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State Members

Medicare

Medicare eligible members must submit a copy of their Medicare card to MCHCP and the reason for Medicare coverage.

If Medicare coverage begins before age 65, members will receive a Medicare Disability Questionnaire. MCHCP must receive the completed questionnaire to update the member’s Medicare status.

Active employees and dependents do not need to enroll in Medicare Part B, except if Medicare eligible solely due to End Stage Renal Disease (ESRD). When Medicare-eligible members are no longer actively employed, Medicare becomes the primary plan. MCHCP medical plans coordinate benefits with Medicare Parts A and B. If MCHCP does not receive verification of Medicare Part B enrollment, the member is responsible for expenses Medicare Part B would have covered.

  • Active Employees and Dependents with Medicare
    MCHCP is primary and claims are submitted first to the MCHCP medical plan, then to Medicare. The exception is for active employees and dependents with Medicare solely due to End Stage Renal Disease (ESRD). Those in the Health Savings Account (HSA) Plan can no longer contribute to their HSA. However, existing funds can still be used for qualified medical expenses.
  • Retirees, Survivors, Long-Term Disability and Terminated Vested Subscribers and Dependents with Medicare
    Medicare is primary and claims are submitted first to Medicare, then to the MCHCP medical plan. MCHCP premium may be adjusted based on Medicare status. Members are automatically enrolled in Express Scripts Medicare Prescription Drug Plan (a Medicare Part D plan). Under federal regulations, enrollment in an additional Medicare Part D plan is not allowed.
  • Medicare Eligible Due to End Stage Renal Disease (ESRD)
    When eligible for Medicare solely because of ESRD, the MCHCP medical plan is primary to Medicare during the first 30 months of Medicare eligibility. After 30 months, Medicare becomes primary and claims are submitted first to Medicare, then to the MCHCP medical plan. The member is responsible for notifying MCHCP of their Medicare status. When members become Medicare primary, they are automatically enrolled in Express Scripts Medicare Prescription Drug Plan (a Medicare Part D plan). Under federal regulations, enrollment in an additional Medicare Part D plan is not allowed.

When Medicare is primary, members do not have to use network providers. As long as the provider accepts Medicare assignment, benefits will be paid at the network level. Services not covered by Medicare, such as hearing aids, are subject to preauthorization.

For claim questions, members should contact their medical plan or call the Medicare Coordination of Benefits Unit at 800-999-1118. For more details regarding Medicare enrollment, contact the local Social Security office or call 1-800-MEDICARE (1-800-633-4227).

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