Frequently Asked Questions - National Programs
For UN members that have Medicare and go to providers that accept Medicare, claims are automatically processed by Medicare and UN insurance (Aetna, Blue Cross, or HIP) as it is the provider’s responsibility to submit claims to Medicare.
Once you enrol in Medicare Part B and you provide your Medicare details to the UN via the Medicare Part B Premium Reimbursement form, we will update our system with your information and pass it to the applicable insurance (Aetna, Blue Cross, or HIP) for future processing.
For UN members that elect to go to providers that do not accept Medicare, it is the member’s responsibility to adhere to the standard claims processes currently in place.
If the medical service that you are planning to receive is not covered by Medicare, your secondary insurance plan (hence the UN plan) will pay for it, as long as the service is included into the secondary plan’s reimbursable items.
Doctors who opt out of Medicare are provided with a Medicare Opt-Out Letter. Most providers who opt out of Medicare are updated in Aetna and Blue Cross's Provider Databases already. However, if the insurance carrier does not have record that the provider opted out of Medicare, the provider could include that information with the claims that are submitted. (i.e. copy of the Medicare Opt-Out Letter).
Yes. The penalty is of 10% for every year for which you were eligible for Medicare and did not apply. If you are 65 or over at 1 January 2011 and did not apply for Medicare prior to that date, the UN will pay the applicable penalty if you join during your Medicare enrolment eligibility period. If however you only become eligible for Medicare after 1 January 2011 and choose not to enrol, then you will be responsible to pay the penalty and the UN will only reimburse you the premium amount before any penalty is applied by the US Social Security Administration.
The itemized bill or claim can be submitted directly to Aetna or Blue Cross. Providers who have opted out of Medicare should include that information with the claim. If neither Aetna nor Blue Cross has a record that the provider has opted out of Medicare, the claim may be pending for a Medicare EOB/Copy of Medicare Opt-Out Letter.
Since our US based insurance plans (Aetna, Blue Cross, and HIP) cover prescription drugs, there is no need to apply for Medicare D. Moreover, the United Nations receives a drug subsidy from the US Government for each UN retiree enrolled in Medicare Part A or Part B or both, and not enrolled in Part D. We therefore require our ASHI participants not to enrol in Medicare Part D.
The UN insurance plan (Aetna, Blue Cross, or HIP) will pay up to the remaining 20% as applicable and if the services are covered.
Your spouse does need to apply as soon as he/she is eligible. The premium will be reimbursed by the UN by reducing the monthly ASHI contribution. Any amounts in excess will be accumulated and paid out in lump sums to the ASHI participant. Please note that the ASHI Unit will need to receive a duly filled Medicare Part B Reimbursement Request Form and the required attachments before refunding premiums.
The UN insurance plans (Aetna, Blue Cross, or HIP) will cover the yearly Medicare deductible each year. It is best for your provider to claim the deductible with your insurance carrier as opposed to paying out of pocket and filing a claim yourself with your carrier as it may be difficult or impossible to recover this money.
Medicare Advantage Plan and MediGap are supplemental coverages that are offered to eligible members at an additional cost. You do not need to enrol in these supplemental insurances since our US based insurance plans will reimburse what Medicare A and B do not cover under what is determined to be reasonable and customary, and covered under UN plans.
Beginning 2016, the reimbursements for Medicare Part B premiums will be made directly to your bank account on a monthly basis on the last working day of the month.
Please note that the UN Health and Life Insurance Section will need to receive a duly filled Medicare Part B Reimbursement form along with a copy of the letter/notice from SSA indicating premium amount before refunding any premiums. If you are submitting for the first time, you must also submit a copy of your Medicare card. This request only needs to be submitted once a year, unless there is a change in your monthly Medicare Part B premium.
People who live in US Territories such as Puerto Rico are eligible.
You may contact Social Security and request a “Social Security Benefit Verification” document. You may request this document online at www.socialsecurity.gov, by calling 800-772-1213, or by visiting your local Social Security office.
No, you are not eligible for reimbursement as the Medicare Part B requirement only applies to retired staff members covered in ASHI.
You are not required to enrol at the moment and the United Nations will therefore not reimburse the Medicare premium if you do decide to enrol. Please contact us to discuss the particulars of your situation upon your return to the US.
The Medicare Part B premiums are only reimbursed to ASHI participants. As soon as your ASHI coverage is terminated, so does the reimbursement. You may drop your Medicare coverage and re-enrol when the active insurance coverage ceases. However, everything has to be done in a timely fashion so as not to have a gap in your Medicare coverage when you re-join ASHI. If you decide not to drop the Medicare coverage for the period of the post-retirement appointment, please note that the UN will not reimburse the premiums during that period.
- Participating doctors are those who accept the set Medicare assignment (maximum amount a doctor can charge for a specific service).
- Non-participating doctors are allowed to go above the Medicare assignment, up to a federal maximum of an additional 15% (for NY, the maximum is 5%)
- Opt-out doctors are those doctors who have fully opted out of Medicare. This means that if you go to such a doctor, Medicare will not cover your claim and you are advised to follow your normal claim process. Please note that opt-out doctors may still be within your medical insurance plan’s network.
Additionally, please note that being enrolled in Medicare Part B does not restrict your choice of doctors under a UN plan and you will still be reimbursed as before if the doctor has “opted-out” of Medicare. Your claims have to be accompanied by a letter from your doctor indicating he/she has opted out of Medicare before sending claims to insurance carrier.
Your claims will be adjudicated as if your had Medicare. You will be responsible for 80% of your claims. It is important to re-enrol in Medicare as soon as possible if they allow you or at the very least, during the following Medicare general enrolment period which is held from January to March every year.
No it does not. If you are enrolled under the UN Cigna dental plan, the Medicare Part B enrolment/eligibility has no impact on your Cigna coverage.
If you do not receive a social security check, you will be billed by Medicare for Medicare Part B premiums once every quarter. However, you may contact the SSA at the number provided at the back of your quarterly invoice to sign up for monthly direct payments. By so doing, the premium will be deducted from your bank account monthly.
If you did not contribute to Social Security, you do not need to enrol in Part A since it will be an additional cost to you. However, you need to enrol in Part B as the United Nations has made the enrolment in Part B a requirement for all eligible ASHI participants and their dependents as of 1 January 2011.
The date your Medicare Part B coverage becomes effective will be the first day when your UN insurance becomes secondary when you visit a doctor who has not “opted-out of Medicare”.
You maintain your full right to choose the doctor of your choice. The quality of medical service from doctors rather depends on each individual provider and quality of his/her skills. Evaluating your medical providers should always take place regardless of the type of insurance you have. There is also a large variation in quality of hospitals.
You are eligible for Medicare Part B (doctors visits from age 65), if you have lawfully resided in the United States for a minimum of 5 years, including periods under a G-4 visa.
- Example: You retire at age 62 after being on a G4 visa at UNHQ and apply for a permanent resident status (Green card). You are eligible to apply for Medicare three years later at age 65, although you would have only been a permanent resident for about 3 years. You do not need to receive US Social Security payments to be eligible for Medicare Part B.
Even though most individuals become eligible for Medicare Part B upon attainment of age 65, there is an exception to the age requirement if Social Security has declared you disabled.
If you are a retired staff member, Medicare is primary for your spouse and the UN insurance (Aetna, Blue Cross, and HIP) is secondary. However, the UN insurance remains primary for you as a subscriber. If you are an active staff member, the UN insurance is always primary and Medicare secondary, even if you or your spouse have Medicare Part B. Your spouse has the choice to keep or drop his/her Medicare insurance, note that the premiums will not be reimbursed under an active plan.
If you plan to be away from the US for a prolonged period of time, you are still responsible for ensuring that Medicare payments are made in a timely manner. In the event the SSA terminates your coverage due to non-payment, your claims will be adjudicated as if you had Medicare and you will therefore be responsible for 80% of your claims. No exceptions will be granted by the UN for a retiree's failure to pay their Medicare premiums.
If you are entitled to US Social Security payments, you will be automatically enrolled as you approach age 65 and should receive a card in the mail. If however you are not entitled to Social Security or if you declined to enrol when you reached age 65, but need to enrol in Medicare Part B, you may do so by contacting your local Social Security Administration office. You can locate your local office by going to the Social Security Administration website, www.socialsecurity.gov.
Yes, any doctor has the right not to accept a new patient.
Yes you are eligible to enrol in Medicare Part B even though you did not contribute to Social Security. You do not need to enrol in Part A since it will be an additional cost to you. However, you need to enrol in Part B as the United Nations has made the enrolment in part B a requirement for all eligible ASHI participants and their dependents as of 1 January 2011.
If your physician is not a Medicare provider, you can still remain with this doctor. Your physician’s billing procedures will not change. In other words, if:
- the doctor is an in-network doctor, you will only have to pay your co-pay of either $15.00 or $20.00;
- the doctor is an out-of-network doctor; you will be responsible for the applicable deductibles and co-insurance.