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  1. #1
    Join Date
    Sep. 7, 2009
    Location
    Lexington, KY
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    16,912

    Default Company Health Insurance and Age Discrimination Question

    A friend works for a national farm supply company. He just turned 65 and signed up for Medicare (instructed to by company). They (the company) are self insured and they have removed him and his wife from the group plan. The wife is only 61 and diabetic, my friend has cancer.

    From what I've read so far, they cannot do this and it is discriminatory.

    He has an appointment with Social Security to explore his options (assuming the damn govt. finally opens).

    Anyone more familiar with the law that I...input please. Poor guy is really, really worried.
    "We can judge the heart of a man by his treatment of animals." ~Immanuel Kant



  2. #2
    Join Date
    Jul. 1, 2009
    Location
    Colorado
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    736

    Default

    LauraKY -- Can you provide a guess as to how many employees there are with the national farm supply company? Also, how long has your friend been with the company?

    As for SSA -- the field offices are open and are assisting individuals who must file for benefits.
    Nothing with horses is ever easy or cheap. And if it is, you're doing it wrong. They always rip out part of your soul when they leave. I guess that's how they find us later.



  3. #3
    Join Date
    Sep. 7, 2009
    Location
    Lexington, KY
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    Default

    He's been with them for 25 years. They have between 5,001 and 10,000 employees.

    That's great that the field offices are still open.

    Same company had another friend on temporary part-time...working 40 hours a week for 5 years to avoid paying benefits.
    "We can judge the heart of a man by his treatment of animals." ~Immanuel Kant



  4. #4
    Join Date
    Jul. 1, 2009
    Location
    Colorado
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    736

    Default

    OK -- So his employer offers a Large Group Health Plan (LGHP), which is controlling. Most large employers are self-insured, and I can't find anything that would change your friend's rights to continued coverage under the LGHP as long as he is working fulltime for the employer.

    This may have just been an "honest mistake" from their HR department, or they are trying to avoid the expenses of his treatment and his spouse's treatment. He should nicely ask to meet with someone from HR and ask them to show him where they have the right to discontinue him (or anyone that is 65), as that would be discriminatory.

    The Medicare Secondary Payer statute (42 U.S.C. Section 1395y(b)(3)(C)) prohibits a group health plan from “taking into account” the Medicare entitlement of an active employees or family members if such employees are still considered in “current employment status.”

    Employers are prohibited from discouraging employees from enrolling in their group health plan or from offering “financial or other incentive for an individual entitled to Medicare ”not to enroll (or to terminate enrollment) under” a group health plan that would otherwise be a primary plan.

    I asked about how many employees there were, because these rules do not apply to employers with less than 20 employees for each working day in at least 20 weeks in either the current or the preceding calendar year, as provided in 42 U.S.C. Section 1395y(b)(1)(A)(ii).
    Nothing with horses is ever easy or cheap. And if it is, you're doing it wrong. They always rip out part of your soul when they leave. I guess that's how they find us later.



  5. #5
    Join Date
    Jan. 10, 2002
    Location
    Area VIII, Region 2, Zone 5.
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    6,582

    Default

    Quote Originally Posted by twelvegates View Post
    The Medicare Secondary Payer statute (42 U.S.C. Section 1395y(b)(3)(C)) prohibits a group health plan from “taking into account” the Medicare entitlement of an active employees or family members if such employees are still considered in “current employment status.”
    Exactly. You are not required to enroll in Medicare when you turn 65 if these three conditions are met:

    1. You are actively working
    2. More than 20 people are covered under your employer’s health plan
    3. The health plan includes drug coverage


    As long as all three conditions are met, you can be 110 and you are not required to enroll in Medicare. Sounds to me like the company wanted to get your friend off their plan, plain and simple.
    Quote Originally Posted by Linny View Post
    Those martingales were so taut, you could play Ode to Joy on them with a comb


    1 members found this post helpful.

  6. #6
    Join Date
    Sep. 7, 2009
    Location
    Lexington, KY
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    Default

    Thank you. Yes, I believe that was exactly what the company wanted. Now to see if he's willing to stand up to them. I'm not sure.
    "We can judge the heart of a man by his treatment of animals." ~Immanuel Kant



  7. #7
    Join Date
    Dec. 4, 2005
    Location
    washington state
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    6,857

    Default

    Is this a union job? I am assuming not but asking anyway. Have your friend tread carefully with HR, they are there for the company not the employees when all is said and done. If he can bring a trusted supervisor to maybe sit in? In my (many, many) years as a supervisor I am pretty familiar with age discrimination and medical benefits, of course, with each situation you have to look at what your state says for labor type laws in addition to federal discrimination issues. Sounds like your friend has two issues going on, one with medical bennies and the other with age discrimination.

    Found an interesting article here--

    "Do you still work and have health care coverage through your employer?
    Active employees who continue to work past age 65 cannot be dropped from their employer's group health plan without violating the federal Age Discrimination in Employment Act (ADEA). In addition, the Medicare secondary payer rules prohibit an employer from reducing health benefits to current employees as a result of their eligibility for Medicare based on age (except in the case of certain small employers). Thus, while coverge for current employees over age 65 may be coordinated with Medicare, the employer must offer health benefits to those employees that are equal to the benefits that it offers to other similarly situated employees (this prohibition does not apply to retirees, as discussed below)."

    http://www.shrm.org/hrdisciplines/be...rechoices.aspx

    Although I am in my last week of being a supervisor after so many years, advocating for employees is very near and dear to my heart. Make sure your friend knows all their options and I would seriously consider making a bit of a stink about this outside of the company. If union, this would be a formal grievance, if not, I would consider a labor attorney. If they get away with it once how many more times? How many have already happened? Employee benefits are part of a business contract, not just some thing they "get" for "fun".
    The Knotted Pony

    Proud and upstanding member of the Snort and Blow Clique.


    1 members found this post helpful.

  8. #8
    Join Date
    Jun. 24, 2005
    Location
    Alabama
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    8,206

    Default

    Unfortunately, my guess is that if he wins this that he will be 'downsized', or if in a state which has (hire at will? or something like that) laws that allow firing at will, that he will be gone very soon. Most companies and health plans with Medicare coverage use the regular health plan as primary payer, and Medicare or Tricare secondary payer.

    If he will only have Medicare when he retires, then he needs to look at Medigap insurance, so the out of pocket and other expenses are covered. I don't know about the rules for the wife at all. The entire subject is very strange to me, and totally confusing.

    (Sonny's Mom-Thanks, I corrected my posting, because I really am confused about the whole thing).
    Last edited by JanM; Oct. 12, 2013 at 07:22 PM.
    You can't fix stupid-Ron White



  9. #9
    Join Date
    Sep. 7, 2009
    Location
    Lexington, KY
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    Default

    No trusted supervisor. He's retiring anyway in January. He's going to have to get outside help and I don't know if he has the nerve to do it.
    "We can judge the heart of a man by his treatment of animals." ~Immanuel Kant



  10. #10
    Join Date
    Mar. 24, 2004
    Location
    Pottstown, PA (East Coventry)
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    3,014

    Default

    Quote Originally Posted by JanM View Post
    Most companies and health plans with Medicare coverage become the second payers to Medicare, so you still have your company coverage.
    As long as he is actively working Medicare is secondary to the employer's plan in the majority of cases. That would also go for his wife. If she has Medicare and he is actively working Medicare is secondary to his company's health plan.

    Generally speaking the government wants somebody else to pay first. Medicaid and TriCare (military) is always secondary to other coverage- health, auto, accident only coverage. Medicare is generally secondary to a plan for somebody that is actively employed or the dependent of somebody that is actively employed. There are a few exceptions for Medicare such as small group and end-stage renal disease.
    Oh, well, clearly you're not thoroughly indoctrinated to COTH yet, because finger pointing and drawing conclusions are the cornerstones of this great online community. (Tidy Rabbit)


    1 members found this post helpful.

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