Coordination of Benefits Between Medicare and the A&M System Health Plan

Although many factors dictate whether your A&M System health plan or Medicare will be primary or secondary, in general, coverage is determined by the status of the A&M health plan policy holder.

 

 

If you are: And the Policy Holder is a(n): And you are: Which plan pays first for you?
The Employee/Retiree, or the Spouse of an Employee/Retiree Active Employee
Any age The A&M System plan
Working Retiree* Under age 65 The A&M System plan
Working Retiree* Age 65 or older The A&M System plan
Retiree Under age 65 The A&M System plan;
if you are a spouse 65 or over or a disabled spouse eligible for Medicare, then Medicare is primary for you. 
Retiree Age 65 or older Medicare;
if you are a spouse under age 65 and not eligible for Medicare, then the A&M System plan is primary for you.
The Disabled Retiree

 

Retiree Under age 65 The A&M System plan;
if you are a spouse 65 or over or a disabled spouse eligible for Medicare, then Medicare is primary for you. 
Retiree Under age 65 and have received Social Security Income for 2 years
Medicare;
if you are a spouse under age 65 and not eligible for Medicare, then the A&M System plan is primary for you.
Retiree Age 65 or older Medicare;
if you are a spouse under age 65 and not eligible for Medicare, then the A&M System plan is primary for you.

*Working retiree definition: The policy holder is an A&M retiree working for the A&M System at least 50% time (20 hours a week) for at least 4 1/2 consecutive months.

For coordination of benefits information concerning End Stage Renal Disease (ESRD), click here.

For more information, you can review the booklet Medicare and Other Health Benefits: Your Guide to Who Pays First, available at: http://www.medicare.gov/Pubs/pdf/02179.pdf or you can contact Medicare to get a copy. You can also review the fact sheets on the System Benefits Administration website at: http://www.tamus.edu/offices/benefits/employee-retiree-benefits/medicare-information/.

January 2014