Pre-65 retirees are priced into your active plan. They can have a plan of their own.
Retirees under 65 can come out of the active plan and into a self-funded group captive of their own, with stop-loss behind it and claims priced off Medicare rates rather than a network discount. Because the plan covers retirees only, it sits outside the ACA market reforms. We evaluate whether the structure fits your retirees, and set it up when it does.
A self-funded group captive for retirees, with stop-loss above it.
The arrangement separates what you expect to pay from what you are protected against.
Self-Funded Claims
The plan pays retiree claims as they are incurred, so its cost follows your retirees’ actual experience rather than a blended active rate. That is why a well-run program shows its true cost clearly each year.
The Captive Layer
Participating employers share a layer of risk inside the captive. That pooling steadies results for a retiree group too small to carry its own volatility, so a single bad year does not decide the program.
Stop-Loss Above It
Specific and aggregate stop-loss sit above the captive layer and limit what one catastrophic claim or one bad year can cost. We review attachment points and contract terms, because stop-loss protects only what the contract says it does.
Priced Off Medicare
Claims are paid at a set margin over Medicare rates rather than a discount off billed charges. The price is anchored to a public benchmark, which is why provider acceptance and balance-billing protection have to be planned from the start.
A retiree-only plan sits outside the ACA market reforms. That is design freedom, and it comes with conditions.
The market reforms that shape the active plan do not apply to a plan covering retirees only. That changes what the design can do, and what has to be decided deliberately.
What Opens Up
Cost sharing, plan design and eligibility can be set around retirees rather than around rules written for active workforces. We design them carefully, because freedom from a rule is not a reason to drop the protection it provided.
What Has to Stay Clean
The treatment depends on the plan actually covering retirees only. Keeping active employees out of it is a structural requirement, so counsel confirms the setup before the first enrollment.
What Still Applies
For private employers, ERISA fiduciary duties, a plan document and the required disclosures still apply to a retiree plan. We keep those on the calendar like any other plan, which is why the structure holds up when someone reviews it.
A Medicare-based price only works if retirees can still see their doctors.
Pricing off Medicare changes how providers are paid, and retirees notice that before they notice anything else.
Provider Acceptance
Providers know Medicare rates, but not every provider accepts a plan paying a margin over them. We review where your retirees actually get care before launch, so the first surprise does not happen at a hospital billing desk.
Someone to Call
When a provider disputes a payment, the retiree needs one number to call. Disputes come to our team and the vendors we manage behind the plan, so the retiree is not left negotiating a bill alone.
The Handoff at 65
Each retiree leaves this plan when Medicare begins. We track those dates and move people to the post-65 plan on time, so no Part B enrollment window is missed on the way.
What employers ask about pre-65 retiree plans.
Does this take the retiree liability off our books?
No. It changes how retiree coverage is funded and priced, and the obligation is still measured by your actuary under your accounting rules. We model the effect; your actuary and auditor decide the numbers.
How many retirees do we need?
There is no single minimum; the captive pooling is what makes smaller retiree groups workable. We evaluate your census and the stop-loss terms before recommending anything.
What happens with a very large claim?
Specific stop-loss responds above its attachment point, and the captive shares the layer below it. We check how the contract treats known conditions before anyone signs, because that is where surprises hide.
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.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
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