RE: COBRA

[Guest guest]

Hi all -

We just transplanted a patient who has BC and Medicare. BC is primary

because he is within his first 30 months.

However, he is on COBRA. I am being told by the mail order pharmacy

that Medicare is primary because he has COBRA. Does anyone know the

rule?

Thanks,

Janet M. Lovely

Lankenau Hospital

[Guest guest]

We hear this a lot. I think the easiest way of thinking about it is that COBRA allows folks to stay on their employer group plan at their own expense. So the 30 month COB applies. You might have to have the EGHP intervene w/the pharmacy. One caveat: if the pt had COBRA first and added Medicare, the EGHP had the right to drop the patient retro to the Medicare effective date, which would indeed leave him Medicare primary, with no secondary.

onFinancial CounselorLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 toll free faxlmorriso@..."The real threat to the life of the nation, in the sense of a people living in accordance with its traditional laws and political values, comes not from terrorism but from laws such as these."LORD HOFFMAN, of Britain's highest court, which ruled against indefinite detention of terror suspects.

-----Original Message-----From: Lovely, Janet M. Sent: Friday, December 17, 2004 9:00 AMTo: TxFinancialCoordinators Subject: RE: COBRAHi all -We just transplanted a patient who has BC and Medicare. BC is primarybecause he is within his first 30 months. However, he is on COBRA. I am being told by the mail order pharmacythat Medicare is primary because he has COBRA. Does anyone know therule?Thanks,Janet M. LovelyLankenau Hospital

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[Guest guest]

Hello

My understanding is if the pt is paying the COBRA premiums in full w/o

the employer financial contribution- the COBRA policy is like having a

private policy vs eghp. So in that case, the MC would be primary.

McIver

Renal Services Financial Counselor

Summa Health System

RE: COBRA

Hi all -

We just transplanted a patient who has BC and Medicare. BC is primary

because he is within his first 30 months.

However, he is on COBRA. I am being told by the mail order pharmacy

that Medicare is primary because he has COBRA. Does anyone know the

rule?

Thanks,

Janet M. Lovely

Lankenau Hospital

[Guest guest]

Hello Janet, and All,

After making my comment, I went on to CMS website and it has a good

explanation --

it can be found under Medicare Secondary Payor- A Fact Sheet for Provider

Billing Staff .

My understanding does not seem to hold true.

- gives more detail of your explanation.

McIver

Renal Financial Counselor

Summa Health System

RE: COBRA

Hi all -

We just transplanted a patient who has BC and Medicare. BC is primary

because he is within his first 30 months.

However, he is on COBRA. I am being told by the mail order pharmacy

that Medicare is primary because he has COBRA. Does anyone know the

rule?

Thanks,

Janet M. Lovely

Lankenau Hospital

[Guest guest]

Thanks ! Sounds like Cobra has to play out the 30 month COB like a

GHP does. Is this how you understood it also?

Fornash

Kidney TFC

Mayo Clinic ville

RE: COBRA

Hi all -

We just transplanted a patient who has BC and Medicare. BC is primary

because he is within his first 30 months.

However, he is on COBRA. I am being told by the mail order pharmacy

that Medicare is primary because he has COBRA. Does anyone know the

rule?

Thanks,

Janet M. Lovely

Lankenau Hospital

[Guest guest]

,

Yes

McIver

Renal Services Financial Counselor

Summa Health System

RE: COBRA

Hi all -

We just transplanted a patient who has BC and Medicare. BC is primary

because he is within his first 30 months.

However, he is on COBRA. I am being told by the mail order pharmacy

that Medicare is primary because he has COBRA. Does anyone know the

rule?

Thanks,

Janet M. Lovely

Lankenau Hospital

[Guest guest]

Hi, here's a link to 's reference. Section 20.2 spells it out - and I'm especially glad that it spells out that employers can voluntarily keep their folks on COBRA after Medicare is added to the mix - many payors don't believe that this choice exists, so you have to go to the employer's benefits dept to find out what their policy is.

http://www.cms.hhs.gov/manuals/105_msp/msp105c02.pdf

onFinancial CounselorLegacy Transplant Services1040 NW 22nd Ave Ste 480Portland OR 97210 toll free faxlmorriso@..."The real threat to the life of the nation, in the sense of a people living in accordance with its traditional laws and political values, comes not from terrorism but from laws such as these."LORD HOFFMAN, of Britain's highest court, which ruled against indefinite detention of terror suspects.

RE: COBRAHelloMy understanding is if the pt is paying the COBRA premiums in full w/othe employer financial contribution- the COBRA policy is like having aprivate policy vs eghp. So in that case, the MC would be primary. McIverRenal Services Financial CounselorSumma Health System-----Original Message-----From: Lovely, Janet M. Sent: Friday, December 17, 2004 12:00 PMTo: TxFinancialCoordinators Subject: RE: COBRAHi all -We just transplanted a patient who has BC and Medicare. BC is primarybecause he is within his first 30 months. However, he is on COBRA. I am being told by the mail order pharmacythat Medicare is primary because he has COBRA. Does anyone know therule?Thanks,Janet M. LovelyLankenau Hospital

[Guest guest]

Thanks, everyone for your input. I have

confirmed with Medicare that the group employer insurance remains primary for

30 mo. for a pt. with entitlement due to ESRD.

RE: COBRA

Hi all -

We just transplanted a patient who has BC and

Medicare. BC is primary

because he is within his first 30 months.

However, he is on COBRA. I am being told by

the mail order pharmacy

that Medicare is primary because he has

COBRA. Does anyone know the

rule?

Thanks,

Janet M. Lovely

Lankenau Hospital

[Guest guest]

Hi All -

I was asked to forward this message to the group by Pat (See contact

info. below)

Jan

------------------------------------------------------------------------

I have a patient who is under his wife's insurance effective the 1st of

January his prescription plan was to change and have a cap of $1500.00.

Luckily he was able to get a rider to this plan for the year. He came

in to me and asked what his options would be if in the future his

insurance changes and he could not get a rider.

Any help would be greatly appreciated.

Sincerely,

Pat Brehony

Liver Center

Hahnemann University

[Guest guest]

Michele,

It is my understanding by what I have read on the www.cms.hhs.gov website:

Individuals who obtain other coverage (including Medicare) on or before the

COBRA election date are permitted ot continue this coverage along with

COBRA. Thus, where ESRD-based Medicare entitlement predates the COBRA

qualifying event, the plan is obligated to offer COBRA...to the extent the

period of COBRA coverage overlaps the ESRD MSP coordination period, COBRA is

the primary and the employer plan has no discresion to terminate COBRA

because of the ESRD entitlement.

Those who obtain other coverage AFTER the COBRA election date can be termed

from COBRA coverage.

This came right out of the website above.

Hope this helps.

Fornash

TFC - Renal

Mayo Clinic ville

COBRA

I'm looking for clarification on some COBRA coverage. Here's the

scenario: Pt has Medicare A & B effective 7/1/03 for ESRD. Employed,

so also covered under EGHP. Pt is in the middle of her COB. Pt

quites job and COBRA's her EGHP. They can not drop her as she had

her medicare in place before COBRA. My question: Does the COB

continue since she is still enrolled in the EGHP but paying her

premiums, or does it default to Medicare prime automatically?

Thanks for your thoughts

Michele Snyders