Question
QUESTION: Hi John,
Thank you for your responses to my questions regarding enrollment in Medicare A & B . You said to read my current UHC plan carefully and the following paragraph have me confused as to whether UHC PPO plan will or will not remain my primary.
D. The first of the following rules that describe which COVERAGE Plan pays its benefits before another coverage plan is the rule to use-
1. Non Dependent or Dependent. The Coverage Plan that covers the person other than as a dependent, for example as an employee, member, subscriber or retiree is primary and the Coverage Plan that covers the person as a dependent a secondary. However if the person is a Medicare beneficiary, and as a result of federal law, Medicare is secondary to the Coverage Plan covering the person as a dependent and primary to the Coverage Plan covering the person as other than a dependent (e.g. retired employee)then the order of benefits between the two coverage Plans is reversed so that the Coverage Plan covering the person as an employee, member, subscriber or retiree is secondary and the other Coverage Plan is primary.
ANSWER: Hi again.
That would confuse anyone.
Working person: plan first====Medicare 2nd
spouse plan first====Medicare 2nd
Neither working Medicare first=====Plan 2nd
=====================================================
Both working====on each others plan
Husband==his first===hers 2nd===Medicare 3rd
Wife====hers first===his 2nd===Medicare 3rd
John
---------- FOLLOW-UP ----------
QUESTION: Thanks John! I appreciate the translation. Your help is outstanding and I am so grateful. I have one more paragraph in my coverage plan that I am also confused about. I am interpreting it to say if I am eligible for Medicare I have to enroll or stand the chance of being charged for services previously paid by UHC. Can you please shed some light and plain english on the following paragraph in my coverage plan
Medicare Eligibility
Benefits under the Plan are not intended to supplement any
coverage provided by Medicare. Nevertheless, in some
circumstances Covered Persons who are eligible for or enrolled in
Medicare may also be enrolled under the Plan.
If you are eligible for or enrolled in Medicare, please
read the following information carefully.
If you are eligible for Medicare on a primary basis (Medicare pays
before Benefits under the Plan), you should enroll for and maintain
coverage under both Medicare Part A and Part B. If you don't enroll
and maintain that coverage, and if we are the secondary payer as
described in (Section 7: Coordination of Benefits), we will pay
Benefits under the Plan as if you were covered under both Medicare
Part A and Part B. As a result, you will be responsible for the costs
that Medicare would have paid and you will incur a larger out-of-
pocket cost.
If you are enrolled in a Medicare Advantage (Medicare Part C) plan
on a primary basis (Medicare pays before Benefits under the Plan),
you should follow all rules of that plan that require you to seek
services from that plan's participating providers. When we are the
secondary payer, we will pay any Benefits available to you under the
Plan as if you had followed all rules of the Medicare Advantage plan.
You will be responsible for any additional costs or reduced Benefits
that result from your failure to follow these rules, and you will incur
a larger out-of-pocket cost.
Answer
Hi again
single and not working or
married and neither working
Medicare is primary, employer plan 2nd
they are reminding you that you better have both Part a and Part B, or you be getting billed for more money that if you had both parts.
John
