Medicare Part B
> IMPORTANT UPDATE! Once members receive their new Medicare Card (with the new number replacing the previously-used Social Security Number identifier), the Health & Life Insurance Section indicates that they must be provided a copy, being sure to include your full name, index number, mailing address and email address. This copy may be sent via email using firstname.lastname@example.org or by fax at (917) 367-1670. Please note that failure to provide the updated Medicare information may affect the processing of your claims.
> As reported by Mr. Karia, AFICS/NY Vice President and Co-Chair, Insurance Committee, at the AFICS/NY 48th Annual Assembly on 25 June, some eligible retirees are not being reimbursed for their Medicare premium as they have not submitted the required documentation to the Insurance & Disbursement Service (IDS). Retirees are urged to verify that they are being reimbursed for Medicare premiums paid by them directly, or through deductions from their Social Security payments. Anyone having problems on Medicare Part B premium reimbursement should inform the UN Insurance Service.
> Starting in April 2018, new Medicare cards were being issued, and will no longer contain Social Security Numbers. You can sign-up at medicare.gov to stay up-to-date on information about the new card, Open Enrollment and how to take advantage of your Medicare benefits.
Medicare Eligibility - U.S. Citizen or Permanent Resident
To be eligible to buy Medicare, a person must be age 65 or older, a resident of the United States and either a U.S. citizen or a lawfully admitted permanent resident who has resided in the United States continuously for at least 5 years befoe the month of enrollment.
Medicare Part B Requirement for ASHI Participants
Subsidy Related to Participatory Contributions in Medicare Part B
Important additional information on the process and needed form submission is available on the UN Health & Life Insurance Section’s (HLIS) website page on the matter:
Medicare Part D
Medicare Part D is an optional plan that provides coverage for some prescription drugs. Please note that the prescription drug benefits provided by the UNHQ Medical Programme is considered to be a "Creditable Prescription Drug Coverage", therefore ASHI participants do not need to enrol in Medicare Part D.
For further details, the Insurance and Disbursement Service (IDS) provided a notice to ASHI participants 31 December 2013 regarding Medicare Part D, with FAQs and an Annex that compares costs to you in the UN programme vs the Standard Medicare prescription drug coverage, showing that the UN programme is more valuable.
A Medicare Primer (from "Medicare & You")
If you’re close to 65, but not getting Social Security, you’ll need to sign up for Medicare; you qualify for it automatically if you're eligible for Social Security. You should contact Social Security 3 months before you turn 65. You can also apply for Part A and Part B (Original Medicare) at SOCIALSECURITY.GOV/RETIREMENT, or go to MEDICARE.GOV. Note that If you don’t sign up for Part B when you’re first eligible, you may have a delay in getting Medicare coverage in the future, and you may have to pay a late enrollment penalty for as long as you have Part B.
If you’re already getting Social Security benefits, the Social Security Admnistration will contact you a few months before you become eligible for Medicare at age 65, and send you information. If you live in one of the 50 states, Washington, D.C., the Northern Mariana Islands, Guam, American Samoa, or the U.S. Virgin Islands, they will automatically enroll you in Medicare Parts A and B. However, because you must pay a premium for Part B coverage, you can choose to turn it down.
What are my Medicare coverage options?
When you first enroll in Medicare, you’ll have Original Medicare (Part A and Part B). Optional additional choices are enrolling in a Medicare Advantage Plan (Part C), or joining a Medicare Prescription Drug Plan (Part D).
[*NOTE: Per the UN's Health & Life Insurance Section, Part C or Part D plans are not necessary as the ASHI coverage has proven to be more cost-effective for participants.]
What are the different parts of Medicare?
Medicare Part A (Hospital Insurance) helps cover:
■ Inpatient care in hospitals
■ Skilled nursing facility care
■ Hospice care
■ Home health care
Medicare Part B (Medical Insurance) helps cover:
■ Services from doctors and other health care providers
■ Outpatient care
■ Home health care
■ Durable medical equipment
■ Many preventive services
Medicare Part C (Medicare Advantage): See [*NOTE]
Medicare Part D (Medicare prescription drug coverage): See [*NOTE]
What’s NOT covered by Part A and Part B?
Some of the items and services that Original Medicare doesn’t cover include:
✘ Most dental care.
✘ Eye examinations related to prescribing glasses.
✘ Cosmetic surgery.
✘ Hearing aids and exams for fitting them.
✘ Long-term care.
✘ Concierge care (also called concierge medicine, retainer-based medicine, boutique medicine, platinum practice, or direct care).
Initial Enrollment Period
You can first sign up for Part A and/or Part B during the 7-month period that begins 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65. If you sign up for Part A and/or Part B during the first 3 months of your Initial Enrollment Period, in most cases, your coverage starts the first day of your birthday month. However, if your birthday is on the first day of the month, your coverage will start the first day of the prior month. If you enroll in Part A and/or Part B the month you turn 65 or during the last 3 months of your Initial Enrollment Period, the start date for your Medicare coverage will be delayed.
General Enrollment Period
If you didn’t sign up for Part A (if you have to buy it) and/or Part B (for which you must pay premiums) during your Initial Enrollment Period, and you don’t qualify for a Special Enrollment Period, you can sign up between January 1–March 31 each year. Your coverage won’t start until July 1 of that year, and you may have to pay a higher Part A and/or Part B premium for late enrollment.
How does my other insurance work with Medicare?
When you have other insurance and Medicare, there are rules for whether Medicare or your other insurance pays first. If you have retiree insurance (insurance from your or your spouse’s former employment), Medicare pays first.
[i.e., Medicare is the primary payer; your retiree insurance (ASHI) is the secondary payer.]
Here are some important facts to remember:
■ The insurance that pays first (primary payer) pays up to the limits of its coverage.
■ The insurance that pays second (secondary payer) only pays if there are costs the primary insurer didn’t cover.
■ The secondary payer might not pay all of the uncovered costs.
■ If your employer insurance is the secondary payer, you might need to enroll in Part B before your insurance will pay.
How much does Part A coverage cost?
You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes while working for a certain amount of time. This is sometimes called premium-free Part A. If you aren’t eligible for premium-free Part A, you may be able to buy Part A. In most cases, if you choose to buy Part A, you must also have Part B and pay monthly premiums for both. People who have to buy Part A will pay up to $422 each month in 2018.
How much does Part B coverage cost?
The standard Part B premium amount for 2018 is $134 or higher depending on income. However, some people who get Social Security benefits will pay less than this amount ($130 on average). Social Security will tell you the exact amount you’ll pay for Part B in 2018.
How can I pay my Part B premium?
If you get Social Security benefits, your Medicare Part B (Medical Insurance) premium will get deducted from your benefit payment. If you don’t get these benefit payments, you’ll get a bill. If you choose to buy Part A, you’ll always get a bill for your premium.
"Original Medicare" FAQs (from "Medicare & You")
Can I get my health care from any doctor, other health care provider, or hospital? In most cases, yes. You can go to any doctor, other health care provider, hospital, or other facility that’s enrolled in Medicare and accepting Medicare patients. Visit MEDICARE.GOV to search for and compare health care providers, hospitals, and facilities in your area.
Are prescription drugs covered? No, with a few exceptions, most prescriptions aren’t covered.
Medicare covers a limited number of drugs like injections you get in a doctor’s office, certain oral anti-cancer drugs, drugs used with some types of durable medical equipment (like a nebulizer or external infusion pump), immunosuppressant drugs, and, under very limited circumstances, certain drugs you get in a hospital outpatient setting. You pay 20% of the Medicare-approved amount for these covered drugs, and the Part B deductible applies. If the covered drugs you get in a hospital outpatient setting are part of your outpatient services, you pay a copayment for the services. However, other types of drugs in a hospital outpatient setting (sometimes called “self-administered drugs” or drugs you’d normally take on your own) aren’t covered by Part B.
Do I need to choose a primary care doctor? No.
Do I have to get a referral to see a specialist? In most cases, no, but the specialist must be enrolled in Medicare.
What else do I need to know about Original Medicare?
■ You generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance/copayment) for covered services and supplies. There’s no yearly limit for what you pay out-of-pocket.
■ You usually pay a monthly premium for Part B.
■ You generally don’t need to file Medicare claims. The law requires providers (like doctors, hospitals, skilled nursing facilities, and home health agencies) and suppliers to file your claims for the covered services and supplies you get.
What do I pay?
Your out-of-pocket costs in Original Medicare depend on:
■ Whether you have Part A and/or Part B. Most people have both.
■ Whether your doctor, other health care provider, or supplier accepts “assignment.”
■ The type of health care you need and how often you need it.
■ Whether you choose to get services or supplies Medicare doesn’t cover. If you do, you pay all costs unless you have other insurance that covers it.
■ Whether you have other health insurance that works with Medicare.
■ Whether you and your doctor or other health care provider sign a “private contract.”
How do I know what Medicare paid?
If you have Original Medicare, you’ll get a “Medicare Summary Notice” (MSN) in the mail every 3 months that lists all the services billed to Medicare. The MSN shows what Medicare paid and what you may owe the provider. The MSN isn’t a bill. Review your MSNs to be sure you got all the services, supplies, or equipment listed. If you need to change your address on your notice, call Social Security at 1-800-772-1213. TTY users can call 1-800-325-0778.
Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. To find out if your doctors and other health care providers accept assignment or participate in Medicare, visit MEDICARE.GOV/PHYSICIAN or MEDICARE.GOV/SUPPLIER. You can also call 1-800-MEDICARE (1-800-633-4227), or ask your doctor, provider, or supplier. TTY users can call 1-877-486-2048.
If your doctor, provider, or supplier accepts assignment:
■ Your out-of-pocket costs may be less.
■ They agree to charge you only the Medicare deductible and coinsurance amount and usually wait for Medicare to pay its share before asking you to pay your share.
■ They have to submit your claim directly to Medicare and can’t charge you for submitting the claim.
Non-participating providers haven’t signed an agreement to accept assignment for all Medicare-covered services, but they can still choose to accept assignment for individual services. These providers are called “non-participating.” Here’s what happens if your doctor, provider, or supplier doesn’t accept assignment:
■ You might have to pay the entire charge at the time of service. Your doctor, provider, or supplier is supposed to submit a claim to Medicare for any Medicare-covered services they provide to you. If they don’t submit the Medicare claim once you ask them to, call 1-800-MEDICARE.
■ They can charge you more than the Medicare-approved amount, but there’s a limit called “the limiting charge.” Call 1-800-MEDICARE to find out if you were charged the right amount.
What are private contracts?
A “private contract” is a written agreement between you and a doctor or other health care provider who has decided not to provide services to anyone through Medicare. The private contract only applies to the services provided by the doctor or other provider who asked you to sign it.