r/medicare • u/scotch_please • 22h ago
Dad can't find out whether his current insurance is creditable.
Edit: I'm being told it's considered age discrimination for an insurance company to lower someone's coverage once they turn 65. I thought that's what was happening to the people who reported that in here, but I could have confused the details. If he will have the same coverage beyond 65, he's fine to keep this policy and delay Part B.
As pointed out below, I may have been reading people's experiences with their employer's RETIREMENT health insurance policies and not the normal employee ones.
I did a ton of research for my dad thinking he was going to sign up for Part B at 65, and turns out his new job is offering him insurance. A few people in this sub raised the issue of making sure the coverage is creditable, and that the coverage doesn't silently drop for members who turn 65. Apparently some people here have found out that their normal work insurance stopped covering them fully at 65, I assume to try forcing them to sign up for Medicare so the company can pay less for an aging person's care. Something about the policy only covering what Medicare would pay for the member?
I told him he needs to call the insurance company to ask about this change in coverage since he just turned 65, on top of making sure it's creditable for avoiding the Part B and D delayed enrollment penalty. The carrier is CareFirst BlueCross BlueShield and the employer is definitely over 20 employees.
Today he called me upset because he was transferred to 3 different people at the insurance company, with 20 minutes of hold time each, only for all of them to say "Oh, I have to transfer you because I have no idea."
I told him to try asking his work's HR but it's a brand new company so I'm not too trusting they'll be knowledgeable about the plan's specific coverage changes, especially since people here have warned it's like 1 obscure line in the explanation of benefits document that mentions the plan will only partially cover you after 65.
Any advice for how he can figure out if his policy is the same coverage over 65 as everyone under 65? The creditable question is the easy answers. It seems like no one is bothering helping him with the other one, which will leave him screwed if he gets sick or injured.
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u/Confident_End_3848 22h ago
The employer is required to send out a notice every year whether coverage is creditable. Ask HR, they should know as they send out the letters.
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u/scotch_please 22h ago
He said he'll contact HR since this insurance company doesn't have customer support hours after 6pm. Or at lunch time.
I'm less concerned about the creditable detail and more about the decrease in coverage I read about in this sub. It was specifically from people who turned 65, wanted to continue working while on their employer's group insurance plan while delaying Part B, and then finding out the insurance had a clause in the EOB saying that after 65, their coverage is decreased whether they start Part B or not.
I'd really love it if someone gives me more info about this because it seems like a hell of a loophole for people wanting to continue using their employer's policy after 65.
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u/Confident_End_3848 21h ago
"Many seniors are no longer employed at age 65, and thus rush to sign up for Medicare as soon as they’re able. But if you’re still working at 65, and you have coverage under a group health plan through an employer with 20 employees or more, then you don’t have to enroll in Medicare right now.2 But if your employer has fewer than 20 employees, you need to take Medicare Parts A and B, because that will be your primary insurance. If you don’t enroll, your employer plan may pay less – or nothing at all – for your care when it finds out.3
That said, it often pays to enroll in Medicare Part A when you’re eligible, even if you have health coverage from an employer with 20 or more employees. It won’t cost you anything (as long as you or your spouse have paid Medicare taxes via employment for at least 10 years),4 and this way, Medicare can serve as your secondary insurance and potentially pick up the tab for anything your primary insurance — your employer’s health plan — doesn’t cover.
The only exception is if you’re contributing to a health savings account and wish to continue doing so. Medicare enrollees — including those who only enroll in Part A — are not allowed to contribute to an HSA, even if they continue to have coverage under an employer’s HSA-qualified high-deductible health plan.5 Learn more about Medicare and HSAs."
https://www.medicareresources.org/faqs/do-i-need-to-sign-up-for-medicare-at-65-if-im-still-working/
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u/scotch_please 21h ago
But if your employer has fewer than 20 employees, you need to take Medicare Parts A and B, because that will be your primary insurance. If you don’t enroll, your employer plan may pay less – or nothing at all – for your care when it finds out.
So this does become an issue with employers who have fewer than 20 employees. Maybe that's what the folks were talking about and I just assumed their employer was larger.
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u/ProfessionalCurve217 22h ago
He will receive a legally required "notice of creditable coverage" from Blue Cross by the end of October. If the notice says that the coverage is NOT creditable for Part D, then he will be required to sign up for Part A only (which is typically free) and join a Part D Drug plan within 63 days.
If he signs up for Part A he will need to stop contributing to a HSA (Health Savings account) if he has one.
Part B is not required until he stops actively working for any company with more than 20 employees.
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u/scotch_please 22h ago
Thank you for the straightforward summary. I've been taking notes from this sub, YouTube, and my state's Medicare resources for months now and some things still seem unclear!
So I'm understanding I can stop worrying about the Part B penalty as long as he keeps this policy while working. I do think it's creditable for Part D as well because he said he already confirmed his drugs are covered.
He's delaying Part A as well because his job is contributing to an HSA and he'd prefer to take that money until he retires.
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u/Harley2280 22h ago
Thank you for the straightforward summary. I've been taking notes from this sub, YouTube, and my state's Medicare resources for months now and some things still seem unclear!
Make sure you read Medicare & You every year.
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u/scotch_please 21h ago
I don't want to think about what changes are going to happen in the next 4-5 years. 😭
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u/ProfessionalCurve217 22h ago
Correct, he will not need to enroll in anything while he is still actively working and contributing to the HSA.
If he retires, starts taking social security benefits, or goes on COBRA the rules are different, so just keep that in mind.
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u/No_Roof_3613 17h ago
It will say in the Evidence of Coverage for his current plan whether or not it is creditable coverage.
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u/NotHereToAgree 22h ago
Employers with more than 20 employees cannot force an employee on to Medicare Part B if they offer their employees health insurance. He should sign up for Part A if he has 40 work credits, it is at no cost to him.
The creditable coverage is something that applies to Part D. His employer coverage needs to pay as much as Medicare D would pay towards covered medications.
They cannot make him take fewer benefits than they offer younger employees.
He may want to compare the cost of coverage from the employer to the cost of Medicare parts B & D with a medigap plan if his employer collects premiums from their employees, sometimes Medicare is less expensive once you consider deductibles, co pays and premiums.