Once Medicare pays first, your plan’s job is to fill what Medicare leaves, and nothing more.
For retirees 65 and over, Medicare is the primary payer and the retiree plan pays second. We place a fully insured group indemnity plan that supplements Medicare, so retirees can use any provider or hospital that accepts Medicare and the employer’s cost is a premium rather than a claims risk.
Medicare pays, then the group plan pays, then the retiree pays what is left.
The design sits on top of Medicare’s rules, which is why it is simpler for retirees than an active plan.
Medicare Pays First
For retirees, Medicare pays first regardless of employer size. The plan is built around that, so it does not duplicate anything Medicare already covers. Medicare-primary design is the foundation of post-65 retiree coverage. The plan is designed around Medicare, so it does not duplicate what Medicare pays. Check the dates and rules for your own group with our free Medicare enrollment window calculator.
The Plan Fills the Gaps
The group plan picks up Medicare’s deductibles and coinsurance according to its design. We set the design to what your retirees use, because the gaps that matter differ from one retiree group to the next. Usage-based design makes Medicare supplement coverage fit.
No Network to Manage
Retirees can see any provider or hospital that accepts Medicare. That matters for retirees who travel or live part of the year elsewhere, because the plan follows Medicare rather than a network map. Medicare-wide access helps traveling retirees. Any provider accepting Medicare works.
Fully Insured
The insurer carries the claims risk and the employer pays a premium. That makes the employer’s cost predictable, which is why this structure suits sponsors who want a retiree promise they can budget for. Fully insured retiree plans keep employer costs predictable.
Group supplement, Medicare Advantage or a subsidy: each asks something different of the retiree.
There is more than one way to provide post-65 coverage. We compare them on your retirees, not on a brochure.
Group Indemnity Supplement
Broad provider access and a simple claims experience, priced as a premium. It suits retirees who value choice of doctor, which is why it is our starting point for comparison. Group indemnity supplements offer retirees broad provider choice. They suit retirees who travel or split the year between homes.
Medicare Advantage
A managed plan that replaces Original Medicare for the retiree, often with a network. It can be priced differently, but network limits land on retirees, so we test it against where they actually get care. Network testing shows whether Medicare Advantage fits your retirees.
Drug Coverage
Prescription coverage has to be solved alongside medical. The plan must tell retirees each year whether its drug coverage is creditable, because 63 days or more without creditable coverage can mean a lifetime Part D penalty. Annual creditable coverage notices protect retirees from Part D penalties.
Retirees rarely arrive at 65 ready. The plan has to meet them there.
The move from pre-65 coverage to Medicare plus the group plan is where retirees need the most help.
Part B in Place
The group plan assumes Part B is in place. We make sure retirees enroll on time, because a retiree without Part B faces a gap the plan was never designed to fill. On-time Part B enrollment keeps post-65 retiree coverage working the way it was designed to.
Steps Before the Birthday
We send each retiree their steps and dates well ahead of 65, which is why the first claim after the switch is paid correctly rather than sorted out later. Advance reminders make the switch to post-65 retiree coverage smooth and keep the first claims paid in the right order.
Support After
Retirees call with questions about explanations of benefits from two payers. Those calls come to our team, so the retiree gets an answer rather than a referral. Dedicated support helps retirees read claims from Medicare and the group plan, so two explanations of benefits make sense.
What employers and retirees ask about post-65 coverage.
Is this the same as a Medigap policy?
It works in a similar way, supplementing Medicare, but it is a group plan the employer sponsors rather than an individual policy the retiree buys. That keeps the employer’s contribution and the retiree’s enrollment in one place. Group Medicare supplement plans keep retiree coverage in one place.
Can the employer change the plan later?
That depends on your plan documents, any bargaining agreements and what retirees were told. Counsel decides it, and we make sure the documents are reviewed before any change is proposed. Plan documents decide whether retiree coverage can change. Counsel reviews any change first.
What does it cost the employer?
A fully insured premium, of which the employer pays whatever share it chooses. We model a defined-dollar contribution against a percentage of premium, so the long-term cost is visible before the decision. Contribution modeling shows the long-term cost of retiree coverage.
Where the Rules Come From.
The laws and rules named on this page link to the statute or regulation they come from. This is general information, not legal or tax advice, and rules change, so check the current text.
COBRA Continuation Coverage (29 U.S.C. 1161)
Requires many group health plans to offer temporary continuation coverage after a qualifying event.
Creditable Prescription Coverage (42 CFR 423.56)
Defines creditable coverage for Medicare Part D disclosure and notice rules.
Medicare HRA
Reimbursing Medicare premiums for retirees.
Medicare Secondary Payer Reporting
Who reports Medicare beneficiaries on your plan to CMS.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
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