15.10 COORDINATION WITH MEDICARE
Medicare is a health insurance program for people 65 years of age or older, certain younger people with disabilities, and people with end-stage renal disease (ESRD). The original Medicare plan has two parts: Part A (hospital insurance) and Part B (medical insurance). As Medicare now offers new health plan choices besides the original Medicare plan, be sure to contact your local Social Security Administration Office for information about Medicare.
Medicare Part A helps pay for care in hospitals and skilled nursing facilities, and for home health and hospice care. Part A coverage is paid for through payroll taxes during your working career. Medicare Part B helps pay for physician’s services, outpatient hospital care and some other medical services that Part A doesn’t cover, such as outpatient diagnostic laboratory and x-ray services, preventive care, or services of therapists. For Part B coverage, you must pay the Part B premium; this monthly premium is deducted from your Social Security
You need to enroll for both Medicare Part A and Medicare Part B to receive the maximum available benefits under this Plan. If a Participant does not enroll in and utilize Medicare Parts A & B when eligible, benefits payable under this Plan will still be reduced by the amount Medicare would have paid under Medicare Parts A & B.
Using Providers Who Accept Medicare Assignment
A provider who accepts Medicare assignment agrees that the total charge to you will not be more than the Medicare allowed charge. Providers who don’t accept Medicare assignment are allowed to charge a Medicare beneficiary up to 15% over Medicare’s approved payment amount. To make the best use of benefits available under this Plan, use the services of a provider who accepts Medicare assignment.
Medicare Participants May Retain or Cancel Coverage Under This Plan.
If a Participant becomes covered by Medicare, whether because of end-stage renal disease (ESRD), disability or age, the Participant may either retain or cancel coverage under this Plan.
- If a Participant is covered by this Plan and by Medicare, and retains coverage under this Plan, and the Participant is not a Retired Participant, this Plan will continue to provide the same benefits. This Plan pays first and Medicare pays second. Refer to Rule 1 under WHICH PLAN PAYS FIRST.
- If the Eligible Employee or Retired Participant cancels coverage under this Plan, coverage of the Eligible Employee’s or Retired Participant’s Dependents will also terminate, but the Dependents will be entitled to elect COBRA Continuation Coverage.