Medicare Parts A and B

Overview

The Medicare program is a federal health insurance program for:

Individuals age sixty five (65) or older (even if the individual’s full retirement age for Social Security or Railroad Retirement benefits is older than age 65);
Individuals of all ages suffering from end stage renal disease; or

Individuals under age sixty-five (65) with certain medical disabilities.

The Medicare Program consists of three parts:

Hospital Insurance Benefits (Medicare Part A)
Medical Insurance Benefits (Medicare Part B)
Prescription Drug Coverage Plan (Medicare Part D)

Eligibility

Individuals Age Sixty-five (65) or Older

Medicare Parts A and B is available for every individual who has attained age sixty-five (65) and is either entitled to monthly Social Security benefits, or is a qualified Railroad Retirement beneficiary (even if the individual’s retirement age for full benefits under either of these programs is older than 65).
Entitlement to Medicare Parts A and B benefits begins on the first day of the month in which the beneficiary reaches age sixty-five (65). To receive Medicare Part A, an individual need only apply for it. To receive Medicare Part B, an individual must apply for it, and pay a small premium.
Individuals who are already receiving Social Security or Railroad Retirement benefit payments when they turn 65, will automatically receive a Medicare card in the mail. The card will show coverage for both Medicare Part A and Part B. (If the individual chooses to decline Part B, the individual should follow the instructions that come with the Medicare card).

Individuals Suffering From End Stage Renal Disease

Medicare Parts A and B are provided to individuals under age sixty-five (65) who require hemodialysis, self-dialysis or renal transplantation for chronic renal disease.

Individuals With Certain Medical Disabilities

Individuals under age sixty-five (65) who have been entitled to disability benefits under the Social Security or Railroad Retirement Acts for at least twenty-four (24) consecutive months are entitled to Medicare Parts A and B. Coverage beginning the first day of the 25th month of entitlement to disability benefits and terminates at the end of the month following the month in which notice of termination of disability insurance is provided by the Social Security Administration.

Enrollment

Individuals are encouraged to enroll in Medicare A and B as soon as possible when they become eligible. They should apply for these benefits three (3) months prior to their 65th birthday at their local Social Security Administration Office.

When a retiree or their eligible dependent(s) reach age 65 and become eligible for Medicare, Company provided health care coverage will end. Medicare will be the primary medical coverage.

Active employees and their eligible dependents age 65 and older do not need to enroll in Medicare until they retire and become Medicare eligible.

Individuals will automatically be enrolled in Medicare Parts A and B if:

They turn age sixty-five (65) and applied for Social Security benefits prior to age sixty-five (65). At this time they will receive a card that indicates they have Medicare Parts A and B.
They are already receiving benefits from Social Security or the Railroad Retirement Board.
They have been receiving disability benefits under Social Security for at least twenty-four (24) consecutive months, with an effective date on the first day of the 25th month of entitlement to such disability benefits.

Coverage

Medicare Part A

Medicare Part A helps pay for the following services when medically necessary:

Inpatient hospital care;
Inpatient care in a skilled nursing facility following a hospital stay;
Home health care;
Hospice care; and
Blood, subject to restrictions, received at a hospital or skilled nursing facility during a covered stay.

Medicare Part B

Medicare Part B helps pay for the following services when medically necessary:

Doctors' services;
Outpatient hospital, medical and surgical care;
Diagnostic tests;
Durable medical equipment;
Outpatient occupational, physical and speech therapy;
Limited foot care services ;
Clinical Laboratory Services;
Limited Home Health Care;
Blood you as an outpatient or as part of a Part B-covered service;
Ambulance services;
Many other medical services and supplies which are not covered by Medicare Part A including, but not limited to, chiropractic services, and qualifying clinical trials;
If Part B coverage begins on or after January 1, 2005, Medicare will also cover a “Welcome to Medicare” one time physical examination within the first six months of coverage, and
Certain Preventative Services including, but not limited to, bone mass measurements, cardiovascular screening blood tests, colorectal cancer screening, diabetes testing and self-management training, glaucoma testing, pap test and pelvic examination, prostate cancer screening, screening mammograms, shots (flu, pneumococcal, and Hepatitis B under certain circumstances)

Caution: For complete details on Medicare Parts A and B coverage call either (800) 633-4227, your local Social Security Administration office, or go to the Medicare website (http://www.medicare.gov/).

Cost

Payment Procedures

Medicare Part A is premium free for most people who paid Medicare taxes while working,
Medicare Part B requires a monthly premium. The cost of Medicare B will go up 10% for each full 12-month period an individual was eligible for Medicare Part B during the Initial Enrollment period but did not take it.
Both Medicare Parts A and B have deductibles and coinsurance amounts that the individual must pay personally before Medicare begins paying for services and supplies covered by the program.

It is important to present both Medicare and basic health care coverage identification cards whenever services are obtained. All health care providers are required to file claims with the Medicare carrier in the state in which services are received.

For complete details on Medicare Parts A and B deductibles and coinsurance, telephone your local Social Security Administration office or go to the Medicare website (http://www.medicare.gov/).

Assignment Method

If physicians or suppliers accept a Medicare assignment, they agree to accept the reasonable charge allowed by Medicare and cannot charge more than 20% (not reimbursed by Medicare) after the Medicare Part B annual deductible has been met. When a provider accepts a Medicare assignment, payment will be made directly to the provider. You will receive an Explanation of Medicare Benefits form advising you of the payment information.

Non-Assignment Method

If your physicians or suppliers do not accept a Medicare assignment, you must pay the physicians or suppliers directly. In this case, Medicare pays you 80% of the approved amount for covered services after subtracting any part of the Medicare Part B annual deductible you have not met. You will receive an Explanation of Medicare Benefits Form advising you of the payment information.

Integration of Chrysler Benefits and Medicare Benefits

The coverage provided by Medicare when Medicare is the primary payer is integrated with your Chrysler Health Care Benefits Program to maintain the level of coverage currently available to enrollees not enrolled in Medicare. Under this integration, payments for Medicare covered services are excluded under the Plan to the extent that they are covered under Medicare Parts A and B.

Coordination of Benefits

If You Work Past Age 65

If you are age 65 or older, actively working for Chrysler and have Medicare coverage, the Chrysler Plan will continue to be the primary payer of eligible health care expenses. Medicare will be the secondary payer of benefits. Your claims should be submitted to your health care plan first and then to Medicare for coordination of benefits. Medicare provides some additional benefits, such as office visits, which are not covered by the Standard Plan.
If your spouse has their own coverage as an active employee or non-Medicare retiree from another Corporation, the health care plan covering the spouse is the primary payer of health care expenses and Chrysler would be the secondary payer of eligible health care expenses.
If your spouse has Medicare coverage and also has their own coverage as an active employee, your spouse’s health care plan would be the primary payer of health care benefits, Chrysler coverage would be the secondary payer and Medicare would be the tertiary payer of health benefits.
If your spouse has Medicare coverage and also has their own coverage as a retiree, the Corporation would be the primary payer of eligible health care expenses, Medicare would be the secondary payer and the coverage as a retiree would be the tertiary payer of health benefits.
If your spouse has Medicare and has no other group health coverage of their own, the Chrysler Plan will be the primary payer of eligible health care expenses. Medicare will be the secondary payer of benefits.
You may elect to have Medicare as your primary payer. By doing so, however, you must reject Corporation provided Hospital/Surgical/Medical coverage completely.
Medicare does not affect your Chrysler prescription drug, dental, vision care, and hearing aid benefits.

If You Are Retired

If you are retired from Chrysler and have Medicare coverage, your Medicare health care plan will be the primary payer of health care expenses. The Chrysler Plan will be the secondary payer of eligible health care benefits. Your claims should be submitted to the Medicare health care plan first and then to the Chrysler carrier for coordination of benefits. Medicare provides some additional benefits, such as office visits, which are not covered by the Standard Plan.
If your spouse has their own coverage as an active employee or non-Medicare retiree, the health care plan covering the spouse is the primary payer of health care expenses and Chrysler would be the secondary payer of eligible health care expenses.
If your spouse has Medicare coverage and also has their own coverage as an active employee, your spouse’s health care plan would be the primary payer of health care benefits, Medicare coverage would be the secondary payer and Chrysler would be the tertiary payer of health benefits.
If your spouse has Medicare coverage and also their own coverage as a retiree, Medicare would be the primary payer of eligible health care expenses, your spouse’s health care plan would be the secondary payer and Chrysler would be the tertiary payer of health benefits.
If your spouse has Medicare and has no other group health coverage of their own, the Medicare health care plan will be the primary payer of health care expenses. Chrysler will be the secondary payer of eligible health care expenses.
Medicare does not affect the Chrysler prescription drug, dental, vision care, and hearing aid benefits.

If You Are Disabled And Under Age 65

If you are under age 65 and are eligible for Medicare due to a disability, your Chrysler health care plan is the secondary payer of eligible health care expenses and Medicare is the primary payer. Claims should be submitted to Medicare first and then to your health care plan for supplemental benefits.
However, if you are also covered as a dependent on the health care plan of a spouse who is an active employee, that plan is primary. Claims should be submitted to that plan first, Medicare second, then to the Chrysler Plan for supplemental benefits.
If your spouse has their own coverage as an active employee or non-Medicare retiree, the health care plan covering the spouse is the primary payer of health care expenses and Chrysler would be the secondary payer of eligible health care expenses.
If your spouse has Medicare coverage and also has their own coverage as an active employee, your spouse’s health care plan would be the primary payer of health care benefits, Medicare coverage would be the secondary payer and Chrysler would be the tertiary payer of health benefits.
If your spouse has Medicare coverage and also has their own coverage as a retiree, Medicare would be the primary payer of eligible health care expenses, your spouse’s health care plan would be the secondary payer and Chrysler would be the tertiary payer of health benefits.
If your spouse has Medicare and has no other group health coverage of their own, the Medicare health care plan will be the primary payer of health care expenses. Chrysler will be the secondary payer of eligible health care expenses.

Medicare Prescription Drug Coverage Plan (Medicare D)

Overview

A voluntary plan that will primarily benefit Medicare participants who do not have comprehensive prescription drug coverage through an employer.

Retiree Choice participants age 65 and older are eligible for the Health Care Retirement Account (HRA) and will no longer have Corporation provided comprehensive prescription drug coverage. These participants may want to consider a Medicare D plan.

Non-Retiree Choice participants and pre-age 65 Retiree Choice participants have employer provided prescription drug coverage which provides benefits at or above those available from a Medicare prescription drug plan. To continue current prescription drug coverage, do not enroll in a Medicare Prescription Drug Plan.

For More Information:

Contact the Center for Medicare and Medicaid (CMS) at: 1-800-633-4227 (TTY: 1-877-486-2048). Go to the Medicare web site.
For limited income and resources eligibility, contact the Social Security Administration online or by phone at 1-800-772-1213.