Insurance & Employee Benefits
TEFRA status and Medicare Part B claims
TEFRA status determines a group's size for purposes of determining whether the Medicare Secondary Payer Rules apply.
Employers subject to TEFRA
Employers with 20 or more employees are subject to TEFRA including all full-
Leased employees, and employees of affiliated companies may be subject to TEFRA and it is recommended to seek the advise of a qualified tax advisor. Independent contractors are NOT counted as employees subject to TEFRA or counted towards determining the status.
Employers not subject to TEFRA
For group with less 20 employees Medicare is the primary carrier. Any covered member that is eligible for Medicare that is on the employers health insurance plan must have both Medicare Part A and B or be subject to reduced benefits and additional-
A Medicare eligible employee is one that is working and over the age of 65 that are covered by the employer’s group health insurance plan. Working spouses of any age may also be subject to this rule.
When claims are submitted to the group health insurance carrier by a covered member not enrolled in Part B, the Medicare benefits are estimated by the carrier and the member becomes responsible for the portion Medicare B would have paid.
This applies to members that are covered by that are working and over the age of 65.