As a retiree age 65 and over, Medicare is your primary coverage and HealthSelect secondary. The following is information on how benefits coordinate with Medicare. For more information:
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View the Interactive Benefits Training (Flash Interactive Demo)
Coordination of Benefits with Medicare
- You should enroll in Medicare Part B.
- HealthSelect coordinates with Medicare.
- Your Medicare deductible counts toward your HealthSelect deductible.
- HealthSelect covers services that are not covered by Medicare.
If you are retired and turned 65 after August 31, 1992, you should enroll in Medicare Part B. Even if you do not have Medicare Part B, HealthSelect will only pay secondary benefits for Part B services, and you will be responsible for the remainder of the provider’s charges. This would mean a significant out-of-pocket cost for you.
With HealthSelect, a $200 calendar year deductible applies to most services. The Medicare Part B deductible will apply toward the $200 HealthSelect deductible. Once your deductibles are met, in most instances, Medicare will pay 80% of eligible charges if you use providers who accept Medicare assignment, and HealthSelect will pay secondary benefits. Read more on how to find a provider.
HealthSelect covers a number of services that are not covered by Medicare such as routine eye exams, hearing aids, and an annual physical. In these instances, HealthSelect will pay primary benefits.
The following chart shows what Medicare and HealthSelect will pay and your patient responsibility, assuming the Medicare Part B deductible has been met, services are covered under both HealthSelect and Medicare, and that the provider accepts Medicare assignment.
|
Service |
Medicare Pays |
HealthSelect Pays |
You Pay |
|
Inpatient Hospital |
All covered charges minus Part A deductible & first 3 pints of blood |
Part A deductible & first 3 pints of blood |
Cost of personal items (You may be responsible for an inpatient copayment amount.) |
|
Outpatient Hospital |
80% of covered charges |
20% of covered charges |
Usually $0. (You may be responsible for a copayment amount for outpatient surgery performed in a hospital.) |
|
Physician’s Services |
80% of covered charges |
20% of covered charges |
Usually $0 |
|
Laboratory Services |
If covered, paid at 100% |
$0, unless Medicare denies, then 80% |
Usually $0; 20% if Medicare denies |
|
Radiology |
80% of covered charges |
20% of covered charges |
Usually $0 |
|
Durable Medical Equipment |
80% of covered charges |
20% of covered charges |
Usually $0 |
