PF Compass wants you to know some important rules for your Medicare-eligible employees. Eligible members are encouraged to enroll in Medicare in order to maximize their health plan benefits and minimize expenses.
- If your employer has an employee headcount of twenty or more employees, a commercial health plan is the primary payer.
- If your employer has an employee headcount of under twenty employees, Medicare is the primary payer.
It’s important for eligible members to enroll in Medicare
Once a member is eligible for Medicare as their primary payor, and if they are not enrolled in Medicare, health plans will coordinate benefits with their group coverage and pay benefits as though they were enrolled in Medicare Part B. This means that benefits will be paid by subtracting the amount that Medicare would have paid (usually 80 percent of the Medicare rate) and paying only the remaining balance of the claim as if the member had enrolled in Medicare Part B. As a result, members will be responsible for the amount that their health plan did not pay in addition to any applicable copayments, coinsurance, and deductibles.
This process is described in the group’s benefit plan documents as Medicare Primary and/or Medicare as Secondary Payer.
Wrapping it Up
We at PF Compass are dedicated to helping employers and employees alike. We treat everyone with the same top of the line industry standard regardless of employee size. That’s why we have been New Jersey’s top employee benefits brokerage for 25 years plus. If you are interested in learning more, please feel free to contact us for an obligation-free phone call!
PF Compass works with clients who primarily reside up and down the Eastern Corridor. We work with all types of businesses, large and small, across a wide range of industries. Over the years we have created a reputation of providing quality group benefits and unmatched service for all our clients. As a result, we are proud to say that many of our clients have become loyal and continue to work with us for years to come.