Informational Update March 2018

(from Norm Sherman,  CSA Florida Outreach Coordinator)

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1.   Does Medicare Coverage Extend Outside of the USA? – In most cases, Medicare does not cover medical services or health supplies outside of the USA, including using a doctor on a cruise ship. “Outside the USA” means anywhere outside of the 50 states, the District of Columbia, Puerto Rico, the US Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands. However, if you incur a medical expense abroad, GHI, as your secondary coverage, will offer coverage. The way it works is:

·  Blue Shield Blue Cross will cover hospitalization.

·  Emblem Health (GHI) will cover 100% of the amount it allows (which may not be much) for a medical expense after a $200 deductible.

·  Procedure for Receiving Reimbursement: You must have an itemized bill in English. The money must be in dollars and cents. Submit the bill along with proof of payment to the CSA Retiree Welfare Fund, 40 Rector St., New York, NY 10006, Attention: Dr. Douglas Hathaway

Because GHI offers minimal coverage in a foreign country, I highly recommend you obtain travel insurance before traveling abroad.

 

2.   “Valentine’s Gift” – Retired CSA administrators or supervisors who are Medicare eligible and have the GHI Enhanced Plan D plan should have received their “Valentine’s gift” of $480 for 2017 this past February. This is a CSA Welfare Fund benefit designed to help defray the cost of the High Option Rider that pays for the Enhanced Plan D. The amount was sent in a check. Those who were eligible for reimbursement, but were not on Medicare for the full year, should have received a pro-rated check.

Eligible CSA retirees who have not received a check should contact the CSA Retiree Welfare Fund, 212-962-6061. Remember, only Medicare eligible CSA retirees are entitled to the “Valentine’s Gift.” If both husband and wife are Medicare eligible CSA retirees, then both are entitled to the gift.

For non-Medicare CSA retirees and non-Medicare dependent spouses, the CSA Welfare Fund and CSA Retiree Chapter will continue to cover copays, providing the member and spouse are under the GHI or HMO plans. After a $100 deductible, the reimbursement is 80% of the drug cost up to a maximum of $10,000. In addition, the CSA Retiree Chapter supplements the reimbursement with an additional 20% of the Fund payment.  

 

3.   Medicare Coverage of Immunizations and Vaccines – Medicare covers vaccines and immunizations. How they are covered and the costs will depend on the type of immunization and your particular circumstance.

Most vaccines and immunizations are covered under Medicare Part D prescription drug benefit. If you need to get one of these immunizations, check with the CSA Retiree Welfare Fund to learn the coverage and cost to you.

There are three immunizations that fall under Medicare Part B since they are considered preventative. These immunizations are covered at the 100% Medicare-approved amount. This means that if you receive one of these immunizations from a Medicare doctor, you will not have to pay anything. These immunizations are: 

· Flu Shot – Medicare Part B pays for 1 shot per year. In some instances, depending when you received the shot, it may pay for two. For example, if you got one Jan 2018 for the 2017/18 season, you could get another in December 2018 for the 2018/19 season.

· Pneumonia Shot – Part B covers two separate shots. If you are receiving a shot for the first time, Part B covers the first shot. The second year, you will be covered for a different, second vaccination. You are not required to provide any vaccination history. Your word will be good enough.

· Hepatitis B Shot – Part B covers this shot if you are medium to high risk for hepatitis B. You should ask your family doctor if you are in the aforementioned categories. If you are a low risk candidate for hepatitis B, Part D covers the vaccine.

There are other medically necessary vaccines, e.g., rabies shot, covered by Medicare Part B, but only 80% of the cost. However, your secondary coverage should pick up the other 20%.

 

4. Medicare Therapy Caps Removed – Great News! The Medicare cap of $2010 for Physical, Speech and Occupational Therapy has been removed as a result of Congress repealing the caps. Under the cap, you would only be able to get about 16 sessions. If you were lucky, you were able to get an extension. Now, the cap no longer applies and you can get therapy for as long as your doctor says you need it.

What about the CSA Retiree Welfare Fund Therapy benefit? The Fund is reviewing that benefit to see if it can be applied to another area. More on that in the future.