If you are enrolled in both Medicare Part A and Part B as well as the High Option Compass Rose Health Plan, you may be wondering how the two plans work together. That depends on which plan is considered primary.
Typically, if you are actively working, the Compass Rose Health Plan is your primary coverage and if you are retired, Medicare is your primary coverage.
Once Medicare becomes primary, that means Medicare pays for your service first, and then we pay our portion second. Even though enrolling in Medicare is not required, there are some definite advantages to having both Medicare Part A and Part B and the High Option Compass Rose Health Plan.
Benefits of Having Our High Option Plan & Medicare
Waived medical deductibles, co-pays and coinsurance
Coverage for services outside the U.S.
Coverage for certain things Medicare doesn’t cover
Opportunity to enhance benefits with Compass Rose Medicare Advantage
Enrolling in Medicare Part A and Part B does not automatically enroll you in Compass Rose Medicare Advantage.
Get $125/month with Compass Rose Medicare Advantage
High Option members who are retired and enrolled in Medicare Part A and Part B can get up to $1,500 per year toward their Medicare Part B premium with Compass Rose Medicare Advantage, a UnitedHealthcare® Group Medicare Advantage (PPO) Plan.
Medicare is a health insurance program for:
- People 65 years of age or older
- People under 65 with certain disabilities
- People of any age diagnosed with End-Stage Renal Disease (ESRD) - permanent kidney failure requiring dialysis or a kidney transplant
Three months prior to your 65th birthday, the United States Social Security Administration will notify you about your upcoming benefits available through Medicare. If you choose to enroll prior to turning 65, your coverage becomes effective the first day of the month you turn 65. If you enroll during the month of your birthday or the three months that follow, coverage becomes effective the following month.
4 Parts of Medicare
Medicare part A helps cover inpatient care in hospitals, skilled nursing facilities, hospice and home health care. Most people are not responsible for paying Part A premiums because they paid Medicare taxes while working. If you or your spouse worked for at least 10 years in a Medicare-covered position, you should be able to qualify for premium-free Medicare Part A insurance.
If you are not responsible for paying premiums, we strongly encourage you to obtain Medicare Part A when you become eligible.
Medicare Part B helps cover a portion of medically necessary services (i.e. doctors’ services, outpatient care, home health services and other medical services not covered by Medicare Part A). Part B also covers some preventive services. Coverage is voluntary and requires payments for premiums, deductibles and coinsurance.
Retired members enrolled in the High Option Compass Rose Health Plan as well as Medicare Part A and Part B can get up to $1,500 per year toward their Medicare Part B premium with Compass Rose Medicare Advantage.
If you choose NOT to enroll in Medicare Part B when you first become eligible, you may be charged a Part B late enrollment penalty, resulting in a 10% increase in premiums for every 12 months you are not enrolled.
You may have to pay a higher premium because of your income, known as an income-related monthly adjustment amount (IRMAA). Social Security will tell you if your modified adjusted gross income, as reported on your IRS tax return from 2 years ago, is above a certain amount that requires you to pay a higher premium. The income brackets and Part B premiums can change each year.
Two years following a decrease in your modified adjusted gross income, you can request the Centers for Medicare & Medicaid Services (CMS) performs a lookback to have your IRMAA decreased or removed if applicable.
Medicare Part C Advantage Plans are private health care choices (HMOs and regional PPOs) in select areas of the country.
Retired members enrolled in the High Option Compass Rose Health Plan as well as Medicare Part A and Part B are eligible for Compass Rose Medicare Advantage. Your dual coverage will be combined into one plan, so you don’t need to worry about coordination of benefits. Plus, you’ll get extra perks you won’t find anywhere else!
Medicare Part D helps cover the cost of prescription drugs.
The Office of Personnel Management (OPM) determined that the Compass Rose Health Plan’s prescription drug coverage is, on average, expected to pay out as much as the standard Medicare Prescription Drug Coverage will pay for all plan participants and is considered creditable coverage.
Your Benefits When Medicare is PrimaryThis is a summary of covered benefits when you are enrolled in both Medicare Part A and Part B and the High Option Compass Rose Health Plan, and Medicare is primary.
As your secondary insurer, we will waive your hospital co-pays and coinsurance.
As your secondary insurer, we will waive your calendar year deductible, most co-pays and coinsurance for medical services and supplies provided by physicians and other health care professionals.
You have the freedom to be seen by any participating Medicare provider, in- or out-of-network, without penalty.
Visit medicare.gov to verify whether your provider participates in Medicare.
In most situations, Medicare won't pay for health care or supplies you get outside the U.S.
Our High Option Plan has you covered. You can see any health care provider or visit any hospital and be reimbursed at the in-network level of benefits.
When you use a provider outside the United States, you will pay them up front, then submit the receipt and detailed billing invoice for claims processing and reimbursement.
The High Option Compass Rose Health Plan covers certain things Medicare doesn’t, including:
- Up to $60 per visit for massage therapy (12 visits max)
- Up to $1,200 for one hearing aid per ear every three (3) years (from date of service)
- Diabetes testing supplies, respiratory supplies and medications, immunosuppressive medications, and oral anti-cancer medications