Florida 2-15 Life, Health and Variable Annuity AgentGeneral Knowledge of Health InsuranceMedium
A client is 65 years old and continues to work for an employer with 30 employees. They are covered under the employer's group health plan. Which of the following statements regarding their Medicare coverage is accurate?
- AThe client must drop the employer's group plan and rely solely on Medicare.
- BThe employer's group plan is the primary payer, and Medicare is secondary.
- CThe client cannot enroll in Medicare Part B while covered by the employer's plan.
- DMedicare is the primary payer, and the employer's group plan is secondary.
Show answer & explanationAnswer & explanation
Correct answer: B. The employer's group plan is the primary payer, and Medicare is secondary.
For individuals aged 65 or older who are still working and covered by a group health plan from an employer with 20 or more employees, the group health plan is primary, and Medicare is secondary. Since this employer has 30 employees, this rule applies.
Why the other options are wrong
- A. This is incorrect. The client has the option to keep both, with the group plan being primary.
- C. This is incorrect. The client can enroll in Part B, but it will typically be secondary to the group plan.
- D. This is incorrect. For employers with 20 or more employees, the group plan is primary.
Medicare Secondary Payer (MSP) Rules - Working Aged
Regulations that determine whether Medicare or a private health insurance plan pays first for healthcare services for individuals aged 65 or older who are still working.
- Applies to employers with 20 or more employees.
- Group health plan is primary payer.
- Medicare is secondary payer.
Memory trick: Working Aged: Group first, then Medicare's last.