Medicare/CIGNA Coordination of Benefits

At age 65, you become medicare-eligible and are required to enroll in Medicare Parts A and B.

How Medicare parts A and B affect your coverage

  • Medicare becomes the primary coverage for you and any covered dependents age 65 years of age or older, or disabled
  • Your Oberlin College CIGNA coverage becomes secondary or supplementary to Medicare
  • All services must be submitted to Medicare first for payment
  • Retirees and their dependents must enroll in Medicare benefits when first eligible. Copies of Medicare Parts A & B cards for retirees and dependents must be forwarded to Human Resources to get a reduction in your health insurance premium.

How will claims be processed?

Your Health Care Professional accepts Medicare's assignment, that is, they agree to bill only the amount Medicare approves for a particular service. Your Explanation of Benefit from CIGNA will indicate, the Covered Amount which is the amount Medicare allows. It will also show the Amount Not Covered, that is, the amount Medicare doesn't allow. You will not be responsible for the Amount Not Covered or not allowed. Once Medicare pays its applicable percentage of the allowed amount, CIGNA pays the difference up to the applicable percentage amount on the CIGNA Comp plan. (Note: if the amount Medicare paid is equivalent to what CIGNA would have paid as the primary carrier, then CIGNA makes no payment.)

The Medicare/CIGNA Coordination of Benefits Table in the document below shows an example of how Medicare is coordinated with your CIGNA benefit.

Medicare approved/allowed amounts are established by the Federal government each year. The example below uses the 2016 allowed amounts.