UT SELECT and Medicare

Active Employees

In most cases, an active employee or dependent of an active employee enrolled in UT SELECT should enroll in Medicare Part A and decline Parts B and D once eligible, typically at age 65. Once you retire, you and your Medicare-eligible dependent(s) should then enroll in Part B without penalty and continue to waive Part D. In most instances, if you are eligible for Medicare and are working at UT in a benefits-eligible position for at least 20 hours per week, your UT medical plan will be primary for you and your covered dependent, regardless of age, and Medicare will be secondary. Medicare may be primary for some Medicareeligible active employees with certain medical conditions such as end stage renal disease (ESRD). Consult with your local Social Security Administration office to learn what illnesses qualify for Medicare coverage prior to turning age 65.

Retired Employees

When you or your covered dependent(s) become eligible for Medicare, you and your Medicare-eligible dependents should enroll in Part A (typically inpatient coverage) and Part B coverage (typically office visits and doctor fees) and decline Part D (prescription drug coverage) in most cases. The University of Texas System urges all retired employees and dependents to enroll in Medicare Parts A and B when they become eligible at age 65, or earlier if they are eligible due to a disability such as end stage renal disease. Retired employees, or soon-to-be retired employees, or their dependents who are eligible for Medicare must have Medicare Parts A and B to receive the maximum benefits available from the UT SELECT plan.

In most instances, if you are eligible for Medicare and are working in a position for at least 20 hours per week, your UT medical plan will be primary, and Medicare will be secondary. Medicare may be primary for some Medicare-eligible active employees with certain medical conditions such as End Stage Renal Disease. Consult with your local Social Security Administration office to learn what illnesses qualify for Medicare coverage prior to turning age 65.

If you are retired and also eligible for Medicare, Medicare becomes your primary payer and pays your medical claims first; UT SELECT pays second. If you choose a doctor who accepts Medicare assignment, you will not be responsible for any difference between the billed charge and the Medicare allowed amount.

If you decline Part B, you will have to pay a higher premium if you ever re-apply for Medicare coverage. As a retiree, if you or your Medicare-eligible dependent have declined Medicare Part B and fail to re-apply, you will be required to pay the portion that Medicare Part B would have paid as primary insurer for Part B-covered items for yourself and any Medicare-eligible dependents.

To ensure claims are correctly processed, you should contact Blue Cross and Blue Shield of Texas and report you or your dependent’s Medicare Health Insurance Claim (HIC) number and the effective dates of Medicare Parts A and B immediately upon enrollment. It is important to inform your providers of all the insurance plans in which you are enrolled. Understanding correct coordination of benefits will help to ensure timely and accurate claims payments.

If you or your dependents are enrolled in Medicare and your doctor accepts Medicare assignment:

  • The doctor may be in or out of the UT SELECT Network;
  • UT SELECT will pay 100% of benefits approved but not paid by Medicare (subject to UT SELECT plan limitations);
  • There are no deductibles, copayments or coinsurance; and
  • When you or your dependents are an inpatient at a facility that accepts Medicare assignment, UT SELECT will pay the Medicare inpatient deductible, and the $100 per day Co-pay ($500 maximum) will not apply.

If your doctor does not accept Medicare assignment:

  • Network and Out-of-Network benefits apply;
  • UT SELECT will coordinate with Medicare; and
  • Deductibles, copayments and coinsurance may apply.

This chart shows you how UT SELECT coordinates benefits with Medicare. All benefits are subject to plan limitations.

 

Provider Accepts Medicare Assignment BCBSTX In-Network Provider Service Covered by Medicare Medicare Pays UT SELECT Pays 1 UT SELECT
Member Pays
Y Y Y 80% MC Allowed 20% MC Allowed No Charge
Y N Y 80% MC Allowed 20% MC Allowed No Charge
Y Y N 0 80% of BCBS Allowed after $350 UT SELECT Deductible or 100% after Copay, whichever is applicable 20% of BCBS Allowed after $350 UT SELECT Deductible or Copay, whichever is applicable
Y N N 0 60% of BCBS Allowed after $750 UT SELECT Deductible $750 UT SELECT Deductible + 40% of BCBS Allowed + Difference between Billed Charge and BCBS Allowed
N Y Y After MC Deductible is satisfied, 80% MC Limiting Charge2 20% of allowed charges3 after $350 Deductible or 100% after Copay, whichever is applicable $350 UT SELECT Deductible and 20% coinsurance or Copay, whichever is applicable
N N Y After MC Deductible is satisfied, 80% MC Limiting Charge2 20% of allowed charges3 after $750 UT SELECT Deductible $750 UT SELECT Deductible and 40% coinsurance
N Y N 0 80% of BCBS Allowed after $350 UT SELECT Deductible or 100% after Copay, whichever is applicable 20% of BCBS Allowed after $350 UT SELECT Deductible or Copay, whichever is applicable
N N N 0 60% of BCBS Allowed After $750 UT SELECT Deductible $750 Deductible + 40% of BCBS Allowed + Difference between Billed Charge and BCBS Allowed

1 If a service is not covered by the UT SELECT plan, no payment will be made.
2 Provider who does not participate with Medicare may not bill more than the Medicare Limiting Charge (115% of MC Allowed).
3 Allowed charges are the lesser of the Medicare Limiting Charge (115% of MC Allowed) or the Blue Cross and Blue Shield allowed amount. If the Blue Cross and Blue Shield allowed amount is less, the member may be billed the difference.

Medicare is secondary when:

  • The Beneficiary has Medicare Part A or Parts A and B;
  • The Beneficiary is eligible for Medicare due to age (65) or disability; and
  • The Beneficiary has group plan coverage through active employment

For more information on Coordination of Benefits with UT SELECT and Medicare, please see the UT Benefits Handbook for Retired Employees. You may also request a copy from your institution’s benefits office.

 

 

The Seal of the University of Texas System

  • © 2013 The University of Texas System
  • 702 Colorado Street, Suite 2.100
  • Austin, TX 78701
  • Phone: (512)499-4616
  •