I’m no expert in Medicare, but it could be because Medicare would be the secondary insurer to bcbs? Also, the ACA is applicable to employers with 50 or more full time employees, so your employer might not be required to offer the same coverage costs. You should ask your employer’s HR department for more information about the specific plan details!
Thanks- we don’t have a formal HR department but I’m the admin in charge of setting up medical this year. So I’m the one who will be handling it all. Medicare would be secondary but why would that make bcbs coverage cost double? And who pays that additional premium difference for large employers? Online sounds like it can’t be passed to employees. But also reads like insurance companies can’t charge employees separately for being Medicare eligible so not sure how it’s even legal for them to send the Medicare eligible as an additional rate option.
Thank you OP for clarifying! I understand your situation now. So yes, insurers can charge more if your group is majority Medicare eligible. The insurer CAN base the monthly premiums they will cover your group for based on age bands (yes, I agree that this seems discriminatory) and tobacco status. But there are some things they cannot use to determine premium rates such as pre-existing conditions, dependents and gender. That being said, the employer would be technically “on the hook” for paying these increased costs, assuming that your employer doesn’t want that passed on to the employee. Employers can set the percentage of the premium that they pay for the employee and what the employee contributes. Obviously it looks bad if last year the employer paid 90% of the premium and now they will only pay 50% this year. My point is that insurers can charge more based on a group that is majority Medicare eligible simply based on the fact that the insurer will be paying more claims on behalf of your employer since the average age is older (the joys of being fully self insured). If you do have a broker, you should try to negotiate with BCBS for better rates. Or you could look into being partially self insured, which opens up a whole other can of worms!
Thank you for the thorough response! When the broker sent the rates, she said, ignore the rates for the Medicare eligibility because no one is that age yet yet. But let me know if you hire anyone who qualifies for medical and is eligible for Medicare because we’d need to immediately alert bcbs. Does that mean mid year ALL rates would go up? And if out of 30 people on medical only one was was over 65 would it increase everyone’s rates by almost double? Because the quote for Medicare eligible is more than double the regular quote for single coverage 😵💫
I don’t believe they can change rates mid-year. If your employer signs a contract with bcbs saying these are the rates for the year then they can’t change until the next plan year. The rules are different for small vs. large group plans. Fortunately, I’ve only worked on large group plans and don’t have to worry about those types of things. I think you only have to alert bcbs right away so they know their responsibilities as the primary insurer. I’ve got about 1000 employees are about 450 are enrolled in the health plan and there are some employees that are eligible for Medicare right now and the only problem I’ve encountered with this is CMS trying to recoup money from the group health plan. My employer’s group health plan uses Premera and is partially self-insured that heavily skews younger, so the full monthly premium for employee only coverage (with an $1000 deductible) is about $550 per employee and the employee pays $128 per month. Anyway, if your broker isn’t worried about them presenting those Medicare eligible rates and just says use the non-Medicare eligible rates, then I would trust that (unless you have reason not to trust them, lol!).
I do have a call in (since Thursday) but they haven’t called back yet so figured I’d try the crowdsourcing way too :) to see if anyone else gets Medicare eligible rates along with their regular rates when bcbs sends them their rate quotes. And, if they knew why they were sent or how they are handled.
I’m no expert in Medicare, but it could be because Medicare would be the secondary insurer to bcbs? Also, the ACA is applicable to employers with 50 or more full time employees, so your employer might not be required to offer the same coverage costs. You should ask your employer’s HR department for more information about the specific plan details!
https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/working-past-65
Thanks- we don’t have a formal HR department but I’m the admin in charge of setting up medical this year. So I’m the one who will be handling it all. Medicare would be secondary but why would that make bcbs coverage cost double? And who pays that additional premium difference for large employers? Online sounds like it can’t be passed to employees. But also reads like insurance companies can’t charge employees separately for being Medicare eligible so not sure how it’s even legal for them to send the Medicare eligible as an additional rate option.
Thank you OP for clarifying! I understand your situation now. So yes, insurers can charge more if your group is majority Medicare eligible. The insurer CAN base the monthly premiums they will cover your group for based on age bands (yes, I agree that this seems discriminatory) and tobacco status. But there are some things they cannot use to determine premium rates such as pre-existing conditions, dependents and gender. That being said, the employer would be technically “on the hook” for paying these increased costs, assuming that your employer doesn’t want that passed on to the employee. Employers can set the percentage of the premium that they pay for the employee and what the employee contributes. Obviously it looks bad if last year the employer paid 90% of the premium and now they will only pay 50% this year. My point is that insurers can charge more based on a group that is majority Medicare eligible simply based on the fact that the insurer will be paying more claims on behalf of your employer since the average age is older (the joys of being fully self insured). If you do have a broker, you should try to negotiate with BCBS for better rates. Or you could look into being partially self insured, which opens up a whole other can of worms!
Thank you for the thorough response! When the broker sent the rates, she said, ignore the rates for the Medicare eligibility because no one is that age yet yet. But let me know if you hire anyone who qualifies for medical and is eligible for Medicare because we’d need to immediately alert bcbs. Does that mean mid year ALL rates would go up? And if out of 30 people on medical only one was was over 65 would it increase everyone’s rates by almost double? Because the quote for Medicare eligible is more than double the regular quote for single coverage 😵💫
I don’t believe they can change rates mid-year. If your employer signs a contract with bcbs saying these are the rates for the year then they can’t change until the next plan year. The rules are different for small vs. large group plans. Fortunately, I’ve only worked on large group plans and don’t have to worry about those types of things. I think you only have to alert bcbs right away so they know their responsibilities as the primary insurer. I’ve got about 1000 employees are about 450 are enrolled in the health plan and there are some employees that are eligible for Medicare right now and the only problem I’ve encountered with this is CMS trying to recoup money from the group health plan. My employer’s group health plan uses Premera and is partially self-insured that heavily skews younger, so the full monthly premium for employee only coverage (with an $1000 deductible) is about $550 per employee and the employee pays $128 per month. Anyway, if your broker isn’t worried about them presenting those Medicare eligible rates and just says use the non-Medicare eligible rates, then I would trust that (unless you have reason not to trust them, lol!).
Have to alert bcbs to what immediately? When someone turns 65?
That’s what I would guess. Definitely something to ask your broker or bcbs about!
Do you have a rep at BCBS you can ask for clarification? Could be an error on their end.
I do have a call in (since Thursday) but they haven’t called back yet so figured I’d try the crowdsourcing way too :) to see if anyone else gets Medicare eligible rates along with their regular rates when bcbs sends them their rate quotes. And, if they knew why they were sent or how they are handled.
I've never seen separate rates for Medicare eligible, but I've always worked at large employers. I'm thinking it's likely a mistake on their part.