Medical Coverage: Medicare Retirees, Surviving Spouses and Dependents
The Plan provides a separate coverage level for Medicare eligible retirees and surviving spouses and/or dependents. Medicare is the primary payer for a retired employee, surviving spouse, or dependent of a retired employee, or surviving spouse who is:
- Age 65 or older.
- Under age 65 with Social Security disability.
- Under age 65 with end-stage renal disease after the first 30 months of Medicare eligibility.
Medicare coordination provisions are subject to change in accordance with changes in the Medicare program.
When Medicare is primary, the Plan will provide 100 percent toward the Medicare deductible and coinsurance amounts not covered by Medicare. The Plan only provides benefits for covered expenses outlined in this Plan Document. Benefits are paid at 100 percent for a covered expense that is not covered by Medicare.
Benefits are allowed based on the difference between the Medicare maximum allowable charge and the amount Medicare paid (or the difference between the Medicare allowed amount and the amount Medicare paid if assignment is accepted by the provider). This provision applies regardless of whether or not the provider participates in Medicare or contracts directly with the participant.
If a retired employee, dependent of a retired employee, surviving spouse, or dependent of a surviving spouse is eligible for Medicare and does not elect Medicare Part A and B, benefits will be reduced as though Medicare is the primary payer. The Plan will calculate benefits assuming the participant has both Medicare A and B.
Enroll in Medicare Parts A, B, and D
Contact your local Social Security office for details and ensure you receive maximum benefits by enrolling in these Medicare plans.
Retirees should notify BCBSMS immediately upon being approved for Medicare due to Social Security disability by submitting a copy of their Medicare ID card. The Plan will update their records to reflect Medicare as the primary coverage effective the date of Medicare eligibility. The Plan will also refund any overpayment of premiums and reprocess claims not to exceed a two-year limit to calculate benefits as secondary to Medicare retroactive to the effective date of Medicare.