Medicare Elegibility: Equity-League Fund

Medicare Eligibility

Medicare consists of two parts: Part A which provides hospital benefits and Part B which provides medical benefits. Both parts require a deductible before they pay benefits and there is a premium for Part B.

You and your dependents may become eligible for Medicare:

due to attainment of age 65, or
after the first 18 months of end stage renal disease, or
when you have been declared totally and permanently disabled by the Social Security Administration.

This section describes what happens to your hospital and medical benefits through the Equity-League Health Trust Fund when you become eligible for Medicare.

MEDICARE ELIGIBILITY AT AGE 65

If you or your covered spouse become eligible for Social Security Retirement Benefits at age 65, you are also eligible for Medicare even if you don't retire.

FOR ACTIVE MEMBERS AND THEIR DEPENDENTS

If you are covered for benefits through employment and eligible under the Fund's continuing eligibility rules, you may elect one of the following three options for how you want your medical benefits provided. When your covered spouse reaches age 65, he or she will have the opportunity to elect one of the coverage options described below. If no election is made, the Fund will assume the participant elected Option 1.

Option 1: Equity-League Health Trust Fund as Primary/Medicare as Secondary

If you elect this option, the Fund is primary and pays benefits for covered expenses in the same way as it does for all other active employees. After the Fund pays benefits, you may submit a claim for unpaid balances to Medicare for consideration on a secondary basis.

Option 2: Medicare Only

You may elect to stop participating in the Fund and have Medicare as your only insurance. If you elect this option, you may submit claims for payment only to Medicare because the Fund is prevented by law from providing coverage for any types of expenses for which Medicare provides benefits. If you elect this option, when your spouse reaches age 65, he or she may not continue to be covered under the Fund, even if otherwise eligible.

Option 3: Equity-League Health Trust Fund Only

You may elect not to enroll in Medicare and to have the Equity-League Health Trust Fund provide your only insurance. If you elect this option, you may submit claims only to the Equity-League Health Trust Fund.

FOR RETIRED MEMBERS AND THEIR DEPENDENTS (OVER AGE 65)

IF YOU ARE NOT COVERED FOR BENEFITS THROUGH EMPLOYMENT BUT ARE PAYING THE PREMIUM TO THE EQUITY-LEAGUE HEALTH TRUST FUND FOR YOU OR YOUR DEPENDENTS AGE 65 OR OVER, you must first submit your claims to Medicare for processing since Medicare is the primary carrier. A copy of the Explanation of Medicare Benefits (EOMB) that you receive from Medicare and a copy of the claims submitted to Medicare relating to the Explanation of Medicare Benefits should then be submitted to the Equity-League Health Trust Fund office as secondary payor for processing of any additional payments that may be coordinated with Medicare.

If Medicare is the primary carrier and a claim is not properly submitted to Medicare, the amounts payable by the Equity-League Health Trust Fund will be reduced by the amounts that would have been payable by Medicare if the claim were first properly submitted to Medicare.

Questions About Medicare

It is important that you and your spouse visit an office of the Social Security Administration during the three months before you reach age 65 so that you can learn about the Medicare system.

If you have any questions about coverage under the Fund, or need help in comparing benefits offered by the Fund and Medicare, please contact the Fund Office.