How do I access care?
As you know, original Medicare (Parts A and B) only covers a portion of medical expenses, leaving you to pay the remaining costs out-of-pocket. This is why most people look for a supplement to assist with the remaining costs.
Some Medicare supplement plans may have limited networks of healthcare providers, making it difficult for individuals to access the care they need. Impact members are not restricted to a network. You can see any provider you wish. You just need to be sure that they accept Medicare.
Always ask the provider to bill Medicare first, then Impact, so make sure to have both cards with you at each appointment.
Medicare will send you a Medicare Summary Notice (MSN) or Explanation of Benefits (EOB).
The MSN is a notice that you are sent in the mail every 3 months. If you sign up for an electronic notice, you will get it monthly. You will want to do that and get them monthly to submit to Impact for more timely processing.
The MSN will show::
- All your Part A and Part B-covered services or supplies billed to Medicare during the period
- What Medicare paid
- The maximum amount you may owe the provider
What should you do?
- Create an online Medicare Account at medicare.gov
- Once your account is created, you can download your MSN/EOB’s as often as you’d like.
- To prevent delays, you should print your MSN/EOB’s monthly and upload them to Impact using the medical expense tool. If you wait for Medicare to send them to Impact you could be waiting a very long time. Impact cannot process your bills until AFTER Medicare has processed them and you have submitted them to Impact.
Completing a medical expense form requires detailed information. Please provide as much as you can to ensure timely processing. Missing information may delay processing.
One of the most important things to include is the billing codes, or you can just ask your provider for the CMS1500/HCFA form or UB04 form to submit with your MSN or EOB.
Medicare should pay their portion of the bill and once you pay your $1000 PRA, Impact will share the remaining 20% of all eligible medical bills.
Remember that first, you must pay your Primary Responsibility Amount (PRA) of $1000 before Impact members will share the portion of your Eligible Medical Bills that Medicare allows but does not pay completely.
Impact for Seniors have a Primary Responsibility amount of $1,000. This amount is similar to an insurance deductible and is the amount you are responsible for paying before bills can be shared. Once you have met that amount, your medical bills will be shared and paid by other members as pursuant to the eligibility criteria. Eligibility of medical bills is determined in accordance with your Impact Guidelines. Your original application and all medical information pertaining to the incident may be reviewed again prior to sharing.
If you have questions regarding your review, you may call Member Services at 855-378-6777.
Prescriptions:
In order for Impact to share in prescription costs, you must have Medicare part D, too.
The sharable amount is limited to $1200 per member per membership year after your PRA has been met.
After your PRA has been met, the prescription amount may be shared as follows:
- After the first $25 on generic drug prescription.
- After the first $50 on brand name prescription when a generic is unavailable.
- Prescription medications must be purchased using the member ID card.
- Members pay 100% of the (discounted) prescription amount at the pharmacy and submit receipts.
- Members must submit their Part D EOB (Explanation of Benefits) to Impact here. Medicare will mail your Part D EOB monthly.