Medicare. Medicare Overview. Medicare Part D Prescription Plans. Medicare

58 Medicare

Medicare

Baltimore County Public Schools requires Medicare enrollment as soon as a retiree, spouse or dependent of a retiree is eligible for Medicare. Parts A & B MUST be elected.

Medicare Overview

There are three parts to Medicare:

■

Hospital Insurance (also called “Part A” Medicare.

Your enrollment is automatic upon turning age 65.

■

Medical Insurance (also called “Part B” Medicare), which is partly financed by monthly premiums paid by individuals who choose to enroll. You MUST enroll, if you are eligible.

■

Prescription Drug Insurance (also called “Part D: Medicare). Do NOT enroll unless you qualify for financial assistance for retirees on limited incomes. If you meet the limited income criteria, please contact the Office of Benefits, Leaves and Retirement.

An individual is automatically enrolled in Part B when he/

she becomes entitled to Part A, if receiving social security benefits due to either age or disability. However, because an individual must pay a monthly premium for Part B coverage, he/she has the option of refusing the coverage.

Note: If you deny coverage you will not be permitted to continue participation in a BCPS sponsored plan.

If you are no longer actively employed and do not enroll in Part B within three months after reaching age 65 you must wait until the next general enrollment period (January 1 through March 31) to sign up. Coverage would begin the following July. There is a 10% monthly premium penalty for each twelve-month period that you were eligible for Part B, but did not enroll. (Note: You are covered under a spouse’s group health plan, enrollment in Part B may be delayed. You will not be required to wait for a general enrollment period or pay the 10% premium surcharge for late enrollment.) Three months prior to becoming Medicare eligible, you will be sent a letter instructing you of the steps necessary to insure you will not be penalized.

Once eligible for Medicare, you, your spouse or dependent, will be eligible to enroll in a Medicare Supplemental Plan through Baltimore County Public Schools. As soon as you are enrolled in Medicare, please notify the Office of Benefits, Leaves and Retirement, so we can insure that your records are updated and that no claim problems will result.

For additional information about Medicare benefits, please contact them directly at 1-800-MEDICARE (1-800-633-4227) or online at www.medicare.gov.

It is Important to Read the Annual Notice of Change Announcement Each Year. Retirees are notified each year, by mail, of the enrollment dates and plan offerings for the next year. Rates for the upcoming year are also included in that packet. This is the only way Baltimore County Public Schools routinely notifies you of plan and/or rate changes.

Medicare Part D Prescription Plans

Federal legislation created prescription drug benefits for Medicare enrollees that took effect on January 1, 2006. The new benefits are called Medicare Part D plans. Retirees who choose to enroll in a Medicare Part D plan will pay a monthly premium for their prescription coverage. They will be required to pay the deductibles and coinsurance amounts required by the plan they selected. Standard Medicare Part D plans have a provision called “the doughnut hole” that allows the plan to stop paying toward prescription drugs for an enrollee after they have incurred annual prescription drug costs of $3,310. The plans resume paying when the prescription expenses reach $4,850 for calendar year 2016. These amounts are adjusted annually by CMS (Center for Medicaid & Medicare Services).

Employers who offered prescription benefits for their

Medicare retirees had a number of options once the new

program was in place. Baltimore County Public Schools

chose to continue BCPS prescription benefits for Medicare

retirees. The benefits provided under the plans are at least as

good as those provided under the standard Medicare Part

D plan and do not contain a “doughnut hole” provision.

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Baltimore County Public Schools 2016 Retiree Benefits Guide

Medicare

For retirees/spouses who chose Cigna Medicare Surround Plan, prescription coverage is included. It is administered by Cigna-HealthSpring Rx (PDP). The member pays 20%

for brand or generic drugs at a retail pharmacy or a $20 copay for generic, $40 copay for brand drugs at mail order.

Your share of the cost is paid directly to the pharmacy.

The remainder of the cost is paid by BCPS. There is no

“doughnut hole” or deductibles in BCPS’ prescription coverage plan.* Cigna Home Delivery Pharmacy also offers the convenience of mail-order service for your maintenance medications.

If you chose the Kaiser Medicare Plus plan, you will continue to have prescription coverage through Kaiser for a small copay amount.

Required Disclosures to Medicare Beneficiaries

Baltimore County Public Schools must provide a notice of creditable prescription drug coverage to Medicare beneficiaries who are covered by, or who apply for, prescription drug coverage under any of the Baltimore County Public Schools plans.

For a copy of this notice, please visit our Website at:

www.bcps.org/offices/benefits_enrollment/ or www.bcps.org/offices/benefits/retiree_ben/.

*The “doughnut hole” refers to the gap in many Medicare Prescription Drug Programs (Part D) during which the consumer must pay 100 percent out-of-pocket for drug purchase costs.

60 Medicare

Medicare Supplemental Plan

Medicare Supplemental Plan

The Cigna Medicare Surround Plan offered through Baltimore County Public Schools is health care coverage which will pay after Medicare. This plan requires you to have Medicare Part A & B in order to receive supplemental benefits. When treated in a doctor’s office or a hospital, always present your Medicare card and your Cigna card.

2016 ID Cards

In addition to your Medicare card, your Medicare Surround card will be provided by Cigna and your pharmacy card will be provided by Cigna-HealthSpring. Don't forget to show your new cards starting 1/1/16.

When seeking medical care, you will have the least out-of- pocket costs when you are seen by a physician who accepts Medicare assignment. Please note that all physicians must submit your claims to Medicare; however, not all physicians have to accept assignment. In other words, the physician who does not accept Medicare assignment may charge you up to 15% above the Medicare allowed amount for services, also defined as the limiting amount. You may be asked to pay the bill in full at the time of service.

Once you have been seen by the physician, the claim will be submitted to Medicare. After the claim is paid, you will receive a Medicare explanation of benefits. Since Cigna is your supplemental or secondary insurance plan, the claim is then filed with us. Cigna also sends an Explanation of Health Care Benefits (EOHB) which states the amount the provider may bill if he accepts assignment. (See “How to file claims” that follows for more details.) The benefit chart within this booklet will show you the type of service, and how it is paid by Medicare and Cigna.

As a member of Cigna Medicare Surround Plan, you are covered for services in Maryland, in the United States, and even outside the U.S. You are also eligible to seek alternative therapies and wellness services at a discount rate through the Cigna Healthy Rewards Program. For more information about the providers and services, you may call Cigna's Member Services toll free number (800) 896-0948 or by visiting the online directory on Cigna's Website www.

mycigna.com.

Baltimore County Public Schools also offers a prescription plan through Cigna. You will be enrolled in the prescription plan once you enroll in the Cigna Medicare Surround Plan.

Note: When seeking medical care, please show both your Medicare card and your Cigna card.

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Baltimore County Public Schools 2016 Retiree Benefits Guide

Medicare

Prescription Drugs

Coverage for Prescription Drugs

The Cigna Medicare Surround Plan does provide coverage for outpatient prescription drugs. The prescription plan is administered through Cigna-HealthSpring Rx (PDP).

This Plan is an approved Medicare Part D Plan. The Plan has been deemed creditable and is equal to or better than the Medicare Part D Plan. Therefore, Baltimore County Public School retirees in the Cigna Medicare Surround Plan do not need to enroll in an Independent Medicare Part D prescription plans. Because you have employer- sponsored prescription benefits, late enrollment penalties will not apply if you need a Medicare prescription plan in the future.

The plan covers federal legend drugs prescribed for FDA and Manufacturer approved diagnoses. Diabetic supplies are also covered under the prescription plan.

Drugs that are excluded from coverage include over-the- counter medications, diet drugs, cosmetic drugs and drugs prescribed for a condition not approved by the FDA as appropriate for that condition.

Medical devices are not included in prescription coverage – those claims should be submitted to Medicare and then to Cigna for payment. Allergy serum claims should be submitted directly to Cigna for coverage under your health benefits.

Certain medications require that an appropriate diagnosis be submitted to Cigna-HealthSpring Rx (PDP) before they can be filled. You and your physician can contact Cigna- HealthSpring Rx (PDP) by phone at 1-800-558-9562 or using the internet for a current listing of medications requiring prior authorization.

Your Share of the Cost of Outpatient Prescriptions:

There is no deductible or “doughnut hole coverage gap”

that applies to this prescription plan.

■

Local Pharmacy – 20% coinsurance per prescription

■

Mail Order – $20 copay for generic drugs;

$40 copay for any brand-name drug

■

Prior Authorization Quantity Limits, or Step Therapy applies in some cases

Cigna Home Delivery Pharmacy also provides a convenient mail-order service for maintenance medications. These are medications you are using, in the same strength, for a three month period. Contact Cigna Home Delivery at 1-855-401- 9868 for more information on mail order service, for order forms, and for a determination of what your medication(s) will cost using mail order.

What is Step Therapy?

Step therapy is a program which encourages the use of lower cost generic medications for treatment of medical conditions which require regular use of medications.

Some examples of medical conditions that step therapy focuses on are high blood pressure, high cholesterol, and gastrointestinal conditions. It helps you get an effective medication to treat your condition while keeping your costs as low as possible.

The next time your doctor writes a prescription for you, ask your doctor if a generic medication listed by your plan as a

“front-line drug”

¹

is right for you. It makes good sense to ask for these drugs because, for most everyone, they work as well as brand-name drugs – and they almost always cost less.

If you’ve already tried a front-line drug, or your doctor decides one of these drugs isn’t appropriate for you, then your doctor can prescribe a “back-up drug.”

²

Ask your doctor if one of the lower-cost brands (Step 2 drugs) listed by your plan is appropriate. In some cases, you may be required to try more than one first line drug. Remember, you can always get a higher-cost brand-name drug at a higher copayment if the front-line or Step 2 back-up drugs aren’t right for you.

1 The first step – are generic drugs proven to be safe, effective and affordable. These drugs should be tried first because they can provide the same health benefit as more expensive drugs, at a lower cost.

2 Step 2 and 3 drugs – are brand-name drugs. There are lower-cost brand drugs (Step 2) and higher-cost brand drugs (Step 3). Back-up drugs typically cost more than front-line drugs.

62 Medicare

Health Benefits Summary Medicare Pays: Baltimore County Public Schools Cigna Medicare Surround Plan Pays:

Inpatient Hospital/Facility Services

Room & Board

(ICU/CCU (other special care units), and Ancillary Services (incl. nursery charges)

100% of the Medicare approved amount after inpatient deductible 100% of inpatient deductible day 1-60; The benefit will reduce to 80% after day 61 unless a new benefit period begins

Extended Care Facility/Skilled Nursing Care

Days 1–20: 100% of the Medicare approved amount;

Days 21–100: 100% of the Medicare approved amount after per day deductible

Day 1-20: Medicare covers at 100% - no Cigna payment is necessary;

Day 21 – 100: 100% of the per day deductible; Days 101-120: 100% of the allowed benefit

Inpatient Professional/Practitioner Services

Physician Surgical Services

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Anesthesia, Assistant Surgeon

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Consultation (including follow-visits) & Physician Visits (Includes ECF)

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Radiation Therapy, Chemotherapy, and Renal Dialysis

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Outpatient Hospital/Facility Services

Minor/All Surgery (includes hospital based and freestanding surgical centers)

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Preadmission Testing

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Radiation Therapy, Chemotherapy, and Renal Dialysis

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Physical & Speech Therapy

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Occupational Therapy

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Diagnostic Tests

80% of the Medicare approved amount after annual deductible.

Note: Medicare pays 100% of the Medicare approved amount for clinical laboratory services.

100% of the balance due after Medicare including the Medicare deductible

Outpatient/Office Professional Services

Minor/All Surgery

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Anesthesia, Assistant Surgeon

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Diagnostic Tests

80% of the Medicare approved amount after annual deductible.

Note: Medicare pays 100% of the Medicare approved amount for clinical laboratory services.

100% of the balance due after Medicare including the Medicare deductible

Office Visit for Illness, Injury or consultation

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Allergy Tests

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Allergy and Other Covered Injections – administration of injections

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Physical therapy & Acupuncture

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Speech & Occupational Therapy

Speech therapy: 80% of the Medicare approved amount after

annual deductible. Note: Occupational therapy limited to $1,920 per year.

Speech & physical therapy limited to $1,920 per year.

80% of the balance due after Medicare including the Medicare deductible

Preventive/Well Care (Routine)

Annual Adult Physicals, Immunizations and Diagnostic Tests: age 18 & older

100% of the Medicare approved amount. One "Welcome" visit within 12 months of becoming eligible for Medicare – A & B deductibles and coinsurance apply.

100% of the balance due after Medicare including the Medicare deductible

Annual GYN Services (includes pap smear) rendered in the office

100% of the Medicare approved amount after annual deductible.

Note: Limited to one every two years and pap smear is not subject to annual deductible.

100% of the balance due after Medicare including the Medicare deductible

Mammography Screening (provider must be American College of Radiology [ACR] approved)

100% of the Medicare approved amount. Note: Limited to one screening annually after age 40.

100% of the balance due after Medicare including the Medicare deductible

Prostate Cancer Screening (including PSA test)

100% of the Medicare approved amount after annual deductible. 100% of the balance due after Medicare including the Medicare deductible

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Baltimore County Public Schools 2016 Retiree Benefits Guide

Baltimore County Public Schools Retiree Benefits Guide

Medicare

Health Benefits Summary Medicare Pays: Baltimore County Public Schools Cigna Medicare Surround Plan Pays:

Inpatient Hospital/Facility Services

Room & Board

(ICU/CCU (other special care units), and Ancillary Services (incl. nursery charges)

100% of the Medicare approved amount after inpatient deductible 100% of inpatient deductible day 1-60; The benefit will reduce to 80% after day 61 unless a new benefit period begins

Extended Care Facility/Skilled Nursing Care

Days 1–20: 100% of the Medicare approved amount;

Days 21–100: 100% of the Medicare approved amount after per day deductible

Day 1-20: Medicare covers at 100% - no Cigna payment is necessary;

Day 21 – 100: 100% of the per day deductible;

Days 101-120: 100% of the allowed benefit

Inpatient Professional/Practitioner Services

Physician Surgical Services

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Anesthesia, Assistant Surgeon

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Consultation (including follow-visits) & Physician Visits (Includes ECF)

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Radiation Therapy, Chemotherapy, and Renal Dialysis

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Outpatient Hospital/Facility Services

Minor/All Surgery (includes hospital based and freestanding surgical centers)

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Preadmission Testing

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Radiation Therapy, Chemotherapy, and Renal Dialysis

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Physical & Speech Therapy

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Occupational Therapy

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Diagnostic Tests

80% of the Medicare approved amount after annual deductible.

Note: Medicare pays 100% of the Medicare approved amount for clinical laboratory services.

100% of the balance due after Medicare including the Medicare deductible

Outpatient/Office Professional Services

Minor/All Surgery

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Anesthesia, Assistant Surgeon

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Diagnostic Tests

80% of the Medicare approved amount after annual deductible.

Note: Medicare pays 100% of the Medicare approved amount for clinical laboratory services.

100% of the balance due after Medicare including the Medicare deductible

Office Visit for Illness, Injury or consultation

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Allergy Tests

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Allergy and Other Covered Injections – administration of injections

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Physical therapy & Acupuncture

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Speech & Occupational Therapy

Speech therapy: 80% of the Medicare approved amount after

annual deductible. Note: Occupational therapy limited to $1,920 per year.

Speech & physical therapy limited to $1,920 per year.

80% of the balance due after Medicare including the Medicare deductible

Preventive/Well Care (Routine)

Annual Adult Physicals, Immunizations and Diagnostic Tests: age 18 & older

100% of the Medicare approved amount. One "Welcome" visit within 12 months of becoming eligible for Medicare – A & B deductibles and coinsurance apply.

100% of the balance due after Medicare including the Medicare deductible

Annual GYN Services (includes pap smear) rendered in the office

100% of the Medicare approved amount after annual deductible.

Note: Limited to one every two years and pap smear is not subject to annual deductible.

100% of the balance due after Medicare including the Medicare deductible

Mammography Screening (provider must be American College of Radiology [ACR] approved)

100% of the Medicare approved amount. Note: Limited to one screening annually after age 40.

100% of the balance due after Medicare including the Medicare deductible

Prostate Cancer Screening (including PSA test)

100% of the Medicare approved amount after annual deductible.

Note: Limited to one exam annually after age 50 and PSA is not subject to coinsurance or deductible.

100% of the balance due after Medicare including the Medicare deductible

64

Note: This benefit matrix is intended for comparison/informational purposes and is not meant to be a binding contract. Note: Cigna will pay up to the Medicare approved amount if the provider accepts Medicare assignment.

Medicare

Health Benefits Summary Medicare Pays: Baltimore County Public Schools Cigna Medicare Surround Plan Pays:

Emergency Care

Accidental Injury/First Aid Medical Emergency or Life Threatening Event

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Follow-Up Visits to an Accidental Injury or Medical Emergency

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Ambulance

Ground (public or private) 80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Mental Health

Inpatient Hospital/Facility and Professional Services

100% of the Medicare approved amount after inpatient deductible Note: Coverage limited to 190 lifetime days.

100% of the balance due after Medicare including the Medicare deductible

Outpatient Facility, Professional Services

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Prosthetic Devices & Orthopedic Braces

Purchase, repair or replacement

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Durable Medical Equipment

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Medical Supplies

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Hearing Aids

Not covered 100% up to $2800 every three years

Home Health Care

Facility/Agency

100% of the Medicare approved amount Medicare covers 100% of the Medicare allowed amount - no Cigna payment necessary

Outpatient Private Duty Nursing

(Non-custodial; pre-authorization required)

100% of the Medicare approved amount Medicare covers 100% of the Medicare allowed amount - no Cigna payment necessary

Hospice Care (Inpatient or At Home)

100% of the Medicare approved amount except $5 per outpatient prescription and 5% of inpatient respite care

Medicare covers 100% of the Medicare allowed amount - no Cigna payment necessary

Cardiac Rehabilitation

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Organ Transplants

Kidney, Cornea, Bone Marrow

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Heart, Heart-Lung, Single or Double Lung, Pancreas, and Liver

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Prescription Drugs

Outpatient Prescription Drugs

Not covered

Drugs dispensed by medical provider in office

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Routine Vision

Not covered Not covered

Dental

Not covered Not covered

Additional Information

Deductible (Part A, Part B)

Verify with Medicare. Deductibles change yearly. Not applicable

Out-of-Pocket Maximum

Not applicable $650

Lifetime Maximum

Not applicable $300,000 (applies to Part B expenses)

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Baltimore County Public Schools 2016 Retiree Benefits Guide

Note: This benefit matrix is intended for comparison/informational purposes and is not meant to be a binding contract. Note: Cigna will pay up to the Medicare approved amount if the provider accepts Medicare assignment.

Specific benefit inquiries or quotes for benefits should be directed to the appropriate customer service department. Cigna will not pay above the limiting amount if the doctor does not accept Medicare assignment.

Baltimore County Public Schools Retiree Benefits Guide

Health Benefits Summary Medicare Pays: Baltimore County Public Schools Cigna Medicare Surround Plan Pays:

Emergency Care

Accidental Injury/First Aid Medical Emergency or Life Threatening Event

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Follow-Up Visits to an Accidental Injury or Medical Emergency

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Ambulance

Ground (public or private) 80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Mental Health

Inpatient Hospital/Facility and Professional Services

100% of the Medicare approved amount after inpatient deductible Note: Coverage limited to 190 lifetime days.

100% of the balance due after Medicare including the Medicare deductible

Outpatient Facility, Professional Services

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Prosthetic Devices & Orthopedic Braces

Purchase, repair or replacement

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Durable Medical Equipment

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Medical Supplies

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Hearing Aids

Not covered 100% up to $2800 every three years

Home Health Care

Facility/Agency

100% of the Medicare approved amount Medicare covers 100% of the Medicare allowed amount - no Cigna payment necessary

Outpatient Private Duty Nursing

(Non-custodial; pre-authorization required)

100% of the Medicare approved amount Medicare covers 100% of the Medicare allowed amount - no Cigna payment necessary

Hospice Care (Inpatient or At Home)

100% of the Medicare approved amount except $5 per outpatient prescription and 5% of inpatient respite care

Medicare covers 100% of the Medicare allowed amount - no Cigna payment necessary

Cardiac Rehabilitation

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Organ Transplants

Kidney, Cornea, Bone Marrow

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Heart, Heart-Lung, Single or Double Lung, Pancreas, and Liver

80% of the Medicare approved amount after annual deductible 100% of the balance due after Medicare including the Medicare deductible

Prescription Drugs

Outpatient Prescription Drugs

Not covered

Drugs dispensed by medical provider in office

80% of the Medicare approved amount after annual deductible 80% of the balance due after Medicare including the Medicare deductible

Routine Vision

Not covered Not covered

Dental

Not covered Not covered

Additional Information

Deductible (Part A, Part B)

Verify with Medicare. Deductibles change yearly. Not applicable

Out-of-Pocket Maximum

Not applicable $650

Lifetime Maximum

Not applicable $300,000 (applies to Part B expenses)

Medicare

66 Medicare

How to File Medical Claims

Provider will file claim to Medicare Part A or B

for processing

Claim is automatically forwarded to Cigna for eligible

supplemental payments

Care Rendered in or outside of Maryland

■

If the provider accepts Medicare assignment, Medicare and Cigna payments are sent directly to the provider.

■

If provider does NOT accept Medicare

assignment, the Medicare and Cigna payments are sent directly to you.

■

You will receive:

1) Medicare Explanation of Benefits

2) Cigna Explanation of Health Care Benefits To find doctors who accept Medicare, or to learn more about Medicare benefits and services, visit www.medicare.gov or call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week.

TTY/TDD users call 1-877-486-2048.

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Baltimore County Public Schools 2016 Retiree Benefits Guide

Medicare

This is an Explanation of Benefits for a resident of Maryland.

Medicare Approved:

The amount medicare approves for a certain service or supply. A provider who accepts Medicare assignment will accept this amount as payment in full. A provider who does not accept Medicare assignment can bill an additional 15% over this amount.

Medicare Paid Provider:

The amount of the payment made by Medicare directly to the provider of care.

You May Be Billed:

This amount represents your deductible or coinsurance under Medicare. Do not pay this amount to the provider at the time you receive this notice. When you receive care in Maryland the claim will automatically be filed to Cigna for review and payment of eligible supplemental plan benefits.

May Be You Billed

Medicare Provider Paid Medicare

Approved

Understanding Your Medicare Explanation of Benefits