BENEFITS SUMMARY

The following is important information which every person covered under the MILA Medicare Wrap-Around Plan should keep inmind when accessing medical services, behavioral health services or prescription drugs. This information will help you to obtain the highest level of benefits from the Medicare Wrap-Around Plan while ensuring that you obtain the care you require.

Medicare

The MILA Medicare Wrap-Around Plan is designed to supplement the benefits provided by Medicare, Part A & B, for MILA Pensioners and their eligible dependents who are eligible to enroll in Medicare and do so. It will not supplement the benefits provided by Medicare, Part C (that is, Medicare Advantage Plans) or Medicare, Part D, Prescription Drug Plans. It is extremely important that each person who is eligible for MILA Wrap-Around Plan benefits enroll in Medicare, Part A & B, and the individual enroll in a “timely manner” as defined by Medicare. This is because coverage under the MILA Wrap-Around Plan is incomplete without Medicare coverage in both Part A & B.

Benefits payable by Medicare under both Part A or B are a part of the deductible for this Plan. The same broad coverage which is available in the Premier, Basic and Core Plans is provided in the MILA Medicare Wrap-Around Plan. However, because Medicare must pay its portion of the cost before MILA, Medicare’s discounts and medical management procedures will be used instead of the Claim Administrator’s discounts and management procedures when Medicare covers the expense. If Medicare does not cover an expense which the Plan regards as eligible, then it will be covered subject to the deductible and coinsurance which is indicated in the MILA Medicare Wrap-Around Plan Chart. MILA’s normal discounts and management procedures will apply.

If a person does not “timely enroll” in Medicare, that person is defined as a “late entrant” by Medicare and the Medicare Part B premium will be permanently increased. MILA Medicare Wrap-Around Plan coverage will begin when entitlement to Medicare benefits could first have begun upon timely enrollment, not when it actually does begin for a “late entrant.”

During the period between the beginning of the MILA Medicare Wrap-Around Plan coverage and entitlement to Medicare benefits, MILA will estimate the benefit that Medicare would have provided in both the discounted charges and the Medicare benefit payments, and the Plan will pay benefits as if Medicare had actually paid. You will be responsible for paying the provider for these additional costs that Medicare would have paid if you had timely enrolled.

Medicare offers two additional options for which you may enroll. They are:

  • Medicare Advantage Plans that used to be called Medicare Part C Plans, and
  • Medicare Part D Prescription Drug Plans.

If you are considering enrolling for either option you should consider your choice carefully. Enrolling in either of these plans will completely replace benefits under the MILA Medicare Wrap-Around Plan.

  • If you enroll in a Medicare Advantage Plan, that coverage will completely replace your traditional Medicare Part A & B and it will replace your MILA Medicare Wrap-Around Plan coverage on the date the Medicare Advantage Plan coverage begins.
    • If the Medicare Advantage Plan contains a Part D prescription drug benefit, MILA will reimburse you for the standard cost of the Medicare Part B premium. This is the premium you must pay unless your income has caused Medicare to charge you a higher premium. It does not contain “late entrant” penalty charges.
    • If your Medicare Advantage Plan does not contain a Part D prescription drug benefit but you separately enroll for a Medicare Part D prescription drug plan, MILA will reimburse you for the standard cost of the Medicare Part B premium.
    • To receive reimbursement of the Part B premium, you must supply MILA with proof of your enrollment. For example, you should supply MILA with a copy of the front and back of your Medicare Advantage Plan identification card and, if you are required to pay a premium to the Medicare Advantage Plan, also supply a copy of your premium statement for a current date.
  • If you are covered in the MILA Medicare Wrap-Around Plan and you or your Medicare eligible spouse also enroll in a Medicare Part D prescription drug plan, your MILA Medicare Wrap-Around Plan benefits will be reduced as follows:
    • If you (the Member) enroll in a Medicare Part D prescription drug plan, you will lose MILA prescription drug coverage for yourself and for each covered dependent, regardless of that person’s Medicare status. Your medical and behavioral health coverage will remain in effect.
    • If only your Medicare eligible spouse or one of your Medicare eligible dependents enrolls in a Medicare Part D prescription drug plan, only that dependent will lose his or her MILA prescription drug coverage. That person’s medical and behavioral health coverage will remain in effect.
  • If you enroll for a Medicare Advantage Plan and subsequently decide to discontinue this coverage and return to Traditional Medicare Part A & B coverage, MILA will readmit you to MILA Wrap-Around Plan coverage on the date your Traditional Medicare coverage begins. You must supply MILA with proof of your reinstatement in Traditional Medicare Part A & B. You should be careful because Medicare limits the times when you may change back to Traditional Medicare.
  • If you enroll in a Medicare Part D Prescription Drug Plan (and you have not enrolled for a Medicare Advantage Plan) and subsequently you end your Medicare Part D enrollment for any reason, MILA will readmit you to prescription drug coverage under the MILA Medicare Wrap-Around Plan on the date your Part D coverage ends. You must supply MILA with proof of your disenrollment from the Part D plan.