Medicare, the federal health program provided for people
65 years and older, has two kinds of health insurance. Part
A, the hospital insurance, helps you with the cost of
hospitalization and related care; and Part B, the medical
insurance, helps pay doctor bills and other health expenses.
Medicare does not have dental insurance or prescription drug
It is strongly recommended that each person covered in
the Welfare Fund contact their local Social Security
Administration office at least three months prior to their
65th birthday for information about Medicare benefits and
enrollment requirements. The Welfare Fund will assume you
have enrolled in both Part A and Part B on the earliest
possible date in providing your benefits. Your Medicare
eligibility commences the first of the month in which you
will turn age 65 or the first day of the month after you
have been receiving a Social Security Disability Award for a
period of 24 months.
When either you or your spouse receives your Health
Insurance (Medicare) Identification card, check it carefully
to see that all of your personal information is recorded
correctly. Also verify that at the bottom of the card
coverage is indicated for both hospital insurance and
medical insurance and that an effective date is indicated
for each type of coverage.
The hospital insurance (Part A) portion of Medicare is
provided to you at no cost. However, the medical insurance
(Part B) portion of Medicare has a monthly premium
associated with it. When you enroll, the premium will be
deducted from your monthly Social Security check.
The Part A deductible is the amount you will pay for the
first day of hospital care during a calendar year. After the
first 60 days of hospitalization, you will pay a daily
charge for a maximum of 150 days of hospital coverage per
The Part B premium will help you pay for the services of
physicians and other medical practitioners, hospital
outpatient services, independent clinical laboratory work
and durable medical equipment and supplies.
Significance Of Medicare Enrollment
If you do not apply for Medicare on a timely basis, your
ability to receive Medicare benefits will be significantly
delayed and the monthly Part B cost to you and your spouse
will be higher.
During any period in which you are eligible for Medicare
and you are not receiving Medicare benefits because you did
not apply in time, the Welfare Fund will deduct from your
claim to the Fund all benefits you would have received from
Medicare and pay to you the difference. This could be very
When you become eligible for Medicare benefits, your
hospital and medical benefits described in these pages will
no longer apply since they would duplicate Medicare benefits
to a large extent.
If you use an Empire Deluxe PPO provider, (or a local
Blue Cross PPO provider outside the Empire area) you will
only be required to pay a $10 co-pay for each visit. If you
reside or travel outside the Empire Deluxe PPO network area
you can obtain a local PPO provider by calling
1.800.810-BLUE. If you use a provider not enrolled in the
PPO network, which is your choice, you will be responsible
to pay the annual deductible of $300 per individual/$750 per
family and the 20% co-insurance per each Medicare claim.
When you are admitted to a covered hospital, present your
Empire HealthChoice, Inc. identification card together with
your Medicare card. Your hospital benefits coverage will pay
the Medicare hospital deductible.
If you are over age 65, actively employed, and covered in
the Welfare Fund due to your employment, you have the right
to reject your Group coverage and rely solely on Medicare
for your hospital and medical benefits. Contact the Fund
Office should you choose to make such an election.
Also, if you are Medicare eligible but can retain group
coverage either through your own active employment or as a
dependent under your spouse’s group plan, it may not be to
your advantage to enroll in Medicare since it will not
duplicate your group benefits.
You may want to contact Medicare to determine if there is
a Medicare HMO in your service area.