How UMP and Medicare work together
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If UMP Classic 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 Classic does not bill Medicare or in any way coordinate benefits with Medicare when Medicare is the secondary payer.
UMP Classic and Medicare are two separate health plans that work together to pay for covered services and supplies. Here is how coordination of benefits 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 coordination of benefits savings. This savings is the part of your UMP benefit saved because Medicare pays part of your claims. See an example of when Medicare pays first in your certificate of coverage.
Note: Services apply to the UMP medical deductible in the order the claims are received, not necessarily in the order the member receives services.
If you meet the $250 UMP Classic deductible, you do not pay both the Medicare Part B and the UMP Classic deductible. The $183 Part B deductible is a part of the same total calendar year expenses processed by UMP Classic. See an example of how this works in your certificate of coverage.
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 does not cover at all. For these services, it does not matter if the provider accepts Medicare, because Medicare does not 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 coordination of benefits savings accrued earlier in the year). Out-of-network providers may balance bill you.
Services not covered by Medicare Part A or Part B 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 does not cover services outside of the U.S.
- Naturopathic medicine.
- Prescription drugs (see "Use network pharmacies that bill Medicare Part B directly" 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, they 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:
- Substance use disorder services (Medicare covers some substance abuse services under mental health).
- Inpatient hospital services.
- Mental health, both outpatient and inpatient services.
- Covered preventive care: Medicare covers some preventive services.
- Skilled nursing facility services.
When Medicare does not cover these services, you may receive the highest benefit level when you see a preferred provider.
To learn more about whether to see a preferred provider, read the "Should I see a preferred provider?" section in your certificate of coverage. You can also call UMP Customer Service at 1-888-849-3681 (TRS: 711) for more information.
UMP Customer Service
Online: Your Regence account
Business hours: Monday through Friday 5 a.m. to 8 p.m. and Saturday 8 a.m. to 4:30 p.m. (Pacific)