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Medicare & The Funds

Medicare & The Funds

There are two types of Medicare coverage in which you required to enroll when you become eligible for Medicare: Part A (Hospital Insurance) and Part B (Medical Insurance). Medicare is the primary payer for Part A and your benefits will continue to be processed through the Medicare intermediaries. Under a special arrangement with Medicare, the Funds processes and pays Medicare Part B benefits for Fund’s beneficiaries who are eligible for Medicare.

If you are eligible for but not enrolled in Medicare Part B at the time you are determined to be eligible for benefits from the Funds, the effective date for your health benefit coverage from the Funds will be delayed. (The Funds does not require you to enroll in a Medicare Advantage plan and you are strongly discouraged from enrolling in a Medicare Part D prescription drug plan.) Once enrolled in Medicare, if you decide to cancel your Medicare Part A or Medicare Part B coverage, your Funds coverage will be suspended until such time as your Medicare benefits are reinstated. Contact your local Social Security Administration office for information about enrolling in Medicare.

Your doctors may call the Funds’ Provider Customer Service Unit at 1-888-865-5290, if they have any billing questions.

Comparison Between Funds and Medicare Coverage

Most services that are covered by Medicare are also covered by the Funds. This list shows where Medicare and the Funds’ coverage may differ:

Funds Covered Services

The following services are covered by the Funds but not covered by Medicare:

  • Skilled care in a Skilled Nursing Facility after Medicare’s 100 days have been used up
  • Certain vision services such as routine eye exams
  • Hearing aids
  • Non-emergency transportation
  • Out of area transportation
  • Certain disposable supplies, such as incontinence supplies (i.e. diapers and Chux)
  • Safety grab bars and transfer benches
  • Routine immunizations (Medicare covers immunizations for flu, pneumococcal pneumonia, and hepatitis B.)

Medicare Covered Services

The following services are covered by Medicare but not covered by the Funds:

Chiropractic services for manual manipulation of a subluxated spine

Important: If you have Medicare, you will have to pay 20% for covered chiropractic services. If you do not have Medicare, you will have to pay 100%.

Excluded Services

The following services are not covered by either Medicare or the Funds:

  • Dental services
  • Custodial care
  • Cosmetic procedures
  • Procedures and devices which are considered experimental or investigational

Medicare & You

“Medicare and You” is the official U.S. government Medicare handbook. It is the best and official source of answers to your Medicare questions. You can use the link below or call: 1-800-MEDICARE (1-800-633-4227) to get specific answers to your questions.