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Insurance insights

Should I Enroll In Medicare? When?

The University of Texas System urges all retired employees and eligible dependents to enroll in Medicare Part B when they become eligible at age 65, or earlier if they are eligible due to a disability.* As a Medicare-eligible individual, retirees and their Medicare-eligible dependents have the option of enrolling in Medicare Part A (in-patient facility coverage available at no cost) and refusing Medicare Part B coverage (physician and other provider charges which require a monthly premium). Although enrolling in Part B is optional, you must have Part B to receive the maximum benefits available from the UT SELECT medical plan. It is also your responsibility to inform your institution’s Benefits Office if your covered dependents are Medicare-eligible.

Keep in mind that while the Medicare Part D prescription drug program is available to eligible retirees, UT System continues to strongly discourage most eligible retirees from enrolling in the Part D program. Only a relatively small number of retirees who also qualify for a “low income subsidy” should consider enrolling in Part D. UT System remains committed to providing your prescription drug coverage now and in the future and to helping you make informed choices about your prescription drug benefit. For more information about Medicare, contact your Campus Benefits Office.

How Medicare and UT SELECT Coordinate

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 Blue Cross Blue Shield of Texas (BCBSTX) doctor who accepts Medicare assignment, you will not be responsible for any difference between the billed charge and the Medicare allowed amount. To view the UT SELECT / Medicare Coordination Table, go to the Group Benefits Handbook for Employees page 26.

Working Retirees

In most instances, if you are eligible for Medicare and are working in a benefits-eligible position, your UT SELECT medical plan will be primary and Medicare will be secondary.

Failure to Enroll

If you decline Medicare Part B, you may have to pay a higher premium upon re-application for Part B coverage. In addition, without Part B, the retiree is responsible for paying any share of the retiree’s and their Medicare-eligible dependent’s medical claims that Part B would have paid. 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 Part B would have paid as primary insurer for Part B-covered charges for yourself and any Medicare-eligible dependents. In order to ensure that claims are correctly processed, you should contact BCBSTX and report your or your dependent’s Medicare Health Insurance Claim (HIC) number and the effective dates of Medicare Parts A and B immediately upon enrollment.

*Medicare may be primary for some Medicare-eligible active employees with certain medical conditions. Consult with your local Social Security Administration office to learn what illnesses qualify for Medicare coverage prior to turning age 65.

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Detailed Plan Information Available Online

Important details about your UT group insurance benefits and the provisions of the insurance plans are available in the Benefits Guides found on the Office of Employee Benefits website.

The Benefits Guides are available at: http://www.utsystem.edu/benefits/guides.asp

Know Your Benefits

Out-of-Pocket Maximum- means the total expenditures you pay for your share of eligible expenses. Out-of-pocket maximum is calculated per plan year and includes the deductible and coinsurance, but does not include co-payments, charges exceeding the allowed amount or non-covered services and supplies. Benefits will be paid at 100% for the remainder of the plan year once the out-of-pocket maximum is met.

Out-of-Pocket Maximum (In-Network):

Reminders for UT FLEX Participants:

More information on UT FLEX is available at http://www.utflex.com.

Contact Us

If you would like a specific topic discussed or have a question you would like answered in a future issue of this newsletter, please send your suggestions to benefits@utsystem.edu.

UT System Employee Benefits Website: www.utsystem.edu/benefits/
UT System Retirement Programs Website: www.utretirement.utsystem.edu
Your Local Benefits Office: www.utsystem.edu/benefits/contacts.asp#1