On COBRA and Medicare (Part A only)

[dp8086]

I'm 62 and currently on COBRA while I look for a new job. My wife is 69 (retired) and was covered under my ex-employers plan, she currently has Medicare Part A only.

I know the COBRA coverage covers my wife as well but I'm not clear if she's REQUIRED to sign up for part B immediately or we can wait until I get a job (or I retire)

I greatly appreciate any info/pointers  that clears this up for me!

Darrell

[GailL1]

@dp8086 

You are fine since you are not eligible for Medicare yet.  However, your wife may not be - 

Sometimes, depending on what your COBRA coverage says:

If you have COBRA and you’re eligible for Medicare but not enrolled, COBRA may only pay for a small portion of the health care services you get, and you may have to pay most of the costs yourself. 

This may be true for your wife on those health coverage items that are covered by Medicare Part B - like doctor visits and a lot of other stuff.  Part A is the hospital insurance so for the everyday stuff it is Part B.

Also Medicare may not count her COBRA coverage as being a replacement for her Part B coverage, like your employer group coverage was when you were employed with your last employer, and they could assess her a late sign up premium penalty which will last forever.  

A lot of this is dependent on what your COBRA policy says about being eligible for Medicare and how it pays in that regards.

Medicare.gov - COBRA coverage 

If she is gonna go ahead and sign up for Part B and since she is already 69, she will need to get this form filled out by the employer holder of the plan(s) she has had continuous coverage under since age 65.

CMS.gov CMS-L564 Request for Employer Information 

If she finds that she doesn’t need it now she will later on when does want to sign up for Part B.  This proves she has had continuous coverage under an employer group plan since 65 - and will give her access to signing up for Part B without having to wait for a special enrollment period and perhaps have a lapse in coverage.  The form is pretty much self explanatory.

Good luck in your job search.

[dp8086]

Thanks, unfortunately your reply has many "may not"s, "may have"s, etc..so I'm still not confident we should get part B immediately.

I believe the Cobra coverage will be identical to the coverage I received when employed, which was good, (employer plan, plus Medicare Part A only for my wife)...but I'm not sure, 

I do have the L564 from my previous employer

My preference is my wife does not get Medicare part B until I retire (we keep Cobra or my future employers plan for both of us)

Thanks again, will keep researching...

Darrell

[DirkB349973]

Your wife should be on Medicare and collecting SS. Get her a supplemental plan and a drug plan and she will probably have better coverage than you, and cheaper as well. Based on what you've said so far, your "preference" makes no sense.

[dp8086]

Thanks! Right now our coverage (from ex employer, through COBRA) is cheaper than an ACA plan just for me. My understanding is my wife can't use ACA as she's eligible for Medicare.

[Tonster521]

@dp8086 Gail has provided excellent information regarding Medicare and COBRA coverage. I will add that you should request the most current copy of your past employer's Summary Plan Description (SPD) and any Summary Modifications if the SPD has not been updated in years. If your past employer was a larger employer, they were probably self insured and provided health insurance benefits via a welfare benefit plan pursuant to the Employee Retirement and Income Security Act (ERISA). If so, there is a high probably that such Plan carves out Medicare benefits whether you or your eligible dependent applies for Medicare or not. Depending on the language of your SPD, you may be self insuring your spouse for Medicare Part B coverage. FYI, the contribution (which Medicare calls premium) for Medicare Part B is $174.70 which is only 25% of the projected cost. The Federal government covers the other 75%. So, if you are looking for a deal, Medicare Part B is outstanding compared to self insuring your spouse which could cost tens of thousands of dollars.

If your employer is a small employer, they may provide health insurance coverage via an insured plan which will be governed by State insurance provisions/laws. In this case, the Plan will carve out Medicare benefits whenever the law allows them to do so. Hope this helps.

[GailL1]

@dp8086 

All those “may or may nots” or “may haves” deal with what is in your COBRA contract in how it deals with those who are eligible for Medicare.  Just like other health insurance plans - Just like other employer group plans, how they deal with it should be covered in your COBRA policy.  

DOL.gov- An Employee’s Guide to Health Benefits Under COBRA

Read the part “ What Is COBRA Continuation Coverage?”

The policy or the insurer should tell you whether or not there is a coordination of benefits with Medicare.

Medicare.gov - WHO PAYS FIRST

This could mean that it is better to have Medicare A & B so that any claims are fully covered.

from the link 

If you have Medicare because you’re 65 or older, Medicare pays first.

If you have COBRA and you’re eligible for Medicare:

• COBRA may only pay a small portion of your medical costs
• You may have to pay most of the costs yourself.

Contact your COBRA plan and ask what percent they pay.

What else do I need to know?

There may be reasons why you should take Medicare drug coverage instead of, or in addition to, COBRA. If you take COBRA and it includes creditable prescription drug coverage, you'll have a Special Enrollment Period to join a Medicare drug plan without a penalty when COBRA ends.

End- copy/paste from the link 

You can read it from AARP:

AARP.org updated 01/11/2024 - Do I need to sign up for Medicare if my former employer’s coverage con... 

[Tonster521]

@GailL1 You have provided pertinent info for Darrell to carefully review. Having worked for a large employer that went thru significant downsizing and Plant closings, I cannot tell you the number of times past employees elected COBRA coverage for Medicare eligible dependents and found out later that COBRA coverage was secondary to Medicare (Carve out provisions). From a monthly cost (premium/contribution) perspective, Medicare Part B and a supplement was significantly less than paying COBRA which is 102% of the employer's plan projected cost. I never understood why some Medicare eligible folks will pay 102% for secondary coverage.