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.
If you or your dependents are enrolled in Medicare and your doctor accepts Medicare assignment, generally:
- The doctor may be in or out of the UT SELECT Network;
- The participant may be in or out-of-area;
- UT SELECT will pay 100% of benefits approved but not paid by Medicare (subject to UT SELECT plan limitations and exclusions);
- There are no deductibles, copayments or coinsurance(subject to UT SELECT plan limitations and exclusions); and
- When you or your dependents are at an inpatient facility that accepts Medicare assignment, UT SELECT will pay the Medicare inpatient deductible, and the $100 per day Copay ($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.
If a service is normally not covered by UT SELECT or is subject to limitations (such as the 20 visit limit on physical therapy), the service beyond plan limitations and exclusions will not be covered.
This chart shows you how UT SELECT coordinates benefits with Medicare. All benefits are subject to plan limitations.
For more information on Coordination of Benefits with UT SELECT and Medicare, please see the Resource Guide for Retired Employees. You may also request a copy from your institution’s benefits office.