Medicare - PEBB

Medicare

Knowing you’re enrolled in the right plan is reassuring when it comes to your well-being. UMP Classic is PEBB’s Medicare plan. It gives you access to a wide range of benefits, plus health and wellness programs designed to support your health care needs. Read the UMP Classic summary for Medicare retirees for a plan overview or check out the Summary of Benefits and Coverage to learn more about covered services and cost information.

 Eligibility

You’re considered a Medicare retiree if all of the following apply to you:

  • Enrolled in Public Employees Benefits Board (PEBB) retiree coverage
  • Age 65 or older (or younger and eligible for Medicare due to medical disability)
  • Enrolled in both Medicare Part A (hospital) and Part B (medical)

As you approach age 65, the PEBB program will send you a letter explaining what you need to do to keep PEBB health plan coverage and apply for Medicare Part A and Part B. For questions about Medicare eligibility, enrollment, and premiums, call PEBB Customer Service at 1 (800) 200-1004 (TRS: 711) or visit Medicare and PEBB Program benefits.

As a retiree, you and your eligible dependents must be enrolled in Medicare Part A and Part B to enroll in the UMP Classic plan. Because UMP Classic includes prescription drug coverage, you cannot also be enrolled in a Medicare Part D drug plan.

 UMP Classic and Medicare

UMP Classic and Medicare are two separate health plans that work together to pay for covered services and supplies. Your monthly premiums will be lower because Medicare pays part of your medical costs. How they work together to pay your claims depends on whether you’re retired.

If you're not retired

If you are not retired, but are a Medicare-eligible PEBB employee and a plan subscriber, you may choose to enroll in Medicare Part A and Part B. Then UMP Classic pays first, and Medicare pays second. This also applies to retired dependents enrolled in UMP Classic under an employee’s account. To get the maximum benefit from both plans, be sure:

  • To tell Medicare about your UMP Classic coverage
  • That your provider agrees to bill Medicare as secondary.

UMP Classic does not bill or coordinate benefits with Medicare when Medicare is the secondary payer. Your provider will need to bill Medicare after UMP Classic has processed the claim.

If you're retired

If you are a Medicare retiree, Medicare pays first and UMP Classic pays second. Be sure to tell Medicare you are enrolled in UMP Classic so they send us your claims after Medicare processes them. Because Medicare pays first, a few rules are different for Medicare retirees. These rules are explained in full in the Medicare section of the UMP Classic 2020 Certificate of Coverage, including:

  • How UMP Classic and Medicare work together
  • What UMP Classic covers that Medicare does not cover
  • What your choices for providers are
  • How billing works
  • How your prescription drug coverage works
  • Where to go for more information

If you're retired, but not eligible for Medicare

If you are retired but you or an eligible dependent are not yet eligible to enroll in Medicare Part A and Part B, the Medicare section in your certificate of coverage does not apply to you.

 Prescription drugs and Medicare

When it comes to prescription drugs and supplies, Medicare Part B pays for some of these under the medical benefit, and they are subject to the medical deductible. When this is the case, UMP Classic also pays under the medical benefit, and charges are subject to the medical deductible.

Medicare Part B does cover a few drugs and supplies under the UMP prescription drug benefit. These drugs and supplies are identified on the UMP Preferred Drug List. When purchasing these drugs and supplies, be sure to choose a network pharmacy that can bill Medicare Part B directly.

You cannot enroll in both UMP Classic and a Medicare Part D prescription drug plan. UMP Classic provides your prescription drug coverage and you may not have both. Medicare will notify the PEBB program if you enroll in a Part D plan while enrolled in UMP Classic. You could lose your eligibility for PEBB coverage if you do this.

If you think you want a Part D prescription drug plan, you must change your medical plan from UMP Classic to Medicare Supplement Plan F.

Some diabetes care supplies are covered under the durable medical equipment benefit, and the medical deductible applies. See the Diabetes care supplies section in your certificate of coverage for more about this benefit.

Prescription drug claims

Medicare accepts claims only from pharmacies, not from individuals. If Medicare covers a drug or supply and the pharmacy doesn't send the claim to Medicare first for payment, UMP Classic will reject the claim. Use the Pharmacy Locator to find a network retail pharmacy. Be sure to confirm that the network pharmacy can bill Medicare Part B directly.

UMP’s network mail-order pharmacy, Postal Prescription Services, cannot bill Medicare for diabetes care supplies when Medicare is your primary coverage. To find a Medicare-approved mail-order pharmacy for diabetes care supplies, call Medicare.

 Preferred providers and Medicare

You’ll pay less when you see a preferred provider for services covered by UMP Classic, but preferred providers do not always accept Medicare, so be sure to ask.

When a service is covered by Medicare, you must see a provider who accepts Medicare for the service to be covered by both Medicare and UMP Classic. If your provider is not contracted with Medicare or has opted out of participating, UMP Classic will not cover services by that provider, even if they are in the UMP Classic network.

Providers that opt out of Medicare are supposed to have you sign a private contract before providing services, but you are responsible for all costs even if you did not sign a contract.

 Need help?

If you have questions about Medicare coverage or providers, call UMP Customer Service or Medicare.