Are you an employer offering group health coverage? Do you have Medicare eligible employees who have opted out of the group? If so, you may expect to receive a letter from CMS as part of the IRS/SSA/CMS Data Match Project. Click here to learn more.
The fines for not completing the requested questionnaire are significant. But that’s just the tip of the ice burg.
Medicare is required to be the secondary claims payer for large groups. In this instance, large is defined as just 20 employees (including part time). Medicare is primary for individual plans.
If as the employer, you offered any financial incentive for a Medicare eligible employee (or spouse) to opt out of the group, CMS is entitled to recovery of the difference.
Depending on your plan design (e.g., high deductibles) and premium sharing arrangement, it still may make sense for some employees to waive coverage. Experts simply advise that you keep careful records.
Hope you’re enjoying this Holiday Season. Sorry to be such a Grinch!