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Medicare and the Plan

MHBP knows that Medicare benefits alone may not meet your total health care needs or expenses. That’s why our Standard Option is the perfect choice when you have Original Medicare (Parts A and B) as your primary coverage.* Experience greater savings, comprehensive benefits and no claim filing hassles. Take a closer look at how Standard Option can benefit you.

MHBP Standard Option Benefits when Medicare is Primary

MHBP Standard Option offers you valuable benefits when you have Original Medicare (Part A and Part B) as your primary coverage.

What MHBP Standard Option with Original Medicare covers:

  • 100% of your Medicare Part A deductible
  • 100% of your Medicare Part B deductible
  • Medicare’s coinsurance that applies to physician and other outpatient services, which does away with most of your out of pocket expenses
  • Comprehensive prescription drug benefits, including mail order pharmacy service for added savings and ease

What MHBP Standard Option with Original Medicare waives:

  • Your annual deductible
  • Your cost-sharing (copayments and coinsurance) for care covered by both MHBP and Medicare

And with MHBP, you’ll get benefits for services that Medicare doesn’t cover:

  • 100% coverage for network preventive care - annual routine exams, immunizations and tests like mammograms, PAP tests, PSA tests and more
  • Overseas coverage - you get network-level benefits for covered care anywhere in the world
  • Chiropractic care - Medicare does not cover chiropractic care, but MHBP does (up to the 26-visit alternative care annual limit)

If you also have a Medicare Part D plan, MHBP will coordinate benefits, but we will not waive our copayments or coinsurance.

For more information about Standard Option and Medicare, review Section 9 of the Official Plan Brochure (RI 71-007) and our Guide to MHBP and Medicare booklet.

If you still have questions, we’re here for you 24 hours a day, 7 days a week. Call us at 800-410-7778, except on major holidays.

MHBP and Medicare: Coordinating Your Benefits FAQ's

  • MHBP Picks Up Where Medicare Leaves Off

    If you’re retired, MHBP generally pays 100% of the difference between what Medicare pays and the allowed amounts for covered medical services when you have Original Medicare (Parts A and B).1 This includes paying Medicare’s cost-sharing, such as the per-admission hospital deductible, Part B deductible, and the coinsurance you would normally have to pay. We’ll also waive your Standard Option cost-sharing for services covered by both Medicare and MHBP.

  • MHBP Coordinates Your Medical Benefits

    Coordinating benefits with Medicare has never been easier. For your convenience, when Medicare is your primary coverage we can automatically retrieve your paid claims from Medicare and process any remaining balances for covered expenses under your MHBP benefits.

  • MHBP Provides Prescription Drug Benefits

    MHBP provides comprehensive prescription drug benefits that help you save on your medications. You can choose generic or brand name drugs, but you'll pay lower copayments when you use a generic. What's more, you have a choice of using a network retail pharmacy or our mail order drug program for many medications.

    The mail order drug program can be used for most maintenance prescription drugs, and you can receive up to a 90-day supply of a covered medication for just one low co-payment. And, you can choose to pick up your 90-day supply at a CVS retail pharmacy, if one is available near you.

  • MHBP Provides Hearing and Vision Discount Programs 2
  • MHBP Offers Additional Dental and Vision Benefits 3

1 The information provided here assumes that you are enrolled in MHBP Standard Option and Original Medicare (Part A and Part B) is your primary coverage. MHBP will waive your cost-sharing (deductible, copayments and coinsurance) for services covered by both MHBP and Medicare. MHBP will not waive your cost-sharing for prescription drugs. If you have a Medicare Advantage Plan, MHBP will not waive your cost-sharing. If you are enrolled in Value Plan, MHBP will not waive your cost-sharing.

2 These benefits are not part of the FEHB contract, but are made available to all MHBP members at no additional premium. You cannot file a FEHB disputed claim about them. The fees you pay for these services do not count toward FEHB deductibles or out-of-pocket maximums.

3 These benefits are not part of the FEHB contract or premium, and you cannot file a FEHB disputed claim about them. The fees you pay for these services do not count toward FEHB deductibles or out-of-pocket maximums. The MHBP Dental Plan is underwritten by First Health Life & Health Insurance Company.

* The information on this page assumes that you are enrolled in MHBP Standard Option and that Original Medicare (Part A and Part B) is your primary coverage for health benefits. MHBP will not waive copayments or coinsurance for retail or mail order prescription drugs. If you have a Medicare Advantage Plan, MHBP will not waive our deductible, copayments or coinsurance. When you are enrolled in MHBP Value Plan, MHBP will not waive our deductible, copayments or coinsurance.