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Medicare: How it Affects Your UM Medical Insurance

Your medical plans are designed to coordinate with Medicare benefits, and it is important that you and your dependents enroll in Medicare when you first become eligible.

Medicare is a federal medical insurance program for people age 65 or older, or have been entitled to Social Security disability benefits for 24 months, or have end-stage renal disease (permanent kidney failure). Medicare is directed by the federal Centers for Medicare and Medicaid Services. Local Social Security Administration offices take applications for Medicare and provide information about the program.

"Original" (fee-for-service) Medicare has two parts:

  • Part A - Hospital Insurance -- Can help pay for inpatient hospital care, care in a skilled nursing facility, home health care, and hospice care.
  • Part B - Medical Insurance -- Can help pay for medically necessary doctors' services, outpatient hospital services, home health services, and a number of other medical services and supplies that are not covered by the hospital insurance part of Medicare.

It is important to understand that Medicare does not cover everything, and it does not pay the total cost for most services or supplies that are covered. Medicare Parts A and B have separate deductibles that must be met before Medicare benefits are payable. Part B benefits are also subject to a 20% patient co-pay.

Medicare provider participation is voluntary. A participating provider is one who is enrolled in the Medicare program, and agrees to accept assignment on all Medicare claims. These doctors may bill you only for Medicare deductible and/or co-insurance amounts. Non-participating providers may bill for amounts in excess of Medicare's deductible, co-insurance amounts, and approved amounts.

How Medicare Affects Your U-M Medical Insurance
A health insurance plan provides "primary coverage" when it is responsible for paying health benefits before any other group health insurance is liable for payment. Medicare provides primary coverage to your U-M medical insurance plan. As soon as you or your covered dependent become eligible for Medicare, you or your covered dependent must be enrolled in Medicare Parts A and B. You must have Medicare in effect and be entitled to receive Medicare benefits when first eligible. If you or a dependent is eligible for Medicare coverage that is primary to U-M, but have failed to enroll when first eligible, your benefits would be drastically reduced because your U-M medical insurance will not make any payments that would be payable by Medicare if Medicare enrollment had occurred.

Re-employment
If you return to active employment in a benefits-eligible position with the University of Michigan, U-M will again provide primary coverage for you, your spouse, and other enrolled dependents during your period of active employment.

For More Information about Medicare

  • Call Medicare at 800-MEDICARE (1-800-633-4227); toll-free within the United States
  • Access Medicare TTY/TDD for speech and hearing-impaired individuals by calling 1-877-486-2048 (toll-free within the United States)
  • Visit the Medicare Web site at http://www.medicare.gov
  • Call the Social Security Administration at 1-800-772-1213, (TTY/TDD number is 1-800-325-0778) or see their Web site at http://www.ssa.gov/.

 

Every effort has been made to ensure the accuracy of the benefits information in this site. However, if any provision on the benefits plans is unclear or ambiguous, the Benefits Office reserves the right to interpret the plan and resolve the problem. If any inconsistency exists between this site and the written plans or contracts, the actual provisions of each benefit plan will govern. The University in its sole discretion may modify, amend, or terminate the benefits provided with respect to any individual receiving benefits, including active employees, retirees, and their spouses, partners, and dependents. 

©2002 University of Michigan Human Resources and Affirmative Action | Benefits Office | Wolverine Tower Low Rise G250, 3003 South State Street, Ann Arbor MI 48109-1278 | Fax (734) 763-0363