- The cost of all services is required (foreign currency will be converted into USD and reimbursement to the member will be in USD).
- If tooth specific services were rendered include the tooth number on which services were completed.
- ADA Dental codes may not be used by international providers, so a detailed narrative of treatment provided will be very helpful.
- If the narrative/treatment plan is not in English, Delta Dental may have translators who can translate the information received.
Dental Plans at a Glance
Standard Dental Plan
View the 2024 Standard Dental plan summary for detailed service class coverages.
Archived SummariesLegacy Dental Plan
View the 2024 Legacy Dental plan summary for detailed service class coverages.
Archived SummariesNetwork Providers
You have access to more than 300 licensed dentists across Alaska and 204,000 office locations nationwide. You will want to stay in the Delta Dental networks to get high quality care at a lower price. Through Delta Dental PPO and Premier networks, limits are set on what dentists can charge for certain services. It’s a way of connecting you with great care at even better rates. To find a provider call toll-free at (888) 558-2705 or you can use the online search tool.
Member Dashboard—Information at your Fingertips
Your Member Dashboard, myModa, gives you a real-time view into your dental claims and benefits. You’ll also have access to online tools and resources to manage your dental care needs.
Vision and Audio Benefits
- You pay no deductible under this plan.
- The plan covers one complete eye examination, including a required refraction, per year.
- The plan covers two lenses during each calendar year.
- The plan covers one set of frames during every two consecutive calendar years.
- The Audio Plan pays up to $2,000 for each person in a covered rolling 36-month period.
- You pay no deductible under this plan.
- The Plan pays 80% of the recognized charge for audio services.
For information about Vision and Audio benefits contact Aetna Concierge toll-free at (855) 784-8646.
AlaskaCare Long Term Care Benefits | CHCS
- LTC Enrollment
- Plan Comparison Chart
- Premiums
- Actuarial Valuations
- LTC Frequently Asked Questions
The State of Alaska is pleased to offer a voluntary Long-Term Care (LTC) Plan for benefit recipients and their spouses. The options available under the LTC plan provide a range of health and social services for people who need assistance with the basic activities of daily living.
CHCS Services, Inc. is the claims administrator. You may contact them at (888) 287-7116 for questions or to initiate a claim. CHCS has made a portal available where members may view which plan they are in enrolled in, review plan documents, and obtain a claim submission packet. Members can also use the portal to view claims and receive messages from their case manager.
LTC Enrollment
You must apply for this coverage before appointment to your first benefit from any retirement system. To meet this deadline, your Retiree Health Benefits Enrollment/Waiver form must be postmarked or received by the retirement application deadline. If you do not apply for coverage at this time, you waive your right to apply for this coverage at a later date.
You can send in the form separately, but most often this form is completed as part of the retirement packet.
Adding a new spouse: Use the Retiree Health Dependent Change form to add your new spouse to your health plans. The request must be received by the Division within 120 days of marriage.
Plan Comparison Chart
| Bronze Option | Silver Option | Gold Option | Platinum Option | |
|---|---|---|---|---|
| Deductible | 90 days of covered long-term care | 90 days of covered long-term care | 90 days of covered long-term care | 90 days of covered long-term care |
| Benefit Eligibility | Inability to perform 2 of 5 activities of daily living | Inability to perform 2 of 6 activities of daily living or cognitive impairment | Inability to perform 2 of 6 activities of daily living or cognitive impairment | Inability to perform 2 of 6 activities of daily living or cognitive impairment |
| Lifetime maximum benefit | $200,000 all services $50,000 home health care | $400,000 all services | $300,000 all services | $300,000 all services |
| Nursing home daily benefit | $125 in Alaska $75 outside Alaska | $200 in and out of Alaska | $200 in and out of Alaska | $200 in and out of Alaska |
| Assisted living facility daily benefit | Covered in lieu of other services if approved | $150 in and out of Alaska | $150 in and out of Alaska | $150 in and out of Alaska |
| Home health care daily benefit | $75 in Alaska $40 outside Alaska | $125 in and out of Alaska | $125 in and out of Alaska | $125 in and out of Alaska |
| Hospice daily benefit | Not Covered | $125 in and out of Alaska | $125 in and out of Alaska | $125 in and out of Alaska |
| Respite care daily benefit amount | Not Covered | Up to $200 in and out of Alaska, maximum of 14 days | Up to $200 in and out of Alaska, maximum of 14 days | Up to $200 in and out of Alaska, maximum of 14 days |
| Inflation protection | None | None | Simple at 5% of original benefit each year. Applies to lifetime and daily benefit amounts. | Compound at 5% of the prior year's benefit each year. Applies to lifetime and daily benefit amounts. |
Existing option closed to new entrants after 1/31/2000
Inflation protection stops at age 85. Please see the plan booklet for more information.
Premiums
Premiums are based on your age at retirement and while all premiums may increase, your premium will always be based on your age on the date you retired. If you elect coverage for your spouse, you pay a separate premium based on their age at the time of your retirement.
| Age at enrollment | Silver Option $400,000 maximum No inflation protection | Gold Option $300,000 maximum Simple inflation protection | Platinum Option $300,000 maximum Compound inflation protection |
|---|---|---|---|
| ≤ 40 | $26 | $76 | $148 |
| 41 | $27 | $77 | $150 |
| 42 | $28 | $78 | $153 |
| 43 | $30 | $79 | $155 |
| 44 | $31 | $81 | $158 |
| 45 | $33 | $82 | $161 |
| 46 | $35 | $84 | $164 |
| 47 | $37 | $85 | $167 |
| 48 | $39 | $89 | $170 |
| 49 | $41 | $92 | $172 |
| 50 | $44 | $96 | $175 |
| 51 | $46 | $100 | $177 |
| 52 | $49 | $103 | $180 |
| 53 | $52 | $109 | $184 |
| 54 | $56 | $114 | $188 |
| 55 | $60 | $120 | $192 |
| 56 | $63 | $126 | $195 |
| 57 | $67 | $131 | $199 |
| 58 | $75 | $143 | $212 |
| 59 | $84 | $156 | $225 |
| 60 | $92 | $168 | $237 |
| 61 | $100 | $181 | $250 |
| 62 | $108 | $193 | $263 |
| 63 | $123 | $212 | $281 |
| 64 | $137 | $231 | $300 |
| 65 | $151 | $250 | $319 |
| 66 | $166 | $269 | $338 |
| 67 | $180 | $288 | $357 |
| 68 | $201 | $313 | $381 |
| 69 | $222 | $339 | $404 |
| 70 | $244 | $364 | $428 |
| 71 | $265 | $389 | $451 |
| 72 | $286 | $414 | $475 |
| 73 | $314 | $444 | $502 |
| 74 | $343 | $474 | $529 |
| 75 | $371 | $503 | $556 |
| 76 | $399 | $533 | $584 |
| 77 | $427 | $563 | $611 |
| 78 | $471 | $609 | $654 |
| 79 | $515 | $654 | $698 |
| 80 | $559 | $700 | $741 |
| 81 | $603 | $746 | $784 |
| 82 | $646 | $791 | $828 |
| 83 | $731 | $887 | $923 |
| 84 | $815 | $982 | $1018 |
| ≥ 85 | $900 | $1078 | $1113 |
Inflation protection increases annually until the covered member reaches age 85.
| Bronze Premiums | |
|---|---|
| May 1, 2000 Age | Premium (in dollars) |
| < 50 | 16.10 |
| 50-54 | 21.45 |
| 55-59 | 26.80 |
| 60-64 | 48.25 |
| 65-69 | 80.45 |
| 70-74 | 128.70 |
| 75-79 | 193.05 |
| 80-84 | 294.95 |
| ≥ 85 | 412.90 |
Definitions
Cognitive Impairment
A measurable deterioration or loss in intellectual capacity requiring substantial supervision or verbal cueing by another individual in order to protect the impaired and others from serious threats to health and safety.
Deductible
the amount you must pay before the plan pays benefits.
Activities of Daily Living
The Silver/Gold/Platinum options include bathing, continence, dressing, eating, toileting, and transferring. The Bronze Option includes dressing, toileting, transferring, eating, and walking.
Actuarial Valuations
- Valuation as of June 30, 2021
- Valuation as of June 30, 2019
- Valuation as of June 30, 2017
- Valuation as of June 30, 2015
- Valuation as of May 31, 2012 (Draft)
- Valuation as of June 30, 2009
Insurance Information Booklets
- AlaskaCare Defined Benefit Retiree Insurance Information Booklet
- AlaskaCare Defined Contribution Retiree Insurance Information Booklet
- 2022 – Retiree Plan Amendment 2022-01
- 2018 - Retiree Plan Amendment 2018-1
- 2016 - Retiree Plan Amendment 2016-2
- 2016 - Retiree Plan Amendment 2016-1
- 2014 - Retiree Plan Amendment
- 2003 - Defined Benefit Plan (DB) Retiree Insurance Information Booklet (with 2018 Plan Amendment)
- 2003 - Defined Benefit Plan (DB) Retiree Insurance Information Booklet (with 2016 Plan Amendment)
- 2003 - Defined Benefit Plan (DB) Retiree Insurance Information Booklet (with 2013 Plan Amendment)
- 2014 - Audiologists
- 2014 - Chiropractic Rehabilitative
- 2014 - Chiropractic Rehabilitative OON
- 2014 - Contact Lens Fitting
- 2014 - Contact Lens
- 2014 - Dental Frequencies
- 2014 - Dental Implants
- 2014 - Dental Nitrous Oxide
- 2014 - Medical Foods
- 2014 - Medicare COB
- 2014 - Medications Self Injectable
- 2014 - Orthotics
- 2014 - Prescription Compound Medications
- 2014 - Prescription Medication Replacement
- 2014 - Prescription Specialty Medication by Mail
- 2014 - Prescription OTC Equivalents
- 2014 - Vision Progressive Lenses
- 2016 - Smoking Cessation
- 2016 - Prescription Auto Refill
- 2016 - Prescription Medication Kit Logic
- 2022 - Maintenance Care MSK Disorders
Defined Benefit
- 2023 - AlaskaCare Defined Benefit Retiree Insurance Information Booklet
- 2022 - AlaskaCare Defined Benefit Retiree Insurance Information Booklet
- 2021 - Defined Benefit (DB) Retiree Insurance Information Booklet
- 2020 - Defined Benefit Plan (DB) Retiree Insurance Information Booklet
- 2020 - Defined Benefit Plan (DB) Retiree Insurance Information DRAFT Booklet (Markup)
- 2020 - Defined Benefit Plan (DB) Retiree Insurance Information DRAFT Booklet (No Markup)
- 2020 - Defined Benefit Plan (DB) Retiree Insurance Information DRAFT Booklet (Summary)
- 2019 - Defined Benefit Plan (DB) Retiree Insurance Information Booklet
- 2019 - Defined Benefit Plan (DB) Retiree Insurance Information DRAFT Booklet with markup
- 2019 - Defined Benefit Plan (DB) Retiree Insurance Information DRAFT Booklet with NO markup
- 2018 - Defined Benefit Plan (DB) Retiree Insurance Information Booklet
- 2018 - Defined Benefit Plan (DB) Retiree Insurance Information DRAFT Booklet with markup
- 2018 - Defined Benefit Plan (DB) Retiree Insurance Information DRAFT Booklet with NO markup
Defined Contribution
- 2023 - AlaskaCare Defined Contribution Retiree Insurance Information Booklet
- 2022 - AlaskaCare Defined Contribution Retiree Insurance Information Booklet
- 2021 - Defined Contribution Retiree (DCR) Insurance Information Booklet
- 2020 - Defined Contribution Plan (DCR) Retiree Insurance Information Booklet
- 2020 - Defined Contribution Plan (DCR) Retiree Insurance Information DRAFT Booklet (Markup)
- 2020 - Defined Contribution Plan (DCR) Retiree Insurance Information DRAFT Booklet (No markup)
- 2020 - Defined Contribution Plan (DCR) Retiree Insurance Information DRAFT Booklet (Summary)
- 2019 - Defined Contribution Plan (DCR) Retiree Insurance Information Booklet
- 2019 - Defined Contribution Plan (DCR) Retiree Insurance Information DRAFT Booklet with markup
- 2019 - Defined Contribution Plan (DCR) Retiree Insurance Information DRAFT Booklet with NO markup
- 2018 - Defined Contribution Plan (DCR) Retiree Insurance Information Booklet
- AlaskaCare_RetireeDBBooklet_2024_FinalCandidate_PublicComment.pdf
- AlaskaCare_RetireeDBBooklet_2024_SummaryChanges
- By Mail: State of Alaska Department of Administration
Division of Retirement and Benefits
P.O. Box 110203
Juneau, AK 99811-0203 - By Email:
A public teleconference will be held October 12, 2023 at 1 p.m. Alaska time.
Teleconference # (907) 202-7104
ID # 192 944 259
After the public comment period ends, the Plan Administrator will either adopt the proposed plans, or other provisions dealing with the same subject, without further notice. The language of the final plan documents may be different from the proposed plan documents. You should comment during the time allowed if your interests could be affected. Written comments received are public records and are subject to public inspection.
Income Related Monthly Adjustment Amount (IRMAA) Reimbursement
Certain high-income retirees are required to pay an extra premium surcharge, known as an Income Related Monthly Adjustment Amount, or IRMAA. This is similar to the surcharge for high-income enrollees in the Medicare Part B plan. If you are an individual or a married couple earning more than the threshold, you will be required to pay an extra surcharge for being enrolled in the AlaskaCare Employer Group Waiver Program (EGWP) because it is a group Medicare Part D plan. Retirees whose household income is below this threshold will not be subject to the IRMAA premium surcharge.
If you are subject to the Medicare Part D IRMAA surcharge, you will be reimbursed.
For all Medicare plans, the IRMAA will be deducted directly from your monthly Social Security check (if you qualify for Social Security) or will otherwise be invoiced to you directly each month. If you are charged a Medicare Part D IRMAA for your prescription drug coverage, the Division of Retirement and Benefits will reimburse you for the full cost of the Medicare Part D premium surcharge each month, through a tax-advantaged Health Reimbursement Arrangement (HRA) account. If you receive a bill from Medicare, you should pay the bill timely, and contact the Division to learn about your reimbursement options.
The Division of Retirement and Benefits has partnered with Optum Rx and Optum Bank to create an efficient way for members to receive reimbursement for their Part D IRMAA surcharge.
What You Need to Know
- You need to set up your HRA account every year, since IRMAA surcharges are based on your annual income and your income may change from year to year.
- If you are not assessed Part D IRMAA surcharge this does not apply to you.
- To receive the reimbursement, you should submit your claim and letter as soon as possible, but no later than 12 months after the last day of the current year. For example: The deadline for submitting your IRMAA for reimbursement is December 31, .
How to Request Reimbursement and/or Set Up Direct Deposit
- Register and/or log in to your Optum Rx.com account either online or through the mobile app.
- Navigate to the AlaskaCare IRMAA Reimbursement Form by taking the following steps:
- On the top of the main page, click the "Information Center" tab.
- Click "Programs and Forms".
- Click on the "AlaskaCare IRMAA Reimbursement" section. There you will find the digital enrollment form as well as the paper version.
- To submit your reimbursement request digitally (the faster method), click and submit the IRMAA HRA Digital Enrollment Form.
- Upload as an attachment, a copy or image of your letter from Social Security or a Medicare Bill that shows what your Part D IRMAA surcharge is.
- Optum Rx will confirm your eligibility and set up your Health Reimbursement Account (HRA) with Optum Bank within 5 to 7 business days of receipt.
- Once your HRA has been set up with Optum Bank, they will send you a Welcome Packet within 5 to 7 business days, which will include information on signing up for Direct Deposit.
- If you currently have Direct Deposit set up with Optum Bank, that information does not need to be submitted again.
- Once you receive your Welcome Packet, log in to OptumBank.com to view your HRA account status/balance or to sign up for Direct Deposit.
- Print the form,
- Fill out the information accurately,
- Include a copy of your letter from Social Security or a Medicare Bill that shows what your Part D IRMAA surcharge is, and
- Mail or email the form to Optum Rx.
If you have any questions on how to submit your IRMAA documents online or if you do not have internet access and would like to submit paper documentation, please contact Optum Rx at (855) 409-6999 or email .
IRMAA Frequently Asked Questions
How will I know if I have to pay an IRMAA, and how much it will be?- Adjusted Gross Income (AGI), which can be found on the last line your IRS 1040 tax form (line 37 on form 1040, line 21 on form 1040A, or line 4 on form 1040EZ), plus
- Any tax-exempt interest income (line 8b on form 1040).
The Social Security Administration requests income information from the IRS for the tax year that is two years prior to the surcharge year. IRMAA is automatically re-determined each year as long as you file an income tax return.
The below table shows the IRMAA for 2024. The MAGI and IRMAA is subject to change from year to year. Please review the table below to see if your income qualifies you to be assessed an IRMAA surcharge based on your Modified Adjusted Gross Income (MAGI) from the 2022 tax year.
| 2024 Part D IRMAA Amounts | ||||
|---|---|---|---|---|
| If your filing status and yearly income in 2022 was. | ||||
| File individual tax return | File joint tax return | File married & separate tax return | You pay each month (in 2024) | |
| Less than or equal to $103,000 | Less than or equal to $206,000 | Less than or equal to $103,000 | Not assessed a surcharge | |
| Greater than $103,000 and less than or equal to $129,000 | Greater than $206,000 and less than or equal to $258,000 | Not applicable | $12.90 | |
| Greater than $129,000 and less than or equal to $161,000 | Greater than $258,000 and less than or equal to $322,000 | Not applicable | $33.30 | |
| Greater than $161,000 and less than or equal to $193,000 | Greater than $322,000 and less than or equal to $386,000 | Not applicable | $53.80 | |
| Greater than $193,000 and less than $500,000 | Greater than $386,000 and less than $750,000 | Greater than $103,000 and less than or equal to $397,000 | $74.20 | |
| Greater than $500,000 or above | Greater than $750,000 or above | Greater than $397,000 or above | $81.00 | |
- Register and/or log in to your Optum Rx.com account either online or through the mobile app.
- Navigate to the AlaskaCare IRMAA Reimbursement Form by taking the following steps:
- On the top of the main page, click the "Information Center" tab.
- Click "Programs and Forms".
- Click on the "AlaskaCare IRMAA Reimbursement" section. There you will find the digital enrollment form as well as the paper version.
- To submit your reimbursement request digitally (the faster method), click and submit the IRMAA HRA Digital Enrollment Form.
- Upload as an attachment, a copy or image of your letter from Social Security or a Medicare Bill that shows what your Part D IRMAA surcharge is.
- Optum Rx will confirm your eligibility and set up your Health Reimbursement Account (HRA) with Optum Bank within 5 to 7 business days of receipt.
- Once your HRA has been set up with Optum Bank, they will send you a Welcome Packet within 5 to 7 business days, which will include information on signing up for Direct Deposit.
- If you currently have Direct Deposit set up with Optum Bank, that information does not need to be submitted again.
- Once you receive your Welcome Packet, log in to OptumBank.com to view your HRA account status/balance or to sign up for Direct Deposit.
- Print the form,
- Fill out the information accurately,
- Include a copy of your letter from Social Security or a Medicare Bill that shows what your Part D IRMAA surcharge is, and
- Mail or email the form to Optum Rx.
If you have any questions on how to submit your IRMAA documents online or if you do not have internet access and would like to submit paper documentation, please contact Optum Rx at (855) 409-6999 or email .
What are my options if I am required to pay the extra surcharge?If you receive notice that you are required to pay the IRMAA surcharge for the enhanced EGWP, follow the steps listed above to request reimbursement. The Division will fund a tax advantaged HRA account that can be used to reimburse you the Part D IRMAA surcharge amount by paper check or through electronic funds transfer to a bank account of your choosing.
How long do I have to submit a claim to the Health Reimbursement Arrangement (HRA) account?To receive reimbursement for the Part D IRMAA surcharge, you should submit the HRA claim as soon as possible, but not later than 12 months after the date you incurred the expenses. Retroactive reimbursements will not be issued for claims received beyond 12 months. Example: if you are assessed a Part D IRMAA surcharge in 2023, you will have until December 31, 2024 to file the HRA claim for reimbursement.
What if I refuse to pay the extra surcharge?If you refuse to pay the extra surcharge for your Medicare Part D coverage, Medicare will cancel your enrollment in the AlaskaCare enhanced EGWP plan. This will be treated as an opt-out from the plan, and you will be placed in a prescription drug program that is much different than the plan prescription drug benefits offered today. This alternative plan may result in increased out-of-pocket expenses for you or your Medicare-eligible dependents. Please contact the Division if you have concerns about this surcharge or would like assistance with understanding the options available to you.
Who can I call if I need assistance understanding the surcharge?For general questions about your pharmacy benefits, contact Optum Rx, the AlaskaCare pharmacy benefits manager at (855) 409-6999. For questions related to your IRMAA surcharge, you may contact Social Security at (800) 772-1213. For more information about the HRA account options, contact the Division at (907) 465-4460 or toll-free at (800) 821-2251.
Who can I contact for an update on my current IRMAA claim?For assistance or a status on a claim you already submitted, you may contact Optum Rx by email: .
Medicare
- Introduction
- Resources for Medicare Information
- Finding a Medicare Provider
- Medicare Overview
- Medicare Enrollment
- Types of Medicare Providers
- Employer Group Waiver Plan
- DB Medicare Frequently Asked Questions
- DCR Medicare Frequently Asked Questions
Introduction
Medicare is a national health insurance program administered by the Centers for Medicare and Medicaid Services (CMS). It primarily provides health insurance for Americans aged 65 and older, but also for some younger people with disability status as determined by the Social Security Administration (SSA), and people with end stage renal disease and amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
Alaska statute requires the AlaskaCare retiree plan become supplemental to Medicare when members turn 65. AlaskaCare will begin processing member’s health claims as if they have Medicare Part A & B on the first day of the month when they turn 65. All members should schedule an appointment with Social Security to apply for Medicare Part A & B within the three months prior to their 65th birthday.
Resources for Medicare Information
- Medicare: To learn more about Medicare visit the Medicare.gov website or call (800) 633-4227 | TTY (877) 486-2048.
- Social Security Administration: If you are looking for information about Social Security, please visit the Social Security Administration page.
- Alaska Medicare Information Office: You may also contact the State of Alaska’s Medicare Information Office at (800) 478-6065 or (907) 269-3680 in Anchorage, or email them at . The Medicare Information Office offers one on one personalized Medicare Counseling and Medicare Seminar events by webinar.
- AlaskaCare Retiree Town Hall: The AlaskaCare Retiree Town Hall is a monthly event that offers information on the AlaskaCare Retiree health plan, below are three helpful events pertaining to Medicare.
- August 18, 2022
- September 15, 2022
Finding a Medicare Provider
Alaska Department of Health offers a Resource Directory to assist in finding Medicare provider information. You can also go to the Medicare website, which offers an online tool to help you find Medicare participating providers.
Medicare Overview
Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
Most people are eligible for premium-free Part A. After members apply for Medicare Part A & B, they will receive a decision letter from Social Security notifying them if they qualify for premium-free Part A. Members who do not qualify for premium-free Medicare Part A, should not enroll in Part A, they must provide a copy of the Social Security letter to the AlaskaCare health claims administrator and the Division of Retirement & Benefits, and AlaskaCare will continue to pay as your primary plan for Part A services.
Part B (Medical Insurance): Helps cover physician and other outpatient medical services, ambulatory surgery center services, medical equipment, and ambulance services. Everyone is eligible for and must pay a premium for Part B, whether or not you are eligible for Part A.
Part D (Drug coverage): Helps cover the cost of prescription drugs. Medicare eligible retirees and/or dependents will be automatically enrolled in the AlaskaCare enhanced Employer Group Waiver Program (EGWP). The AlaskaCare enhanced EGWP is a group Medicare prescription drug plan that provides the same prescription benefits as provided to non-Medicare eligible retirees and dependents, while maximizing federal subsidies.
You do not need to enroll into an individual Medicare Part D plan, and for most members there is no additional premium for prescription drug coverage under AlaskaCare.
However, certain high wage earners will be charged an Income Related Monthly Adjustment Amount (IRMAA) surcharge for prescription drug coverage. Visit the IRMAA section on this webpage for more information.
For more information on EGWP, please visit the Employer Group Waiver Plan webpage.
Medicare Enrollment
If you are receiving Social Security benefits before age 65, you will be automatically enrolled in Parts A and B of Medicare when you turn 65. If you are not receiving Social Security benefits, contact the Social Security Administration (SSA) three months before you turn age 65 to discuss enrolling in Medicare Parts A and B.
Be sure to inform the Social Security Administration if you have health insurance through an employee group health plan that you or your spouse receive as an actively working employee. If you are covered by such a plan, Medicare does not require you to enroll until the active plan terminates. However, if you do not enroll, the amount Medicare would have paid as the secondary plan is not paid by AlaskaCare. The AlaskaCare Retiree Health Plan recommends that you enroll in Medicare Part B at age 65, regardless of any other insurance.
Sign Up for Medicare Direct
After members receive their Medicare Beneficiary Identifier or “MBI”, they should call the Aetna concierge and ask Aetna to set up Medicare Direct so that Medicare will automatically send the Medicare Explanation Of Benefit (MEOB) to Aetna for processing. Once Medicare Direct is set up, Medicare will pay as the member’s primary health insurance and Medicare MEOBs will automatically be sent to Aetna so AlaskaCare benefits will pay as secondary.
Types of Medicare Providers
There are three types of providers: participating, nonparticipating, and those who “opt out.”
Participating Medicare Providers
Participating providers are required by their Medicare contract to accept assignment of your claims. Because you don’t owe any amount over the Medicare allowed amount, AlaskaCare pays the difference between Medicare’s payment and the allowed amount if the expense is covered by both plans. Therefore, for covered expenses the claim is usually paid in full, unless you have not yet met your deductibles. Your provider must bill Medicare and Medicare’s payment will be sent directly to the provider.
Nonparticipating Medicare Providers
Nonparticipating providers may choose whether to accept Medicare assignment on an individual, case-by-case basis. You should ask any nonparticipating providers you see if they will accept assignment of your claim.
If your provider does not accept assignment, there is still a limit on the amount you pay for most services. This limit is 115% of the Medicare allowed amount and is called the limiting charge.
Medicare calculates payment based on the Medicare allowed amount and pays 80%. If the service is covered by AlaskaCare, it recognizes 115% of the allowed amount and pays the difference between what Medicare paid and the 115% that your provider can collect.
A nonparticipating provider who does not accept assignment of your claim must still file your Medicare claim for you.
Providers Who “Opt Out” of Medicare
Providers who “opt out” of Medicare have signed a contract with Medicare stating they will not bill Medicare for services provided to any Medicare beneficiary. These providers are prohibited from filing any claims with Medicare and may charge you any amount for their services, with no limit. You may purchase services from such a provider, but the provider will require you to sign an agreement (a private contract) stating that you are responsible for payment in full. These services are considered to be under a private contract. The AlaskaCare Retiree Health Plan will not pay anything for services provided under a private contract.
Note: This Medicare and Social Security information is an overview and is not intended to provide detailed information regarding Medicare or Social Security benefits.
