MEDICARE MAXIMIZATION SERVICES
If your Company offers health care benefits to pre-65 retirees, typically 20%-28% of the Pre-65 retiree population can be moved to Medicare primary. Medicare Maximization typically saves future claims exposure and incurred claims recovery for the company and provides Medicare primary and company plan secondary insurance coverage for the retiree and or spouse/dependent, plus SSDI (income).
Why Our Services:
We partner with the only company in the United States for this plan that directly exchanges data and works with Center for Medicare/Medicaid Services. With over 30 years of experience, our services ensure the expertise needed for your company. Current clients include state governments and various Fortune 500 companies. For more detailed information, please contact us. We look forward to the opportunity to assist your organization and its employees.
Employees and spouses on company health care plans retire early due to medical conditions or file after retirement. These employees file for Social Security Disability benefits (SSDI) in order to obtain a monthly income.
Per the OBRA 93 law, Medicare becomes the primary health care plan for all individuals awarded SSDI. Those wanting the monthly income SSDI provides inadvertently continue to utilize their company’s health care plan as their primary insurance instead of Medicare. Employers are usually unaware of this and health care providers do not coordinate the benefits. By utilizing the services of one of our premier partners, we can enhance the employee medical program while substantially reducing health care costs to the organization.
The Pre-65 retiree population is the largest area of opportunity with regard to cost reduction. Many of these retirees and/or their spouses may already be drawing SSDI. By identifying these Pre-65 retirees, the organization can save significantly on current and future cost. Retroactive savings can also be achieved through recovering medical payments that were made incorrectly under the employer’s medical plan. This offers a significant advantage to your organization without reduced benefits or added cost.
BENEFITS TO RETIREES AND EMPLOYERS
• Significant additional lifetime income (SSDI)
• Expanded medical coverage by having two insurers
The Employer’s Health Plan
• Significantly reduce in-year health care expenditures
• Significantly reduce long term liability that is recognized in reduction of FAS 106 or GASB 43/45 statements
This service transfers Primary Responsibility for Healthcare Costs for Pre-65 Disabled Plan Members to Medicare. It also provides more robust benefits coverage for impacted plan members and reduces claims costs for health plan.
Value Proposition: Medicare Maximization captures the significant claims costs associated with expensive disabled population and transfers it to Medicare by obtaining reimbursement for prior claims paid by the plan that are responsibility of Medicare. Reduces OPEB liability.
Who Can Benefit? Self-insured Health plans of entities that provide continuation of healthcare benefits for Pre-65 retiree population. Samples include large private sector businesses, municipalities, unions, school districts and trusts.