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How OU Health Works with Medicare

When a member and/or spouse become Medicare eligible, it is very important that they contact Medicare to determine their enrollment needs. Failure to do so at that time could be very costly down the road.

Once an OU Health member is retired or no longer working and on Medicare, you no longer have to be concerned about your provider/facility being a Blue Cross Blue Shield provider. Instead, you must be sure that any healthcare provider/facility you use accepts Medicare. Medicare becomes your primary medical coverage and OU Health becomes secondary (there are a few exceptions, please see the Plan Document for further information).

There are two (2) parts to Medicare.  

  • Medicare Part A is Hospital insurance - Most people get Part A automatically when they turn age 65. You do not have to pay a monthly premium.
  • Medicare Part B is Medical insurance -There is a standard monthly premium. (Go to www.medicare.gov for the current year's premium.) If you do not choose Part B when you first become eligible at age 65, the monthly premium may be increased. (Go to www.medicare.gov for additional information.)

Failure to Enroll in Medicare:

If a Covered Person is eligible for Part A and/or Part B of Medicare, but does not enroll in one or both parts, the benefits payable under this Plan will be reduced by the amount he would have received if he had actually enrolled. A Covered Person is considered eligible for Medicare on the earliest date any coverage under Medicare could become effective for him. It is important to enroll in Medicare as soon as you are eligible, so that you do not lose any benefits the Plan would otherwise pay. 

Coordination of Benefits (COB) with Medicare:

Except as otherwise stated in the Plan Document, Medicare will be primary and this Plan will be secondary. 

Active Employees Medicare-Eligible Due to Age:

If a covered active Employee (or his Dependent) is eligible for Medicare due to age, this Plan will continue to be primary coverage for that covered Employee or Dependent, provided the Employee remains working. 

Always remember to ask your medical provider/hospital if they are a Medicare provider/hospital: 

Examples of the Coordination of Benefits (COB) circumstances with the OU Health Plan. 
Medical and Hospital Charges 
The order in which a claim would be paid if: 

  • Member is retired, with family plan, and on Medicare, spouse is retired with no other coverage through his/her employment and on Medicare - Medicare is then primary for both with the OU Health Plan being secondary.
  • Member is actively employed, with a family plan, spouse is on Medicare (and has no other coverage through his/her employment) -OU Health Plan is primary for active member and spouse, with Medicare secondary for the spouse.
  • Member is retired, with family plan, and on Medicare, spouse is actively employed with family plan and not Medicare eligible, Spouse's active plan is primary for OU member and Medicare is second, OU Plan is tertiary.
  • Member is retired, with family plan, and on Medicare, spouse is actively employed with a family plan, and is Medicare eligible: Spouse's plan is primary for our member, Medicare is second, OU Health Plan will be tertiary.
  • Order of benefits for spouse under the OU member's plan: Spouse's active plan is first, Medicare is second (if spouse does not enroll in Medicare, OU Plan will estimate Medicare's responsibility), OU Plan is tertiary.