To Medicare or Not To Medicare

We are self insured for our group health and dental coverage. With all of us Boomers getting up in years, we are obviously seeing an increase in claim dollars. It is our understanding that you cannot require a full time ee to take Medicare instead of the group plan, nor can you even encourage or entice them to do it. They can take Medicare as primary with us offering a supplement to Medicare ONLY IF they choose to do that.

We put together some comps for our 65 and 65+ ee's showing what they would receive if they stayed on the group plan as is, versus signing up for Medicare with us offering a Medicare supplement. To be sure they would have at least as good a coverage package as they have now, we would also give them the Rx coverage out of our regular plan plus the dental coverage out of our regular plan. We also would pick up the premium cost for their Part B Medicare. We want everything to be apples to apples (obviously, except that our out-of-pocket expenses for the future claims would be a lot less).

Our outside broker told us he was concerned that if we offer a Med Supp + Rx + Dental to our 65+ active ee's, and also pay the premium for their Part B, the paying (or reimbursing) of that Part B premium would be considered an enducement or encouragement. We currently pick up 100% of the premium cost for all ee's and charge a small portion of the premium cost for dependent coverage. Wouldn't it be considered an equal benefit if we pick up the full premium cost for the Part B as it is for us to pick up the full premium cost for the rest of our employees?

Thanks for any help or clarification you can give us.
KathyD

Comments

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  • I'm with your broker. My understanding is that ANY incentive to NOT enroll in the employer plan is considere unallowable and subject to fines and penalties. I'd have to search for the exact regs but I'm sure you can find it on google. Or just ask your broker to point you to the regs.
  • I appreciate your response, dbutton111.

    Where I stumble on this is where we put the two options side by side in front of the ee.

    Each option costs them no premium out of pocket;
    each option covers the same things: doctor, hospital, lab, xray, Rx, dental, etc.;
    each option conforms to "reasonable and customary " charges;
    they can have coverage for dependents, for a reduced premium either way; and
    they will be offered COBRA coverage upon a qualifying event, either way.

    In essence, since the regular group plan has its deductible, co-pays and its co-insurance, compared to Medicare A & B plus a Medicare supplement, regular Rx and dental, they are getting much better coverage with the latter. If I were 65, and put the 2 plans side by side, I would definitely choose the Medicare option.

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