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Medicare for Pensioners

Retired Members (pensioners) and their dependents who are covered by MILA, who are not covered by another medical plan by virtue of their own or their spouse’s active employment and who are eligible to enroll in Medicare must enroll in both Parts A and B in order to have complete coverage under MILA. On the date you retire, Medicare will become the primary payer of your benefits if you are entitled to Medicare benefits on that date. If you become entitled to Medicare after you retire, Medicare will become the primary payer of your benefits on the date you timely enroll and are first eligible for benefits. The MILA National Health Plan will supplement your Medicare benefits in order to supply you with complete coverage. If you do not timely enroll under the Medicare rules, MILA will estimate the benefit that Medicare would have provided in both the discounted charge and the Medicare benefit payments, and the Plan will pay benefits as if Medicare had actually paid. Therefore, it is extremely important for you to timely enroll in Medicare for both Parts A and B as soon as you are eligible to do so after you retire. See the Pensioner Benefits section of this SPD for more details.

MILA coverage includes prescription drug coverage. If a person covered under MILA as a pensioner enrolls for Medicare Part D, his/her MILA prescription drug coverage and the prescription drug coverage of any of his/her dependents will cease as of the date of entitlement for Medicare Part D benefits. If only his/her spouse enrolls for Part D prescription drug coverage, then only the spouse will lose MILA prescription drug coverage.

As discussed, Medicare Advantage Plans replace traditional Medicare Parts A and B coverage and either include Part D prescription drug coverage or offer it in conjunction with the Medicare Advantage Plan. Typically, these Plans offer regional coverage which is generally quite comprehensive for those willing to accept a reduction in the choice of medical providers.

If you elect such coverage instead of traditional Medicare Parts A and B, this coverage will replace your MILA coverage beginning with the date you are first entitled to Medicare Advantage Plan benefits. If your Medicare Advantage Plan includes Part D coverage or you have separately enrolled for this coverage, MILA will reimburse you for the cost of your regular Part B premium (the standard premium) when you supply proof of payment.

Note that there are certain exceptions to the order of payment as provided under the Medicare as Secondary Payer provisions of the Social Security Act and the Internal Revenue Code for persons receiving Plan benefits as a result of active employment.

For example, if you become entitled to Medicare because of ESRD while employed, Medicare will be the secondary payer for the first 30 months under current law. After that, Medicare will be the primary payer. This is true regardless of whether you are receiving Medicare benefits as a result of active employment or as a pensioner. If you have questions about how MILA will coordinate with Medicare benefits, you should contact Medicare or MILA.