US Medicare Enrollment and the Retiree Medical Plan (RMIP)  Under the rules of the RMIP, retirees (and their covered spouse or domestic partner) are required to enroll in the National Health Plan (NHP) of the resident country registered with Pension if they are eligible on the same basis as a national of that country. In the United States, the NHP is Medicare.   This requirement has been part of the retiree medical plan since 1984.   We hope this FAQ will be helpful in understanding Medicare eligibility and enrollment. Failure to enroll when eligible can reduce your benefits.   1)     Medicare? But I did not contribute to US Social Security.  Medicare has three parts: Medicare Part A for Hospital Room and Board, Medicare Part B for Medical Expenses (inpatient and outpatient), and Part D for Prescription Drugs.  Part A coverage is included with a Social Security pension or you may be eligible through marriage to an eligible spouse. If you would be required to pay a premium for Part coverage, neither Medicare nor the RMIP require you to purchase it.     Part B is available to anyone who is age 65 and a citizen or lawfully admitted Permanent Resident with five years of residency in the US (even if part of those five years was in G4 status).   The on time enrollment window for Medicare Part B begins three months before your 65th birthday and up to three months after.  Enrollment after this time period may result in a late enrollment penalty. Part B does not require eligibility for a Social Security pension, nor do you need to buy Part A in order to enroll in Part B.   If you are eligible for Part B, you are required by the RMIP to purchase this coverage and use it as your primary US medical coverage.  Part D is not required nor recommended by the RMIP at this time. Continue to use your separate Catalyst Rx prescription benefit card for US prescription coverage included with your RMIP coverage.   2)     But Medicare Part B will cost me another premium!  Medicare Part B does have a monthly premium, but RMIP costs and premiums would greatly escalate without Medicare Part B as the primary insurer for our US residenced retirees.   The RMIP partially offsets the Part B premium through premium discounts and coordination of claims: a - When you provide a copy of your Medicare card to the HR Service Center, your RMIP premium will be discounted beginning the first day of the month following receipt or the date of your Medicare enrollment, whichever is later. Fax a copy to 202-522-2150 as soon as you receive card. For an Individual, the premium discount is 15% for Part A and 15% for Part B, up to the maximum 30%. If a member is covered under Dual or Family, the discount is 7.5% per Part for member and spouse, up to the maximum of 30%. For example, if a husband and wife are both enrolled in Part B, they will receive a total of 15% off their Dual monthly premium. b – Aetna will coordinate claims between Medicare and RMIP, often resulting in 100% coverage after annual deductibles are satisfied. c – Medicare savings accumulate annually depending on your claim experience and your RMIP deductibles and coinsurance may be reimbursed toward the year end as the RMIP realizes savings from your use of Medicare as primary.  Aetna tracks the plan savings and can advise of any savings balance if you call or send them an email.  (This savings applies only to Plan 1).  3)     What happens if I do not enroll in Medicare?  The RMIP has the right to instruct Aetna to reduce your medical claims reimbursement as if you had Medicare as your primary coverage. This can result in reduced RMIP medical benefits.  4)     I won’t be eligible for a Social Security pension until I’m 66.  Do I still need to apply for Medicare at 65?  Yes. The age for a Social Security pension is increasing, but Medicare currently maintains 65 as their age for on time application.  5)     Where do I apply for Medicare?  Visit your local Social Security office. Be prepared to show birth certificate, proof of citizenship or green card. Other documents may be requested at their discretion.   6)     I went to Social Security and they told me I was not eligible yet because I had not been a Permanent Resident for five years  OR  They told me I had to buy the Part A benefit to get Part B.  This is incorrect. You must be 65, a citizen or permanent resident with five years continuous US residency immediately prior to enrollment, but one need not have been a Permanent Resident or Citizen for five years. Nor do you have to buy Part A in order to enroll in Part B. If the staff at the local SSA office insists that you are not eligible, we have letters from Social Security confirming the correct eligibility that we can provide to you. Contact M. Tuohy at mtuohy@worldbank.org or D. Brown at dbrown2@worldbank.org  7)     I am still working and have employee coverage through that employer   OR   My spouse is still working and I am a dependent under that active coverage. Do I need to apply for Part B?  We strongly recommend that you verify your requirements with Social Security. Typically a person may delay enrollment in Part B until employee coverage ends because Medicare is secondary to an active employee plan, but due to the very strict late enrollment penalties imposed by Medicare, you will want a written response from SSA to prove later that you applied on-time but were advised you could delay Part B enrollment until you are no longer covered under an active employee plan. If you are so advised, the HR Service Center will need a copy of that SSA letter for your insurance records.  As soon as the employee coverage ends, you will need to start your Part B coverage and fax a copy of your Medicare card to the HR Service Center, 202-522-2150.  8)     How do I submit Medicare claims?  You must show your Medicare card at the time of medical services. A doctor or facility that accepts Medicare is obliged to submit claims to Medicare on your behalf.  To make coordination between Medicare and the RMIP easier, we recommend that you enroll in Medicare Direct with Aetna. This free service allows Aetna to contact Medicare to send your processed claims directly to Aetna for secondary review, reducing time and paperwork.  To enroll in Medicare Direct, call or email Aetna as soon as you receive your Medicare card.  (1-800-723-8897 or mclaims@aetna.com)    NOTE: If you choose not to use Medicare Direct, once you have your Medicare explanation of benefits, you may submit it to Aetna for secondary review using the MIP medical claim form, #892.  9)     My doctor/s are in the Aetna network. Can I still see them?  Yes. Since Medicare Part B becomes your primary coverage it is easier to coordinate the claims if the network doctor does not collect an office visit copay and simply files directly to Medicare. However, if a copay is collected, Aetna will consider this when they process the secondary portion of your claim after Medicare.  10)  My current doctor does not accept Medicare patients.   You are still required to enroll in Part B. To find doctors that participate in Medicare, go to www.medicare.gov, then under Search Tools select Find a Doctor or Other Healthcare Professional.  11)  Where can I find more information?  Requirement to enroll: Section 15 of the MIP Summary Plan Description  Social Security Administration: 1-800-772-1213                           website: www.ssa.gov US Medicare:                             1-800-633-4227                        website: www.medicare.gov Medicare and You – general information on Medicare coverage available as a pdf on www.medicare.govor call 1-800-633-4227 to request a printed copy.  Claims coordination or Medicare savings questions should be directed to Aetna, by email to mclaims@aetna.comor call 1-800-723-8897 for member services.  Scan a copy of your Medicare card and send to: hrservicecenter@worldbank.org OR Fax a copy to: 202-522-2150. Please put your UPI on the copy for faster identification! World Bank Retiree Website:             www.worldbank.org/humanresources         Need a copy of our correspondence with Social Security? Contact M. Tuohy on 202-473-9018 or email, mtuohy@worldbank.org  (Last updated: May 29, 2009, L. Conner)
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