Medicare Information

Is enrollment in Medicare Part A and B required?

Yes. Because Medicare will become the primary payer of claims covered under Medicare Part A and B, to participate in the SEE Plan, any members of the family who are eligible must be enrolled in Medicare Part A and B.

Medicare Part A insurance helps cover the costs of inpatient care in hospitals, skilled nursing facilities, hospices, and home healthcare situations.

Medicare Part B covers doctors’ services and includes general doctor visits, X-rays, lab tests, ambulance services, and therapies such as speech, occupational, and physical therapy. Most participants are required to pay a monthly premium for Medicare Part B coverage.

What Are the Savings for Individuals and Employers?

When Medicare becomes the primary payer for claims under Medicare Part A and Part B, the cost to employers of providing medical coverage may be reduced. Employees’ hospitalization costs, including out-of-pocket expenses such as deductibles and coinsurance, will typically be lower as well. In addition to the cost savings usually realized with Medicare as the primary payer of your claims, additional savings can be realized by using in-network providers. Generally, you pay less for services from in-network providers than you will from out-of-network providers.

Exception Process

Because this is a MEWA, if at least one Participating Employer has at least 20 full and/or part time employees, Medicare is deemed to be secondary even for Participating Employers having fewer than 20 employees. However, there is an exception process for certain individuals entitled to Medicare on the basis of age for a Participating Employer with fewer than 20 employees.

In order to apply for this exception (and avoid the associated costs for the employee and your business), if you have a Participant and/or Participants spouse that become eligible for Medicare, you must provide a notice in writing for whom the Participating Employer is requesting Medicare be the primary payer. Written notice must be provided to those employees prior to them turning 65. Each Participating Employer must also send to Medical Mutual any required census data or application form requested by Medical Mutual.

• Exception Form Instructions
• Exception Form

For more information, please contact your broker or sales representative.

Medicare Part D

A prescription drug plan is considered “creditable” if its benefits are at least as good as government-defined Medicare Part D prescription drug plans.  To help Medicare-eligible participants decide whether or not to sign up for Part D coverage, group health plan sponsors are required by the federal government to send Medicare Part D (prescription drug) “creditable coverage” notices to their Medicare-eligible employees and dependents at various times during each year.

As a courtesy, Medical Mutual will send your Medicare-eligible plan participants  (employees and dependents) their annual notice by the CMS deadline in October of each year.  Medicare eligibility of your plan participants is based on information in Medical Mutual’s system – participants who either will be age 65 or older at any time during the year, or who are under age 65 but otherwise qualify for Medicare due to disability.  If you know of other individuals covered by your plan who are eligible for Medicare but you have not communicated this information to Medical Mutual, it is your responsibility to notify those participants.

Medicare Part D Creditable Coverage

Employer groups are required by law to send an annual notification to members who are currently or will become Medicare eligible during 2024 regarding their prescription drug plan's creditable (at least as good as the base Medicare Part D plan design) status related to Medicare Part D coverage.

We will also send a letter to group officials of each plan with a Medicare-eligible employee, dependent or retiree to whom we mailed a creditable coverage notice. The letter reminds the group official of his or her responsibility to provide notices to eligible employees and dependents at all other times required by law.

All employers, regardless of funding type or group size, must complete the Disclosure to CMS Form on the Centers for Medicare and Medicaid Services (CMS) website at https://www.cms.gov/CreditableCoverage/ to notify the government of their health plan's creditable status.

The COSE MEWA offers a variety of plans to participating employers and their employees.  Most of these plans are creditable, regardless if the participant is Medicare Primary or Medicare Secondary, except for the plans mentioned below:

For the 9200 MMRx:

• If Medicare pays primary to group coverage, then these plans are NOT creditable.
• If Medicare pays secondary to group coverage, then these plans are creditable.
• If you have any questions about the creditable coverage notice or your responsibility to provide it to your Medicare-eligible participants and dependents, please contact your Medical Mutual representative or broker.