We will be contacting Medicare-eligible members to communicate the Medicare
Exclusion and how this exclusion applies to their benefit plan.
What is the Medicare Exclusion?
Members who are eligible for Medicare and for whom Medicare would be the
primary payer will be responsible for paying their doctor, hospital, or other
medical professional the amount Medicare would have paid and any applicable
copayment, coinsurance, or deductible. In turn, their group health benefit plan
will only pay the remaining balance on claims submitted as if the member had
enrolled in Medicare Parts A and B.
Who is eligible for Medicare?
Individuals who are eligible for Medicare, include:
Most people 65 and older. Generally people are Medicare-eligible if they or
their spouse worked for at least ten years in a Medicare-covered employment and
are 65 or older and a citizen or permanent resident of the United States.
Note: People are eligible for Medicare when they turn 65, even if they
are not eligible for Social Security retirement benefits.
Some people younger than 65. People younger than 65 who have certain
disabilities and illnesses, such as Lou Gehrig?s disease (ALS) or other
disabilities for which people are eligible for Social Security Disability
benefits.
People with kidney failure. People of any age with kidney failure who require
dialysis or a kidney transplant.
If your patients have questions about eligibility for Medicare Part A or Part B
or want to apply for Medicare, they should call Social Security at
1-800-772-1213 or visit or call their local Social
Security office. TTY users should call
1-800-325-0778. They can also get information about buying
Part A as well as Part B if they do not qualify for premium-free Part A.