Coordinating Medicare & Your UC Sponsored Plan
What happens to my UC medical plan coverage when I enroll in Medicare?
- In most cases, when you become eligible and enroll in Medicare, you will remain in your UC medical plan. For those individuals who are enrolled in an HMO plan whose Medicare service area does not include your current residence, you will need to change plans. In this case you will have a window of opportunity to choose another UC-sponsored medical plan.
- If you are enrolled in an HMO plan (Kaiser, Health Net, Western Health Advantage), you are required to assign Medicare benefits to the HMO. The medical plan assumes full responsibility for your care. This means that Medicare and your HMO will work together to pay for services. You may not use your Medicare benefits separately from you HMO. In general, your HMO works the same as it did before you enrolled in Medicare.
- If you are enrolled in Blue Cross Plus, PPO, Core or High Option, Medicare will become your primary insurance. Your Blue Cross plan will become the secondary payor for most health services. Providers send claims to Medicare for payment. After Medicare processes your claim, you will receive a Medicare Summary Notice. Medicare will then send the remaining claims to Blue Cross for secondary payment. After Blue Cross processes your claims, you will receive an Explanation of Benefits. If you have a balance due after Blue Cross processes your claims, you will receive a bill from your provider. You must use providers who accept Medicare for all care in the US.
- For detailed information regarding how Medicare will coordinate with your medical plan, review the Medicare Fact Sheet.
- The cost you pay for your medical plan will decrease once you are enrolled in medicare. See Medical Plan Costs for Retirees for more details.
- If you have family members/dependents enrolled on your plan and they are not eligible for Medicare, they will remain in the non-Medicare version of the plan and keep their basic coverage. If you have to choose a new medical plan because you do not live within your current HMO’s Medicare service area, your enrolled family members will also be transferred to basic coverage under your new plan.
- Part B Reimbursement - UC may reimburse a portion of the Medicare Part B premium. If the cost of your medical plan is less than the UC/employer contribution for which you are eligible, the difference goes toward reimbursing you the amount you pay to Social Security for Medicare Part B. This reimbursement is added to your UC retirement check.