Coordination of Benefits

If you have coverage through an employer group plan (yours or your spouse’s), it’s important to establish which coverage has the primary responsibility to pay your claims.  For example, if you or your spouse work for a company with 20 or more employees, the group plan will pay your claims first, with the balance submitted to Medicare.  If fewer than 20 employees, then Medicare is Primary, if you’re over 65.  For those who are under age 65 and covered by Medicare due to a disability, that threshold is 100 employees.


If you’re on COBRA coverage and then become eligible for Medicare, you may be removed from COBRA when Medicare coverage begins.  This is the “correct” procedure based on the COBRA law, but we’ve recently noticed some COBRA administrators are being more lenient and allowing folks to remain on COBRA even after Medicare starts;  we recommend a conversation with your COBRA administrator to be certain how this will be handled in your case.


Those with policies purchased through COVERED CALIFORNIA will need to cancel their policy as soon as Medicare is effectiveYou may not continue with that coverage after Medicare starts, and if your plan is subsidized with the Advance Premium Tax Credit, all of the “subsidy” will be due back to the Government, and any claims paid under that policy may become your responsibility.  It’s important that you cancel your policy through Covered California BEFORE Medicare starts, effective as of the last day of the month prior to Medicare’s inception.


Medicare has a brochure about Coordination of Benefits, which will provide a reference to some of the possibilities.  For complete details, see the Who Pays First.  If you’re not sure, please call us to discuss your particular situation.

Call us at 831-335-8200!