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Eligible for Medicare

Medicare is the nation’s largest health insurance program and is administered by the Centers for Medicare and Medicaid Services (CMS). Generally, Medicare is a federally funded health benefits program for people aged 65 and over, and for certain people under 65 who are disabled or who have permanent kidney failure. Detailed information on the program is available at http://www.medicare.gov. Whether or not you or a family member is covered by Medicare may affect your rights to group health plan coverage, in particular COBRA continuation coverage or the right to take advantage of certain enrollment rights you may have for COBRA continuation coverage.

If you are currently covered under your spouse’s or parent’s group health plan and you are losing coverage under that plan because either your spouse or your parents is becoming covered by Medicare, you may have the right to elect 36 months of COBRA continuation coverage. If you are entitled to receive or are already receiving 18 months of COBRA continuation coverage because your spouse or parent terminated of employment or reduced hours hours of emplyment, and your spouse or parent becomes covered by Medicare, you may be able to extend the maximum period of COBRA continuation coverage for yourself from 18 months to a maximum of 36 months.

If you are covered by both Medicare and a group health plan (and the plan’s rules allow such coverage) and a qualifying event occurs, then you may have the right to elect COBRA continuation coverage with respect to your group health coverage for the maximum period of coverage available. Becoming covered by Medicare at any time after election of COBRA continuation coverage will generally cause your COBRA continuation coverage to end. However, if you are the covered employee, and your COBRA continuation coverage ends because you become covered by Medicare, then the COBRA continuation coverage of your family members may be extended as mentioned above. For more information, see Health Benefits Under the Consolidated Omnibus Budget Reconciliation Act (COBRA).

If you lose coverage under a group health plan because you or the covered employee become eligible for Medicare, or because COBRA continuation coverage is exhausted, there may be other coverage options available to you and your family. However, the interaction between Medicare and group health plans and between COBRA rules and Medicare rules can be very complex. Further information is provided on the Medicare Web site, or by calling 1-800-MEDICARE.

First, you may qualify for special enrollment in another group health plan, such as your spouse’s plan, your other parent’s plan if you are a dependent, or a plan offered through your job. In addition to special enrollment rights, you may have other rights to enroll in a group health plan depending on the plan terms (check the SPD (summary plan description) and, sometimes, under state insurance law (contact your state insurance department ).

You may also be able to buy health coverage unrelated to a job from an insurance company or HMO (health maintenance organization), or through your membership in an association (such as AARP). To find out about insurance and HMO coverage including whether you are a “federally eligible” or “HIPAA eligible” individual qualified for coverage with special protections, contact your state insurance department.

Finally, you may be eligible for Medicaid, a government sponsored health program for low income and individuals with special needs and their families, or for the State Children’s Health Insurance Program (SCHIP), a government sponsored health insurance program for qualified families.