COB Playbook

COBRA Plans

 If a patient has a COBRA PRIOR TO Medicare entitlement, the COBRA can potentially terminate  If a patient is entitled to Medicare PRIOR TO obtaining COBRA, COBRA policy and state law need to be reviewed to determine whether policy will remain active and whether a COB could apply

 COBRA is still an EGHP, as it is a continuation of employer group coverage

Exchange Plans  Due to the Affordable Care Act (ACA) in 2013, individuals can purchase medical health coverage through the Health Insurance Exchange Marketplace for their state. When they purchase a plan through the exchange, it is considered an individual medical plan. If a patient purchases an exchange plan and has Medicare A and B, Medicare will always be the primary payer  Small employers of 50 full-time employees or less can offer medical (and dental) coverage through the exchange. They will do this using the Small Business Health Options Program (SHOP) Marketplace. When you verify a patient who has a medical plan through the SHOP Marketplace, be aware that COB may still apply, depending on Medicare entitlement reason. 1. Patient has Medicare due to ESRD, Medicare will be secondary to the SHOP plan. 2. Patient has Medicare due to Age and is still employed, Medicare will be secondary to the SHOP plan. 3. Patient has Medicare due to Disability (through spouse who’s still employed), Medicare will be primary due to amount of employees. Examples: