Summary Plan Description

Medicare

Medicare includes:

  • Part A (hospital insurance) which helps cover inpatient hospital care, skilled nursing facility care, home health care, and hospice care. Generally, there is no cost for Medicare Part A. Retirees and dependent spouses should enroll in Medicare Part A when eligible, because the benefits of this plan are provided as if actually enrolled in Medicare Part A.
  • Part B (medical insurance) which helps cover physician services and outpatient hospital care. It may also cover some services that Medicare Part A does not cover. A monthly premium is generally required for Medicare Part B. A deductible is also required before Medicare starts to pay. Retirees and dependent spouses should enroll in Medicare Part B when eligible because the benefits of this plan are provided as if actually enrolled in Medicare Part B.
  • Part C (Medicare Advantage Plans) which is the part of Medicare policy that allows private health insurance companies to provide Medicare benefits. These Medicare private health plans, such as HMOs and PPOs, are known as Medicare Advantage Plans.
  • Part D (prescription drug coverage) which helps cover prescription drugs. A monthly premium is generally required for Medicare Part D. However, Medicare Part D coverage is provided to Medicare eligible retirees or their dependents who enroll in Retiree Coverage provided by Carpenters Trusts.

You are eligible to enroll in Medicare if:

  • You are age 65 or older;
  • You are under age 65 and receiving disability benefits from Social Security or the Railroad Retirement Board (there may be a waiting period before commencement of Medicare); or
  • You have end-stage renal disease (ESRD).

Medicare Enrollment

Individuals receiving benefits from Social Security or the Railroad Retirement Board should be automatically enrolled in Medicare the first day of the month they turn age 65. Individuals under age 65 and disabled, should be automatically enrolled after receiving disability benefits from Social Security or the Railroad Retirement Board for 24 months (although a shorter waiting period may apply in some instances). Individuals who do not want Medicare Part B, must follow the instructions that come with the Medicare card. However, if a retiree or dependent of a retiree is eligible for Medicare Part B, benefits under this plan are provided as if the retiree or a dependent is enrolled in Medicare Part B, regardless of whether they actually enroll.

Individuals turning age 65 who are not receiving Social Security or Railroad Retirement benefits, must apply for Medicare. Even if the Social Security age is older than age 65, eligibility for Medicare enrollment is still age 65.

There is an initial enrollment period for Medicare Part B, which begins three months before the month an individual turns age 65, and ends three months after the month an individual turns age 65. However, the starting date for Medicare Part B will be delayed for individuals who do not sign up before the month they turn age 65.

Individuals who do not sign up for Medicare Part B during the initial enrollment period, may sign up during the general enrollment period which runs from January 1 through March 31 of each year. Medicare Part B will start on July 1 of the year of sign up. The cost of Medicare Part B generally increases for each 12-month period that an individual could have taken Medicare Part B but did not.

There is a special enrollment period for those who waited to enroll in Medicare Part B because they or a spouse was working and had other group health plan coverage based upon that employment. The special enrollment period is anytime the individual is still covered in the group health plan, or during the eight months following the earlier of the month that group health plan ends or employment ends.

If you or a dependent is under age 65 and covered by Medicare you must submit proof of Medicare eligibility.

Please notify Carpenters Trusts in writing within 30 days of receipt of notification of Medicare eligibility.

If you or a dependent have end-stage renal disease you should also enroll in Medicare. Different enrollment rules may apply and you should contact Social Security for information (please see Kidney Dialysis).

Importance of Enrollment In Medicare

If you are covered under Retiree Coverage, it is important for you to enroll in Medicare Part A and Part B as soon as you are eligible:

  • You pay a lower monthly contribution rate for Retiree Coverage if you are eligible for Medicare Part A and Part B.
  • If you do not enroll in Medicare, it increases your out-of-pocket expenses because the amount of benefits that would have been payable by Medicare will be subtracted from this plan's payable benefits, even if you are not enrolled in Medicare Part A and Part B (please see Coordination of Benefits).
  • If you do not enroll in Medicare when first eligible, you incur a penalty for your Medicare premium for as long as you have Part B coverage.
  • Medicare Part D (prescription drug coverage) is provided under Retiree Coverage.

SecureHorizons

The Board of Trustees negotiated a special benefit package for Medicare-entitled retirees and dependents permanently living in the SecureHorizons service area in Washington State. The SecureHorizons Medicare Advantage Plan provides benefits for services and supplies otherwise covered by Medicare, as well as prescription drugs, routine vision care, and dental care. Coverage under SecureHorizons also provides life insurance benefits through the Carpenters Health and Security Plan. If you have coverage through SecureHorizons, no coverage is provided by the Carpenters Health and Security Plan, except life insurance coverage.

To enroll in SecureHorizons, please contact Carpenters Trusts for a SecureHorizons Enrollment Kit and Application. If you are not eligible for Medicare at this time, you will be notified of this option when you become eligible for Medicare. Plan benefits are described in a separate document mailed to SecureHorizons enrollees.

The SecureHorizons Medicare Advantage Plan is only available to the extent that the contract between United Healthcare (SecureHorizons) and the Centers For Medicare and Medicaid (CMS) under which SecureHorizons is offered is not terminated, the SecureHorizons service area is not reduced, or the Board of Trustees continues to offer this option as an alternative to Retiree Coverage. Enrollment is subject to CMS rules and regulations.