With more employees continuing to work past the age of 65, employers can find themselves without answers when asked for advice about insurance benefits.
With health care reform and premiums that continue to rise, employers need information to deal with their older employees, says Crystal Manning, account executive/Medicare specialist at JRG Advisors, the management company of ChamberChoice.
“It’s a good idea to start with the basics,” says Manning. “When Congress passed the Medicare federal health insurance program in 1965, it was to provide health care benefits for people ages 65 and older, people younger than 65 who have certain disabilities and those of any age who have permanent kidney failure.”
Smart Business spoke with Manning about what employers need to know about Medicaid when dealing with employees ages 65 and older.
How does Medicare work?
Traditional Medicare has two parts. Part A provides hospital coverage and those covered do not pay a premium if they are age 65 or older and they or their spouse worked and paid Medicare taxes for at least 10 years. Those under age 65 are eligible if they have been entitled to Social Security benefits for two years or are either on dialysis or are a kidney transplant patient.
Part B covers doctors’ visits and other medical services, for which the covered person pays $115.40 per month in 2011. Services for both Part A and Part B are covered at 80 percent, with the Medicare enrollee paying 20 percent of any approved services.
And effective Jan. 1, 2006, Medicare Part D was added to the plan for the prescription drug component. Part D is not optional; anyone with Medicare Part A and B must also enroll in Part D. It is important to sign up for these benefits when you become eligible because penalties may apply if you fail to do so.
While many people retire at age 65, if you plan to continue working after age 65, there are rules that you need to be aware of. First of all, someone who is continuing to work should not decline Part A. In some instances, employees have been given improper advice to decline Medicaid in order to be eligible for a health savings account. This is a mistake, as it may result in penalties and the employee would not receive Social Security retirement benefits.
How would employees age 65 or older be covered?
If there are more than 20 employees in a company, the employer’s medical benefits plan — not Medicare — would be the primary source of coverage for an active employee over the age of 65. In this case, the employee does not need to enroll in Part B if he or she is satisfied with the coverage provided by the employer. However, if the employer has not set up a senior product plan, Part B would be an option.
After officially retiring, the employee would then be eligible for a special election period. If there are fewer than 20 employees in the company from which the employee is retiring, Medicare will be the primary coverage and the employee should enroll in Part B and look at a Medicare Advantage option.
These plans are a complement to Medicare and include a creditable drug benefit, some dental and vision benefits and, in some instances, even health club membership benefits. These plans usually have budget-friendly options.
In 2011, the Medicare Part D Annual Coordinated Election Period will run from Oct. 15 through Dec. 7, with an effective date of Jan. 1, 2012. There can be no changes to the plan once someone has enrolled, unless he or she chooses to go back to original Medicare only.
What is the employer’s role in Medicaid?
Each year, all employers, regardless of the size of the company, are required to send out a Part D creditable coverage letter to all employees. Although they may not realize it, the majority of employers are affected by Medicare Part D in some way. Even if your employee benefits package does not offer a specified retiree prescription drug benefit, you may have an active employee or one of their dependents who is, or will soon become, Medicare eligible.
A common mistake made by many employers is enrolling an employee who is 65 or older in COBRA. However, COBRA is not creditable coverage for Medicare. If a Medicare-eligible employee is put on COBRA because of a lack of knowledge of the employer, that person will be subject to Part D penalties, will inadvertently waive their enrollment options and would then have to wait until the next general enrollment period in order to become eligible.
As many employees choose to continue to work past the traditional age of retirement, employers need to be aware of the issues that will impact those employees. Employees who are working past the age of 65 present special challenges to their employers, who need to be knowledgeable about how Medicare will impact those workers.
Medicare is complex and requires the expertise of someone appropriately licensed/appointed to advise eligible individuals of the options available. In order to prevent mistakes that could potentially harm your older employees, it is a good idea to provide them with access to a Medicare specialist who can clarify any uncertainty.
Crystal Manning is an account executive/Medicare specialist with JRG Advisors, the management company for ChamberChoice. Reach her at (412) 456-7254 or [email protected].
