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What is Medicare?
Medicare is the U.S. health insurance program for people age 65 or older and younger people receiving Social Security disability benefits. The program helps with the cost of health care, but it doesn’t cover all medical expenses.
When must I apply for Medicare?
RMIP members who are turning 65 and are eligible for Medicare (U.S. citizens and U.S. Green Card holders who have been living in the U.S. for the past five years, even if part of those years were in G4 status) are required to apply for Medicare up to three months before or three months after their 65th birthday.
Which Medicare plans must I apply for?
An eligible retiree/spouse/partner is required to enroll in Medicare B (always comes with a premium) and only in Medicare A if (s)he is eligible to enroll premium-free. Premium-free Medicare A is only available for U.S. citizens and permanent residents who have contributed at least 40 quarters to Social Security.
Does my spouse or partner need to enroll in Medicare even if I'm not yet eligible?
Yes, a spouse or partner who is eligible for Medicare needs to enroll in Medicare even if the former staff member is not yet eligible. This is important to avoid Medicare late enrollment penalties.
Where can I find the documents I need to enroll in Medicare?
- The Health Insurance Committee has prepared a comprehensive Medicare Enrollment Information Package. From the Home Page, select Quick Links and click on “Health Insurance” to access (login required).
- See also relevant Medicare details and FAQs provided by HR. The information explains where to apply for Medicare, how claims are submitted, and how premiums are reimbursed by WBG.
I’m a Green Card holder and can’t complete Medicare enrollment online, unlike U.S. citizens. What do I do?
Arrange for an interview with Social Security. Bring a letter from HR confirming retiree eligibility for Social Security.
Do I need to inform anybody after enrollment in Medicare?
- Notify your medical care providers, and pharmacy as soon as you enroll in Medicare and have your card (or membership number) as their billing approach will change. Medical care providers will file with Medicare and pharmacies with SilverScript.
- Also inform AETNA so they can set up direct coordination with Medicare. Providers will bill Medicare who will coordinate with AETNA. Normally, this works automatically, and you do not need to intervene. Medicare and AETNA will inform you separately about what they do (not) pay and what you might have to pay yourself.
What if my doctor does not participate in Medicare?
Ask your doctor to provide you an opt-out letter, which you must include when you file a claim with AETNA for reimbursement. Doctor’s offices are familiar with the opt-out letter requirement.
I am on Medicare and just had surgery. I need physical therapy, but the provider does not deal with insurance. What do I need to do to get reimbursed?
- Note that since the provider does not deal with insurance, you are likely to be charged at a higher rate than what Medicare or Aetna allow and you are probably paying more out of pocket.
- First, submit Patient’s Request for Medical Payment Form (CMS 1490S) along with physician’s referral requisition for physical therapy services and copy(s) of paid invoices for service
- Once you receive approval/rejection from Medicare, send to MIP Claims (Aetna) the following documents:
- Completed World Bank Claim for Hospital and Other Medical Expenses
- Copy of Invoice(s) for physical therapy services showing paid in full or proof of payment
- Medicare approval/rejection of the claims
- Physician’s Referral Requisitions for Physical Therapy Services
What is SilverScript (Medicare Part D) and how do I apply for it?
- The WBG sponsors a Medicare Part D plan combined with additional coverage to mirror the current WBG prescription drug plan for staff. The pharmacy vendor for HQ-based staff is CVS/Caremark.
- You do not need to enroll in Medicare Part D; the WBG automatically enrolls you if you are eligible. Medicare requires that you be given the choice to opt out of the plan. However, if you are eligible for Part D and you choose to opt out, you will lose your prescription drug coverage under RMIP.
- For retirees eligible for U.S. Medicare, a Medicare Part D plan is also offered through SilverScript which is an affiliate of CVS/Caremark.
Will I be reimbursed for the cost of Medicare?
The Medicare B and D premiums are reimbursed by WBG.
I am about to turn 65 or am already participating in Medicare and I get mail which offers additional insurance plans. Do I need to sign up for those?
- U.S. citizens and permanent residents are required to sign up for Medicare B and through HR for Medicare D (Silver Script).
- Retirees who are eligible to receive Medicare A without paying a premium are expected to sign up for this and will benefit from using that option.
- No, you do not need to sign up for so-called ‘Medicare Advantage’ plans which are commercial additional insurance for items already covered by RMIP and Medicare.
I just received a letter from the U.S. SSA announcing higher premiums for Medicare Part B and D due to Income-related Monthly Adjustment Amounts (IRMAA) for next year. What do I need to do?
Submit Form F00032 Retiree MIP Medicare Reimbursements to HR Operations with a copy of all the letters that SSA sent you which specify the Medicare IRMAA Parts B and D you owe for the period for which reimbursement is claimed. If no SSA letter is available, attach Medicare premium invoice.
I’m a Medicare enrollee who pays the standard Part B premium. Do I have to do anything if there is a rate increase?
No, you don’t need to take any action because your premium reimbursement will be automatically updated.
I’m a U.S. citizen and Medicare enrollee whose Medicare premium is deducted directly from my social security payments. Do I need to do anything if there is a rate increase?
- Yes, Medicare enrollees who pay their Medicare premiums via a deductible from their Social Security benefit check are required to submit proof of their most recent Medical Part B premium amounts to HR Operations along with Form F00032.
- Until you submit the updated premium information to HR Operations you will only receive an initial reimbursement of the previous year’s standard reimbursement amount per person.