Humana reimbursement changes affect Medicare-eligible members

Humana reimbursement changes affect Medicare-eligible members

Bulletin Type: 
Carrier Notices

Medicare primary payer rules affect groups with fewer than 20 employees

Effective July 1, 2016, Humana will reduce a Medicare-eligible member’s benefits by the amount that would have been covered if the member were enrolled in Medicare Part B. Those impacted have been notified of this change in a letter from Humana distributed late in 2015.

Under established Medicare payer rules, Medicare is the primary payer of a medical claim for an enrolled Medicare member working at a business with fewer than 20 employees. For Medicare-eligible employees who don’t enroll in Medicare Part B, the reduction in their Humana benefit will likely leave them with higher unreimbursed medical expenses.

For some Medicare-eligible employees, it may be less expensive to drop their employer-provided health plan and enroll in Medicare (A & B) and supplement plans.

Given this change takes effect July 1, 2016, this notice is a courtesy reminder for plan sponsors. Those who are actively working full time and want Part B coverage by July 1 need to elect coverage by June 30.

After July, Part B can still be obtained for a Medicare-eligible working individual who loses group coverage, so long as coverage is secured within the eight-month Special Enrollment Period.

For more information, please contact your Bukaty benefits consultant at 913.345.0440.

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