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COBRA Plans
If a patient has a COBRA
PRIOR TO
Medicare entitlement, the COBRA can
potentially terminate
If a patient is entitled to Medicare
PRIOR TO
obtaining COBRA, COBRA
policy and state law need to be reviewed to determine whether policy will
remain active and whether a COB could apply
COBRA is still an EGHP, as it is a continuation of employer group coverage
Exchange Plans
Due to the Affordable Care Act (ACA) in 2013, individuals can purchase
medical health coverage through the Health Insurance Exchange
Marketplace for their state. When they purchase a plan through the
exchange, it is considered an individual medical plan. If a patient
purchases an exchange plan and has Medicare A and B, Medicare will
always be the primary payer
Small employers of 50 full-time employees or less can offer medical (and
dental) coverage through the exchange. They will do this using the Small
Business Health Options Program (SHOP) Marketplace. When you verify a
patient who has a medical plan through the SHOP Marketplace, be aware
that COB may still apply, depending on Medicare entitlement reason.
Examples:
1. Patient has Medicare due to ESRD, Medicare will be secondary to the
SHOP plan.
2. Patient has Medicare due to Age and is still employed, Medicare will be
secondary to the SHOP plan.
3. Patient has Medicare due to Disability (through spouse who’s still
employed), Medicare will be primary due to amount of employees.