Medicare enrollment and eligibility requirements
Typically, you are eligible for Medicare:
- At age 65, or
- Before age 65, after receiving Social Security disability benefits for at least 24 months
- You should receive Medicare enrollment information from the Social Security Administration (SSA) about four months prior to your 65th birthday.
- Contact Medicare.gov, review the national Medicare handbook, or call your local SSA office for more information.
- Enroll you and any eligible family members in Medicare Part B as soon as you become eligible for Medicare Part A. Failure could result in permanent loss of coverage.
- Inform Empyrean Benefit Solutions of your Medicare status regardless if you are Medicare eligible or not.
Medicare coordination for LANS retirees
The LANS retiree medical provider has a separate plan for Medicare enrollees. The Medicare coordinated version of your medical plan may have different benefits, service areas, and doctors than the non-coordinated version of the plan.
- You may see any Medicare provider to obtain plan benefits.
- When you receive services, Medicare is the primary payer and your coordinated plan is secondary.
- If your provider "accepts assignment," they will accept the Medicare approved rate for services. If the amount the coordinated plan would normally pay is less than what Medicare pays, the plans pay nothing. If the amount the coordinated plan would normally pay is greater than what Medicare pays, the plans pay the difference (up to the Medicare allowable) between their normal payment and Medicare’s payment.
- If your provider does not "accept assignment," they can bill you for an additional amount over the Medicare allowable rate (balance billing). The coordinated plan calculates the benefit on the Medicare "limiting charge" or the plan’s allowable rate, whichever is less, and then subtracts Medicare’s payment. The coordinated plan pays the difference and you pay the balance.
- Once you pay the LANS sponsored plan’s annual deductible, the plan coordinates payment with Medicare to cover a percentage of your expenses.
- The plans have an annual out-of-pocket maximum. Once you have met this amount for services each year, the plan covers your eligible expenses at 100%.