Navigating Medicare can be difficult and sometimes downright confusing. There are many decisions to be made when you become eligible for Medicare. Dean Health Plan (DHP) can help. First, call our Customer Service Department at 608-828-1301 or 800-279-1301.
A representative may be able to answer your questions. If you need further information, our Medicare eligibility specialist can help you. You can contact the Medicare specialist through our Customer Service Department. He will answer your questions directly. If he is not available when you call, please leave your telephone number, and he will contact you as soon as possible regarding any issue you have about Medicare eligibility.
Find Out if You Are Eligible
You may be eligible for Medicare benefits if:
- You are 65 years old. The decision to enroll in Medicare at age 65 depends on your or your spouse’s work status and the size of the employer. If your or your spouse’s employer has 19 or fewer employees, Medicare will become the primary payer of your medical claims, even if you are still working.
- You are considered Medicare disabled. Social Security may deem you eligible for Medicare due to a disability. In most cases, you must be considered disabled for a total of 29 months before Medicare A/B is offered. Prior to the end of the 29 months, Social Security will send you information for enrollment in Medicare. Again, your or your spouse’s work status and the employer size will become a factor. If your or your spouse’s employer has 99 or fewer employees, Medicare will become the primary payer of your medical claims, even if you are still working.
- You are diagnosed with end-stage renal disease (ESRD). If you are eligible to enroll in Medicare because of ESRD, normally your group health plan will be the primary payer of all your medical bills for a 30-month coordination period, whether or not you are enrolled in Medicare. Employer size and work status do not matter in this case if ESRD is the initial reason you became eligible for Medicare. In most cases, at the end of the 30-month coordination period, Medicare will become the primary payer of your claims. There are exceptions. Because ESRD is such a complex situation for all involved, DHP works through each case closely with Social Security and the local Medicare carrier to ensure correct payment of claims.
Monthly Medicare Questionnaires
DHP regularly sends questionnaires out to update coordination of benefits with Medicare. When you receive one of these questionnaires, you should respond as soon as you know your Medicare status. Questionnaires are first sent about 60 days before your 65th birthday. We send a second request within 30 days if we don’t receive a response from the first mailing.
Important Information
to Keep in Mind
Please remember, it is your responsibility to inform DHP when you or any insured dependent becomes eligible or covered under Medicare. You can let DHP know by calling our Customer Service Department, telling your employer (who should pass this to the DHP Marketing Account Representative
handling your group) or calling the DHP Medicare Eligibility Specialist.
Although DHP cannot force anyone to enroll in Medicare, we can pay your claims as if you or a dependent were enrolled. You will have to pay the expenses that Medicare would cover. So please be sure to call us if you have any questions about Medicare eligibility.
This information is contained in the section under “Coordination of Benefits” in the DHP Member Certificates.
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