In general, if you are eligible for Medicare, your Aetna plan benefits are automatically coordinated with Medicare. You become eligible for Medicare either because of your age or your disability. You are eligible for Medicare if you are over 65 years old. You are also qualified for Medicare if you are receiving disability benefits through Social Security or Railroad Retirement, regardless of your age. You are also entitled for Medicare if your disability was caused by end-stage renal disease. Once you are qualified for Medicare, your Aetna plan becomes secondary payor of benefits while Medicare becomes the primary payor. This means that Medicare will first cover your medical epenses, and the rest will be covered by Aetna. The Government Eclusion method is normally used by all of the Emeriti post-65 plans to calculate payment. This method is the simplest to administer and the most common form of Medicare Integration. The covered epenses under your Aetna plan are reduced through the benefits paid by Medicare using the Government Eclusion method. The residual epenses are dependent on the deductible and regular coinsurance provisions of the Aetna plan. The underlying medical plan modifies its benefits under the normal claims adjudication regulations for that plan, regardless of the type of coordination used. For eample, if you incurred a medical epense of $1,100, you will only have to pay $44 in total epenses using the Government Eclusion method. Using this Medicare Integration method, $100 is deducted from the total payment. On the other hand, you will have to pay a bigger amount of $124 if Medicare Integration options are not used, given the same amount of $1,100 in medical epenses. Medicare integration is usually the process applied when Medicare is the primary payor and the Aetna plan is the secondary payor. This process establishes the etent of the payment liability of the Aetna plan as secondary payor. As the Primary Payor, Medicare becomes the primary plan that provides coverage for you. -- June 11, 2009 @ 5:49 pm