Medicare Coordination Rules
Employee Status | Medicare Entitlement | Primary Plan | Secondary Plan |
|---|---|---|---|
Active Employee age 65 or older | Medicare due to age | State and School Employees' Health Insurance Plan | Medicare |
Spouse (age 65 or older) of Active Employee | Spouse has Medicare due to age | State and School Employees' Health Insurance Plan | Medicare |
Retired Employee age 65 or older | Medicare due to age | Medicare | State and School Employees' Health Insurance Plan |
Disabled Retired Employee under age 65 | Medicare due to disability | Medicare | State and School Employees' Health Insurance Plan |
Active Employee any age | Medicare due to ESRD | State and School Employees' Health Insurance Plan (1st 30 months) | Medicare (Primary after 30 months) |
COBRA participant under age 65 | Medicare due to ESRD | State and School Employees' Health Insurance Plan (1st 30 months) | Medicare (Primary after 30 months) |
COBRA participant over 65 or disabled | Medicare due to age or disability | Medicare | COBRA |
If you have COBRA when you become Medicare-eligible, your COBRA coverage ends on the date you enroll into Medicare. If you have Medicare before you are eligible for COBRA, you are allowed to keep the COBRA benefits.
If the Plan is primary at the time the 30-month coordination for ESRD begins, the participant must serve the entire 30 months before Medicare will be primary regardless if they become Medicare eligible for any other reason.
A surviving spouse or dependent of a retired employee or surviving spouse age 65 or older is assumed to have Medicare Part A and B regardless of that participant's Medicare eligibility. The Plan will calculate benefits assuming the participant has Medicare A and B.
If a retiree is retroactively approved for Medicare due to Social Security disability, the Plan will update their records to reflect Medicare as the primary coverage effective the date of Medicare eligibility. Subject to any federal restrictions and/or Plan conditions, the Plan will also refund any overpayment of premiums and reprocess claims to calculate benefits as secondary to Medicare not to exceed two years.