| Medicare |
| Back to Retiree FAQs |
| Q. |
Who is responsible for notifying ADOA of a Medicare change? |
| A. |
If you become eligible to receive Medicare due to a disability, receive your Medicare card prior to your 65th birthday, or there is a change in your Medicare status, you must contact the ADOA Benefits office with this information. If you receive your new Medicare card, you will be asked to provide a copy of it to the Benefits Office. Medicare does not communicate directly with ADOA. |
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| Q. |
I received my Social Security Administration award letter stating when my Medicare is to begin. Will this suffice for proof of Medicare coverage until I receive my actual Medicare card? |
| A. |
Yes, ADOA will accept your Security Administration award letter. Once you receive your Medicare card please send us and copy for your file. |
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| Q. |
What happens if I do not elect Medicare Part B coverage with Social Security? |
| A. |
You will need to contact the Social Security Administration to learn how this will affect your coverage. You will be financially liable for medical costs incurred if you DO NOT take Part B. These costs will not be paid by your ADOA Benefit Options health plans. |
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| Q. |
If I am eligible for Medicare Part B coverage; however, I have not elected Medicare Part B coverage, how are my medical benefits coordinated? |
| A. |
Open Access refers to how you “access” physicians. Instead of getting a referral from your Primary Care Physician (PCP) to see a specialist, you may schedule an appointment directly with the specialist of your choosing. The specialist MUST be contracted within your network. However, if you wish to obtain specialist referrals through your PCP, you may do so. |
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| Q. |
If I am eligible for Medicare but do not have Part B coverage, what Benefit Options plan do I elect? |
| A. |
You may elect the EPO or PPO plan listed under “with Medicare” available in your county for retiree and long-term disability members. |
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| Q. |
If I purchase both Part A and Part B of Medicare, why should I continue to be enrolled in the Benefit Options program? |
| A. |
This is a decision that must be made by the member. Medicare only pays 80% of covered charges once you have met your deductible. Physicians often charge patients the remaining portion of the bill that Medicare has not paid. The Benefit Options plan also incorporates Walgreens Health Initiatives (WHI) for pharmacy coverage. There are no annual limits or caps on preferred or non-preferred medications. Co pays are $10, $20, or $40. PacifiCare members please refer to your Secure Horizons Medicare Advantage Guide or call 1.866.622.8055 for information on co pays. |
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| Q. |
If I am receiving Medicare, why do I still pay co pays? |
| A. |
A co pay is the portion paid by the member to share in the cost of medical services, supplies and prescriptions. This cost sharing will help the Benefit Options program with rising healthcare costs. Medicare also applies cost sharing. For covered services, the Benefit Options self-funded Plans (excluding Pacificare’s Secure Horizons plan) absorbs the Medicare deductible you would otherwise pay for hospital and medical services. The Benefit Options program will pay up to the total allowable amount as determined by the Plan. Most physicians generally charge 20% above the amount covered by Medicare. Co pays are required for all plan members including employees, non-Medicare eligible Retirees, LTD members, Surviving Spouse and Medicare eligible Retirees. Your medical provider understands medical payments will be reduced by the co payment. Therefore, it must be submitted at the time the services are rendered. |
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