Medicare and TRICARE
UT Select and Medicare
You and your dependents should enroll in Medicare Part B at age 65 or earlier if you're eligible due to a disability. When you and your dependents become eligible for Medicare, you have the option of enrolling in Part A and refusing Part B coverage. However, you must enroll in Medicare Part B to receive the maximum benefits available from your university medical plan.
In most instances, if you're eligible for Medicare and are working in a position for at least 20 hours a week, your university medical plan will be primary, and Medicare will be secondary. 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 before age 65.
If you're retired and eligible for Medicare, Medicare is your primary payer and pays your medical claims first. UT Select pays second. If you choose a doctor who accepts Medicare assignment, you won't 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 later reapply for Medicare coverage. Also, without Medicare Part B, you're responsible for paying any share of your and your Medicare-eligible dependents' medical claims that Medicare Part B would have paid.
To ensure that claims are correctly processed, immediately upon enrollment you should contact Blue Cross and Blue Shield of Texas and report your or your dependent’s Medicare Health Insurance Claim (HIC) number and the effective dates of Medicare Parts A and B.
Medicare Coordination of Benefits
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)
- No deductibles
- No co-payments
- No coinsurance
- When you or a dependent is an inpatient at a facility that accepts Medicare assignment, UT Select will pay the Medicare inpatient deductible, and the $100-per-day co-payment ($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
- Deductibles may apply
- Co-payments may apply
- Coinsurance may apply
The chart below shows you how UT Select coordinates benefits with Medicare. All benefits are subject to plan limitations.
|Provider accepts Medicare||In-Network Provider||Service Covered by Medicare||Amount Medicare Pays||Amount UT Select Pays*||Member Pays|
|Yes||Yes||Yes||80% Medicare allowed||20% Medicare allowed||0|
|Yes||No||Yes||80% Medicare allowed||20% Medicare allowed||0|
|Yes||Yes||No||0||80%of BCBS allowed after $250 deductible or 100% after co-pay, whichever is applicable||20% of BCBS allowed after $250 deductible or 100% after co-pay, whichever is applicable|
|Yes||Yes||No||0||60% of BCBS allowed after $500 deductible||$500 deductible + 40% of BCBS allowed-difference between billed charge and BCBSTX allowed|
|No||Yes||Yes||80% Medicare limiting charge||20% Medicare limiting charge after $250 deductible||$500 Deductible|
|No||No||Yes||80% Medicare limiting charge||20% Medicare limiting charge after $500 deductible||$500 Deductible|
|No||Yes||No||0||80% of BCBS allowed after $250 deductible or 100% after co-pay, whichever is applicable||20% of BCBS allowed after $250 deductible or 100% after co-pay, whichever is applicable|
|No||No||No||0||60% of BCBS allowed after $500 deductible||$500 deductible + 40% of BCBS allowed-difference between billed charge and BCBSTX allowed|
For more information on Medicare:
- Important Notice about your Prescription Drug Coverage and Medicare Part D
- Social Security Administration
TRICARE Coordination of Benefits
TRICARE is a regionally managed health care program for active-duty and retired members of the uniformed services, their families and survivors. Survivors are eligible for TRICARE only if they are not eligible for Medicare.
If you are eligible for TRICARE, Medicare will be your primary insurance, your university insurance will be secondary, and TRICARE will be third. If you receive services in a Veteran's Administration facility, your university insurance will assume Medicare benefits (because the Veterans Administration will not file Medicare claims), and only pay 20% of the allowed amount. Veteran's Administration facilities are reimbursed by federal dollars that will cover 80% of the charges.
Use the following resource for more information on TRICARE: