Medicare Requirements

Blog|May 20, 2019

Employers that offer group health insurance benefits to Medicare-eligible individuals generally must comply with 3 key Medicare requirements:

Medicare generally requires employers that offer prescription drug coverage to Medicare-eligible individuals to satisfy two notice requirements:

  1. Prior to October 15 each year, the employer must provide Medicare-eligible individuals with a Medicare Part D Creditable or Non-Creditable Coverage Notice. These notices serve to notify the individuals whether the employer-offered prescription drug coverage is “creditable” under law. Coverage is generally “creditable” if it is expected to pay, on average, as much as the standard Medicare prescription drug coverage. 
  2. Within 60 days of the beginning of each plan year (generally March 1 for calendar-year plans), the employer must complete an online disclosure to the Centers for Medicare and Medicaid Services (CMS) to report whether the coverage offered is “creditable.” 

Medicare Secondary Payer Requirement

When an individual is covered by both an employer-sponsored group health plan and Medicare, it can be confusing as to who should pay for the individual’s medical claims. In general, the employer-sponsored group health plan is the primary payer of these claims, while Medicare is the secondary payer. However, exceptions do apply, including for employers with less than 20 employees. For more information, contact your Arcwood Account Manager or call CMS at 1-800-MEDICARE.

Medicare Nondiscrimination Requirements

Medicare-eligible employees are generally protected against discrimination in group health insurance benefits in two ways:

  1. Employers with 20 or more employees are required by law to offer workers and their spouses who are age 65 or older the same health benefits that are offered to younger employees.
  2. Employers are generally prohibited from encouraging or offering incentives to individuals to enroll in Medicare instead of a group health plan. However, the Equal Employment Opportunity Commission (EEOC) has stated that offering Medicare-eligible employees a choice between either group health insurance coverage or the reimbursement of Medicare Part B premiums is generally lawful as long as the choice creates an advantageous option available only to the Medicare-eligible employees.

Published by

Jessica Cheney

Jessica Cheney

Jessica Cheney is the Vice President of Benefits for Arcwood Consulting. She is responsible for overseeing all aspects of our clients from quoting, onboarding, renewal, compliance and ensuring we are meeting and exceeding our client and company goals. Her vast knowledge of the industry and employers allows her to oversee the processes and ensure our clients’ needs are met. Jessica began her career in 1993 at BlueCross and BlueShield of Arizona and then joined Black Gould and Associates, a large general agency where she worked with carriers, agents and clients implementing and servicing large employers. Jessica joined Arcwood in 2005. In addition to holding her Accident/Health and Life Producer license she has the REBC (Registered Employee Benefits Consultant) designation and certifications in HIPAA (Privacy and Security), Benefits Account Management, Patient Protection and Affordable Care Act (PPACA), Self-Funding, Voluntary Worksite and Wellness. Jessica also serves as President on the board of the Greater Phoenix Association of Health Underwriters (GPAHU). Personally, Jessica, being an Arizona native enjoys outdoor activities such as hiking, biking, camping and attending sporting events with her family.