I have found that when you sign up for Medicare coverage, the world changes.
If you have Medicare and other health insurance or coverage, each type of coverage is called a payer. When there is more than one payer, there are "coordination of benefits" rules that decide which one pays first. The primary payer pays what it owes on your bills and then sends them to the secondary payer to pay. In some cases, there may be a third payer.
Whether Medicare pays first depends on a number of things. Following there are some examples, though these don't cover every situation. (That's a direct quote from CMS, Centers for Medicare & Medicaid Services.)
1) If you are age 65 or older and covered by a group health plan because you or your spouse are still working: You are entitled to Medicare, and if the employer has 20 or more employees, the group health plan pays first and Medicare pays second. But, if the employer has less than 20 employees, Medicare pays first and the group health plan pays second. If the employer participates in a plan that is sponsored by two or more employers, the rules are slightly different. Now that's really clear...
2) If you have an employer group health plan after you retire and are age 65 or older, you are entitled to Medicare. Medicare will pay first and the retiree coverage will pay second.
3) If you are disabled and covered by a large group health plan from your work, or from a family member who is working, you are entitled to Medicare. But, as in example one, the number of employees determines who pays first. If the employer has 100 or more employees, large group health plan pays first and Medicare pays second. Just the opposite if there are less than 100 employees.
4) If you are age 65 or older OR disabled and covered by Medicare and COBRA coverage, Medicare will pay first and COBRA pays second.
5) If you are a veteran and have veterans' benefits, you are entitled to Medicare and veterans' benefits. Medicare pays for Medicare-covered services. Veterans' Affairs pays for VA-authorized services. NOTE: Generally, Medicare and VA can't pay for the same service.
6) If you are covered under TRICARE, you are entitled to Medicare. Medicare pays for Medicare-covered services and TRICARE pays for services from a military hospital or any other federal provider.
There are other reasons you would be eligible for Medicare; for more information call (800) MEDICARE OR (800) 633-4227.
Be sure to tell your doctor and other providers if you have coverage in addition to Medicare. This will help them send your bills to the correct payer to avoid delays. If you have questions about who pays first or if your insurance changes, call the Medicare Coordination of Benefits Contractor (COBC) at (800) 999-1118. TTY users should call (800) 318-8782.
This information is from "Medicare and other Health Benefits: Your Guide to Who Pays First," revised May 2008. This is just one of the many booklets that CMS publishes each year. I find the information helpful in understanding the "world after 65."
Thursday: TOPS will meet at 8:30 a.m. Art class will meet at 10 a.m. Ambassador Singers will practice at 1 p.m. Low Vision Support Group will meet at 3 p.m. for "The Aging Brain: Memory as a Substitute for Vision" program sponsored by Fry Eye Associates and the Senior Center.
Friday: The walking group will meet at Valley View Cemetery at 8:30 a.m. to walk. A health services nurse from St. Catherine Hospital will do screenings at 10:30 a.m. Bridge is played at 1 p.m.
Saturday: The pool room will be open from 1 to 4 p.m.
Sunday: The building is rented.
Monday: The walking group will meet at Lee Richardson Zoo at 8:30 a.m. Humdinger Band will meet at 12:30 p.m. Double pinochle is played at 12:45 p.m. Bridge is played at 1 p.m. Upbeats will practice at 3 p.m. Duplicate bridge is played at 7 p.m.
Tuesday: Pitch is played at 12:45 p.m. Duplicate bridge begins at 1:15 p.m. Bridge is played at 7 p.m.
Aug. 5: Line dancing is at 8:30 a.m. (call 272-3620 for more information about this or any exercise program). Pinochle is played at 12:45 p.m. The Sewing Group meets from 1 to 4 p.m. The Senior Citizens Association will host a dance from 7:30 to 10:30 p.m. The band playing is "Ortiz Band." Bring cookies for the break.
Lunch is served at noon.
Thursday: Fried chicken, mashed potatoes and gravy, broccoli cauliflower salad, gelatin salad, whole wheat roll.
Friday: Smothered steak, baked potato, tossed salad, Waldorf salad, whole wheat bread.
Monday: Chicken and noodles, mashed potatoes, cucumber, onion and green pepper salad, melon mix, whole wheat roll.
Tuesday: Roast turkey and gravy, mashed potatoes, cauliflower with cheese sauce, cranberry crunch.
Aug. 5: Baked fish, au gratin potatoes, green beans, ambrosia fruit salad, whole wheat roll.
Visit the Senior Center Web site at www.seniorcenterfc.com.