General Background

Medicare, the federal health program provided for people 65 years and older, has two kinds of health insurance. Part A, the hospital insurance, helps you with the cost of hospitalization and related care; and Part B, the medical insurance, helps pay doctor bills and other health expenses. Medicare does not have dental insurance or prescription drug benefits.

It is strongly recommended that each person covered in the Welfare Fund contact their local Social Security Administration office at least three months prior to their 65th birthday for information about Medicare benefits and enrollment requirements. The Welfare Fund will assume you have enrolled in both Part A and Part B on the earliest possible date in providing your benefits. Your Medicare eligibility commences the first of the month in which you will turn age 65 or the first day of the month after you have been receiving a Social Security Disability Award for a period of 24 months.

When either you or your spouse receives your Health Insurance (Medicare) Identification card, check it carefully to see that all of your personal information is recorded correctly. Also verify that at the bottom of the card coverage is indicated for both hospital insurance and medical insurance and that an effective date is indicated for each type of coverage.

The hospital insurance (Part A) portion of Medicare is provided to you at no cost. However, the medical insurance (Part B) portion of Medicare has a monthly premium associated with it. When you enroll, the premium will be deducted from your monthly Social Security check.

The Part A deductible is the amount you will pay for the first day of hospital care during a calendar year. After the first 60 days of hospitalization, you will pay a daily charge for a maximum of 150 days of hospital coverage per calendar year.

The Part B premium will help you pay for the services of physicians and other medical practitioners, hospital outpatient services, independent clinical laboratory work and durable medical equipment and supplies.

Significance Of Medicare Enrollment

If you do not apply for Medicare on a timely basis, your ability to receive Medicare benefits will be significantly delayed and the monthly Part B cost to you and your spouse will be higher.

During any period in which you are eligible for Medicare and you are not receiving Medicare benefits because you did not apply in time, the Welfare Fund will deduct from your claim to the Fund all benefits you would have received from Medicare and pay to you the difference. This could be very costly.

When you become eligible for Medicare benefits, your hospital and medical benefits described in these pages will no longer apply since they would duplicate Medicare benefits to a large extent.

If you use an Empire Deluxe PPO provider, (or a local Blue Cross PPO provider outside the Empire area) you will only be required to pay a $10 co-pay for each visit. If you reside or travel outside the Empire Deluxe PPO network area you can obtain a local PPO provider by calling 1.800.810-BLUE. If you use a provider not enrolled in the PPO network, which is your choice, you will be responsible to pay the annual deductible of $300 per individual/$750 per family and the 20% co-insurance per each Medicare claim.

When you are admitted to a covered hospital, present your Empire HealthChoice, Inc. identification card together with your Medicare card. Your hospital benefits coverage will pay the Medicare hospital deductible.

Additional Information

If you are over age 65, actively employed, and covered in the Welfare Fund due to your employment, you have the right to reject your Group coverage and rely solely on Medicare for your hospital and medical benefits. Contact the Fund Office should you choose to make such an election.

Also, if you are Medicare eligible but can retain group coverage either through your own active employment or as a dependent under your spouse’s group plan, it may not be to your advantage to enroll in Medicare since it will not duplicate your group benefits.

You may want to contact Medicare to determine if there is a Medicare HMO in your service area.