Q.- I know there are special primary/secondary payer rules for someone who is on Medicare due to end stage renal disease. If a COBRA continuant enrolls in Medicare due to ESRD, does that change this rule: "If a qualified beneficiary first becomes entitled to Medicare benefit after the date on which COBRA continuation coverage is elected for the qualified beneficiary, then the plan may terminate the qualified beneficiary's COBRA continuation coverage upon the date on which the qualified beneficiary becomes so entitled"?
A.- No. The rule is not changed. There is no special exception to terminating COBRA coverage when a continuant becomes entitled to Medicare for end stage renal disease. 42 CFR 411.108(b)(3) provides- A group health plan may terminate COBRA continuation coverage of an individual who becomes entitled to Medicare on the basis of ESRD when permitted under the COBRA provisions.