12.6 Medicare
Medicare is a federal health insurance program that was signed into law by President Johnson on July 30, 1965, under Title XIX of the 1965 amendment of the Social Security Act and became effective in 1966. http://www.ssa.gov/history/lbjsm.html
Medicare Part A provides hospital coverage, Medicare Part B provides medical coverage, Medicare Part C provides new options, and Medicare Part D covers prescription drugs.
Those persons who meet Medicare eligibility requirements, yet decide they want to enroll in an HMO program, must be informed by the HMO that when they enroll in an HMO they are disenrolled from Medicare.
An HMO application and contract must contain the following notice regarding Medicare.
NOTICE TO BUYER:
When you enroll in this HMO, you will be disenrolled from Medicare. The buyer should be aware that in order to receive payment or coverage for services, such services must be rendered by physicians, hospitals, and other health care providers designated by the HMO. If the services are rendered by a nonparticipating physician, hospital, or other health care provider, the purchase may be liable for payment for such services except in very limited circumstances.
All eligible participants who work for an employer with 20 or more employees are entitled to the same health insurance benefits that the employer offers, regardless of age. In such cases, the employer-sponsored plan is the primary payor and Medicare is the secondary payor.
This also applies to any disabled Medicare enrollee who is also covered by an employer-provided health care plan as a current employee or as a family member of an employee, but only if the employer plan covers 100 or more employees.
REMEMBER: Medicare supplement policies (and long-term care policies) have a free look period of 30 days rather than the customary 14-day free look period.
