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Calculating COB for a Patient
In our example, our patient’s name is Amy. In order to figure out
whether a COB applies to Amy, we need to know her initial
entitlement reason.
Amy is under Age 65, not disabled, began dialysis on 12/18/2015.
She had no training or transplant within the first 3 months of
dialysis, but had a successful transplant back in 2003. Amy’s
husband is the subscriber on an EGHP policy from Cigna and is
working full time for a large employer group.
We conclude Amy’s initial Medicare entitlement reason is ESRD
because she is under 65 and is not disabled.
Based on the ESRD entitlement reason, the subscriber must be
currently working for the policy to coordinate ahead of
Medicare. Since her husband is the employee and currently
works for a large group, 30-month COB will apply.
Due to successful transplant in 2003, 3 month waiting period is
waived.
If we count the 30 months, Medicare will become primary
6/1/2018.
Successful
transplant
ESRD
Entitlement
RCDB / FDODE