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Medicare

Medicare is a federal health insurance program for individuals:

  • Age 65 or older, or;
  • Receiving Social Security Administration (SSA) benefits or Railroad Retirement Board disability benefits for over 24 months, or;
  • With End Stage Renal Disease (ESRD)

The Medicare program is administered by the Federal Centers for Medicare and Medicaid Services, formerly known as the Health Care Financing Administration (HCFA). Medicare Part A provides coverage for Hospital care, skilled nursing facility care, home health and hospice care. Medicare Part B provides coverage for Physician/professional care, outpatient hospital care and other medical services. Medicare Part D provides Prescription Drug benefits. Please find below further information on the following topics:

Qualifying for Medicare
Age 65 & Over - Medicare Eligibility
Under Age 65 - Medicare Due to Disability
Medicare Part B Reduction
Medicare Part D
For Further Information


Qualifying for Medicare

An individual can qualify for Medicare Part A based on his/her own work history or the work history of a former or current spouse. A person hired by the University on or after April 1, 1986, is subject to withholding of the Federal Medicare tax (1.45% of Medicare eligible salary), which contributes towards his/her eligibility for premium-free Medicare Part A.

If the Plan Participant is already receiving retirement benefits from the Social Security Administration (SSA) or the Railroad Retirement Board, Medicare will send a Medicare card and automatically enroll the Plan Participant in Medicare Parts A and B. If the Plan Participant is not receiving retirement benefits from SSA or the Railroad Retirement Board, he/she should contact the local SSA office three months prior to turning age 65 in order to prevent a break in coverage.


Age 65 & Over - Medicare Eligibility

Medicare Eligible
Plan Participants must contact their local Social Security Administration office upon turning age 65 in order to determine if they are eligible for premium-free Medicare Part A benefits based on their own or their spouse's work history. All Plan Participants are eligible for Medicare Part B benefits upon turning age 65. All retired Plan Participants eligible for premium-free Medicare Part A, as well as Plan Participants actively employed with an employer other than the State of Illinois and without other large group health plan coverage or Plan Participants without Current Employment Status (CES), must enroll in Medicare Part A and Part B when first eligible.

Plan Participants with CES with other large group health plan coverage may delay enrolling in Medicare Part B until loss of CES, loss of their large group health insurance through their current employer or retirement (whichever is first). Upon this event, a Plan Participant must enroll in Medicare Part B in order to avoid a reduction in benefits. Note: It is strongly suggested that an employee register for Medicare through the Social Security Administration office at age 65, even if he/she is continuing to work, in order to avoid this benefit reduction. See Medicare Part B Reduction for more information.

If Medicare Part B is not purchased at age 65 when the Plan Participant is either retired or no longer in CES, Medicare will impose a 10% penalty for each year without the purchase of Medicare Part B. The annual Medicare general enrollment period is January, February and March; however, coverage is not effective until July 1.

Medicare Ineligible
If the Plan Participant is ineligible for premium-free Medicare Part A, he/she must provide written certification from the Social Security Administration (SSA) that he/she is ineligible based on his/her work history or the work history of any current or former spouse. The certification must be submitted to his/her Group Insurance Representative (GIR) upon turning age 65. The Plan Participant is not required to purchase Medicare Part B if ineligible for free Medicare Part A.


Under Age 65 - Medicare Due to Disability

In order to apply for Medicare disability coverage, a Plan Participant must contact the local Social Security Administration office. Plan Participants under the age of 65 who are receiving Social Security disability benefits or Railroad Retirement Board disability benefits, will automatically be enrolled in Medicare Parts A and B when determined eligible by the Social Security Administration. If a Plan Participant is retired or without Current Employment Status (CES) and is receiving Medicare benefits, the Plan Participant must remain enrolled in Medicare Part B. If the Plan Participant does not enroll or remain enrolled in Medicare Part B when Medicare is determined to be primary payer, the Plan will pay as if the Plan Participant has Medicare Part B benefits and the Part B benefit reduction applies. See Medicare Part B Reduction for more information.

End Stage Renal Disease (ESRD)
Plan Participants of any age may qualify for premium-free Medicare Part A on the basis of End Stage Renal Disease (ESRD) if certain criteria are met. In order to apply for Medicare ESRD coverage, a Plan Participant must contact the local Social Security Administration Office. Plan Participants who are receiving regular dialysis treatments or who have had a kidney transplant, must make application for Medicare benefits on the basis of ESRD. If it is determined that the Plan Participant is eligible for premium-free Medicare Part A, the Plan Participant must accept the Medicare Part A coverage and notify the Central Management Services Medicare COB Unit at 800-442-1300 or 217-782-7007 in order to establish the coordination of benefit period and to determine the date of Medicare primacy.

When Medicare becomes the primary payer, the purchase of Medicare Part B is required. If the Plan Participant does not enroll or remain enrolled in Medicare Part B when Medicare is determined to be the primary payer, the Plan will pay as if the Plan Participant has Medicare Part B benefits and the Part B benefit reduction applies. See Medicare Part B Reduction for more information.


Medicare Part B Reduction

If Medicare Part B is not purchased, the Plan Participant's health plan (either QCHP or the Plan Participant's Managed Care health plan) will process claims as if Medicare Part B was the primary payer. When Medicare is the primary payer, the standard Medicare Part B plan pays 80% of all Medicare approved amounts. The Quality Care Health Plan (QCHP) pays up to the 20% coinsurance that remains after Medicare Part B pays. If a Plan Participant does not enroll in Medicare Part B when Medicare is primary, the QCHP will not pay the initial 80% of the eligible charges. The QCHP will only pay up to 20% of the eligible charges of the claim. Plan Participants enrolled in a managed care health plan should contact the specific managed care plan for reduction information. This reduction of benefits will remain in place until the date that Medicare Part B becomes effective. Plan Participants who terminate Medicare Part B coverage will be subject to claim adjustments by the claims administrator for any claims paid at the incorrect benefit level.


Medicare Part D

Medicare Part D is part of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, commonly referred to as the MMA. The Act includes a new Prescriptions Drug benefit referred to as Medicare Part D.

Qualifications for Medicare Part D
All individuals eligible for Medicare Part A and/or Part B due to age, disability or End Stage Renal Disease (ESRD) are eligible for the Medicare Part D Benefit. It is recommended that University employees do not enroll in a Medicare Part D Plan unless qualified for low-income/extra-help assistance because the University coverage is the same or better than the Medicare Part D benefit. Please see Notice of Creditable Coverage below.

Notice of Creditable Coverage
The Notice of Creditable Coverage is a document that is intended to advise Medicare beneficiaries whether Prescription Drug coverage through the Program is creditable, meaning that coverage is the same or better than the Medicare Part D benefit. This Notice of Creditable Coverage prevents a Member from being penalized if enrolling in Medicare Part D at a later date. The Notice of Creditable Coverage will be provided prior to the enrollment period for Medicare Part D.


For Further Information

Visit the Medicare website to:

  • See what Medicare plans are in your area
  • Find doctors who participate in Medicare
  • See what Medicare covers, including preventive services
  • Get Medicare appeals information and forms
  • Get information on the quality of care provided by nursing homes, hospitals, home health agencies, plans and dialysis facilities
  • Look up helpful telephone numbers for your area
  • View Medicare publications

With questions about Medicare, call 800-MEDICARE (800-633-4227) or TTY 877-486-2048.

With questions about eligibility for and enrolling in Medicare, Social Security retirement benefits, or disability benefits, call Social Security Administration (SSA) at 800-772-1213 or TTY 800-325-0778.

With questions about the Notice of Creditable Coverage, call CMS Medicare Coordination of Benefits (COB) Unit at 800-442-1300 or 217-782-7007.

 


Maintained by University Human Resources | Contact Information | Last Update: 21-September-2017 | ID: 3794