle management are key.

    Do you offer an EAP you can refer employees to?
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