Options Federal plus Medicare
Coordination of benefits with Original Medicare
In most cases, when you have coverage through Original Medicare, your claim will be coordinated automatically.
If you have Part A and Part B of Medicare, and Original Medicare is your primary payor, we will waive your out-of-pocket costs for Medicare-covered services as follows for the Standard Option:
- Inpatient hospital coinsurance
- Surgical and medical care coinsurance and copayments
We will not waive the following:
- Non-Medicare member’s cost-share
- If you have Part A only, we will not waive deductible, coinsurance, and copayments for Part B services (such as outpatient surgical or medical care)
- If you have Medicare Part B only, we will not waive deductible, coinsurance, and copayments for Part A services (such as home health, hospice, skilled nursing, or inpatient hospital care)
- Prescription drug copayments
- The High Deductible Health Plan (HDHP) deductible and coninsurance
To coordinate benefits, you must tell us about your Medicare coverage.
You must tell us if you or a covered family member has Medicare coverage, and let us obtain information about services denied or paid under Medicare if we ask. You must also tell us about other coverage you or your family members may have, as this coverage may affect the primary/secondary status of your Kaiser Permanente Washington Options Federal coverage and your Medicare coverage. Members can download the Multiple Coverage Form to provide this information.
Please note that the above information is a summary of the Kaiser Permanente Washington Options Federal benefits. Before making a final decision, please read the Plan’s Federal brochure (RI 73-051). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure.
This page was last updated: October 15, 2018 at 3:00 pm PT