How UMP and Medicare work together
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If UMP Classic is pays first and Medicare pays second, make sure that you tell Medicare about your UMP Classic coverage and that your provider agrees to bill Medicare as secondary to get the maximum benefit from both plans.
Medicare generally accepts claims only from providers, so you may not be able to send a claim to Medicare for secondary payment. The provider would need to bill Medicare after UMP Classic has processed the claim.
Alert! UMP does not bill Medicare or in any way coordinate benefits with Medicare when Medicare pays second.
UMP Classic and Medicare are two separate health plans that work together to pay for covered services and supplies. Here's how coordination of benefits (COB) works:
- Your providers bill Medicare. Medicare pays your claims first. After Medicare processes the claim, Medicare sends the claim to UMP Classic.
- UMP Classic pays your claims second. For most covered services, UMP Classic pays the rest of the Medicare allowed amount and you owe nothing.
Each calendar year, you have to meet the UMP Classic medical deductible ($250 per person) before UMP Classic starts paying benefits. If you incur more covered services during the same calendar year, you may be reimbursed for at least some of your UMP Classic deductible. That reimbursement will come from the COB savings reserve. This is the part of the UMP Classic benefit saved because Medicare pays part of your claims. See an example of how this works in your certificate of coverage.
Note: Claims apply to the UMP Classic medical deductible in the order they are processed, not necessarily in the order services were received by the member.
If you meet the $250 UMP Classic deductible, you do not pay both the Medicare Part B and the UMP Classic deductible. The $166 Part B deductible is a part of the same total calendar year expenses processed by UMP Classic.
Alert! Services listed below are paid at the standard rate. You will pay more if you use out-of-network providers for these services.
UMP Classic covers some services that Medicare doesn't cover at all. For these services, it doesn't matter if the provider accepts Medicare, because Medicare doesn't cover the service. You will receive the highest level of benefit if you choose a preferred provider.
For the services listed below, the secondary benefit paid by UMP Classic is the only benefit (plus any COB savings accrued earlier in the year). Out-of-network providers may balance bill you.
Services that UMP covers, but Medicare does not, include but are not limited to:
- Hearing aids.
- Hearing exams for the purpose of getting a hearing aid.
- Massage therapy (a massage therapist must be a preferred provider).
- Medical coverage outside the country; Medicare doesn't cover services outside of the U.S.
- Naturopathic medicine.
- Prescription drugs (see "Prescription drugs and Medicare" for exceptions).
- Routine vision exams and hardware (Medicare covers medical vision exams and vision hardware following cataract surgery).
- Wigs for cancer patients.
If you see a preferred provider, he or she will submit the claim for you. For out-of-network providers, check if the provider will submit the claim. If not, you will need to send a claim to UMP Classic.
Alert! Preferred providers do not necessarily accept Medicare—you should always ask.
UMP Classic covers some services after the Medicare benefit ends. These services include:
- Chemical dependency services (Medicare covers some substance abuse services under mental health).
- Inpatient hospital services.
- Mental health, both outpatient and inpatient services.
- Preventive care; Medicare covers some preventive services.
- Skilled nursing facility services.
You may receive higher UMP Classic benefits if you see preferred providers for these services. See "Should I see a preferred provider?" in your certificate of coverage for details.