# Group health insurer requires Medicare



## Goodfootdoug (Dec 8, 2022)

My small group health insurer has been my primary without need for Medicare. Now they are requiring me to get Medicare Part B, and Medicare will be primary, group health will be secondary. The employer says the monthly premium, for group health, will not change. Why does the rate not decrease? The insurer will now only be paying roughly 20% of my claims, whereas before they paid 100% for the same premium.
  The law requires an 80% loss ratio. If the premium for my group health as primary, paying 100%, satisfied the 80% loss ratio requirement, how can the greatly reduced coverage with the same premium meet the 80% requirement?


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## Kaila (Dec 17, 2022)

I see your point, and I definitely do not know the answer to your question;

but I would just offer 2 thoughts on that general situation.

1)  Perhaps it helps them to keep having medical coverage available _overall_, or it might even _enable_ them to provide the group insurance,  for _everyone_ that gets it,
to require that those who do qualify for Medicare, take it when they qualify.
And/Or, another possible view:
2)  it _is actually _good insurance coverage, I think, to have them both, Medicare Part B and your other medical insurance plan.  The combination will likely serve you well. Something many of us would like to have.

I don't know the rest of your question.  I am not an expert at all.

But, maybe it was an extra good deal, for the younger ones who do not qualify for Medicare, and for you then in the past years, when you benefitted from it, too.


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## Kaila (Dec 17, 2022)

Another possibility related to your question,
*might be something related to the requirements of a small group plan, *rather than for each individual under the plan having a separate requirement of that 80% loss ratio.

Again, I have no training in the field.  I am just pondering and sharing ideas, which is what we do on this sort of forum.  We don't and can't give professional advising.


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## OneEyedDiva (Dec 17, 2022)

I paid nothing for Aetna HMO via the State of N.J. employees then retirees benefits programs (SHBP) until I got on Medicare, at which time I started paying the basic Medicare premiums.  SHBP required that I submitted proof of Medicare B coverage (what then was the red, white and blue card) to add me to their Medicare plan  which is basically an advantage plan. Once I did that, the transition was seamless but just the opposite scenario from yours. Aetna Medicare HMO (and as of this year PPO) is my primary insurance and I was instructed to never use that red, white and blue medicare card as soon as they provided Medicare coverage for me. 

I can't answer your questions either. Perhaps a group insurance representative can answer those questions for you.


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## Lethe200 (Dec 31, 2022)

While my spouse worked, our health insurance for both of was about $130/mo. As each of us turned 65, Medicare became the primary and the private insurer became secondary.

We still pay the private carrier, plus the Medicare premiums on each of us. 

Our coverage is exactly the same. But we get to pay 3x what our previous bill was! 

OTOH, that is still only about 45% of what our HMO would normally charge on a policy for 2 seniors. It's the equivalent of a Medicare Advantage plan, since the HMO has its own hospitals, pharmacy, complete vision and hearing aid departments, etc. - everything but dental is included.


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