Medicare/Coordination of Benefits
Medicare is our country's health insurance program for people age 65 or older. Certain people younger than age 65 can qualify for Medicare too, including those with disabilities and those who have permanent kidney failure.
The Parts of Medicare
Social Security enrolls you in Original Medicare (Part A and Part B).
Medicare Part A (hospital insurance) helps pay for inpatient care in a hospital or limited time at a skilled nursing facility (following a hospital stay). Part A also pays for some home health care and hospice care.
Medicare Part B (medical insurance) helps pay for services from doctors and other health care providers, outpatient care, home health care, durable medical equipment, and some preventive services.
Medicare Advantage Plan (previously known as Part C) includes all benefits and services covered under Part A and Part B. Oberlin College has a Medicare Advantage Plan administered By Medical Mutual. Prescription drug is included.(vision and dental are offered, but not included.
Medicare Part D (Medicare prescription drug coverage) helps cover the cost of prescription drugs. If you are enrolled in the Oberlin College Medicare Advantage Plan, your prescription coverage is included. SilverScript will administer your prescription drugs.
If you are age 65 or older, you or your spouse are still working and you are covered under a group health plan based on that current employment, you may not need to apply for Medicare medical insurance (Part B) at age 65. You may qualify for a "Special Enrollment Period" (SEP) that will let you sign up for Part B:
- During any month you remain covered under the group health plan and your, or your spouse's, current employment continues; or
- In the eight-month period that begins with the month after your group health plan coverage or the current employment it is based on ends, whichever comes first.
Exception: If your group health plan coverage or the employment it is based on ends during your initial enrollment period for Medicare Part B, you do not qualify for a SEP. Your initial enrollment period starts three months before the month you attain age 65 and ends three months after the month you turn 65.
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. Medical Claims should be submitted to Medical Mutual. Prescription claims should be submitted to SilverScript.
Your Explanation of Benefit's from Medical Mutual will indicate, the Covered Amount which is the amount Medicare allows. It will also show the Amount Not Covered, that is, the amount Medicare does not allow. You will not be responsible for the Amount Not Covered or not allowed.