Whether you’re getting ready to retire or are already retired, you can turn to APWU Health Plan for answers to your questions about Medicare. We’ve been serving postal and federal employees, retirees, and families since 1960. If you can’t find an answer to your question, contact APWU Health Plan to speak with a customer service representative:
Monday – Friday, 8:30 am – 6:30 pm ET
Medicare is federal health insurance for anyone age 65 and older and some people under 65 with certain disabilities or conditions, including end-stage renal disease (ESRD). It’s made up of four parts—Part A, Part B, Part C, and Part D. Each part helps pay for certain services and also includes specific costs you may need to pay.
Original Medicare is a fee-for-service health insurance program that has two parts: Part A and Part B. You typically pay a portion of the costs for the covered services you receive. Under Original Medicare, you don’t have coverage through a Medicare Advantage plan or another type of Medicare health plan.
Original Medicare (Parts A and B) covers most medically necessary services and supplies in hospitals, doctors’ offices, and other healthcare facilities. In general, Original Medicare does not cover most vision, dental, and hearing services.
Medicare Part A (hospital insurance) helps pay for inpatient care you get in hospitals, skilled nursing facilities, and some home health care. It also helps cover hospice care.
Most postal and federal employees and retirees are entitled to premium-free Part A.
Medicare Part B (medical insurance) helps cover the outpatient services you receive from doctors and other healthcare providers:
Part B covers medically necessary services and supplies that meet accepted standards of medical practice to diagnose or treat a medical condition. In addition, it covers preventive services, like screenings, flu shots, vaccines, and yearly wellness visits.
Your premium is deducted from your Social Security check each month, and you must meet a deductible. You’ll also need to pay a percentage for most doctor services, usually 20%.
For many retirees, Part B is a critical component of an overall health package. If you don’t sign up for Part B when you’re first eligible, you may be penalized by paying a much higher monthly premium.
Medicare Advantage (Part C) is a Medicare-approved plan from a private company that offers an alternative to Original Medicare. Plans provide Part A (hospital insurance) coverage, Part B (medical insurance) coverage, and usually include Part D (prescription drug) coverage.
Medicare Advantage plans may also offer extra coverage for vision, hearing, dental, and/or health and wellness programs.
APWU Health Plan offers a Medicare Advantage plan for High Option members.
Medicare Part D helps cover the cost of prescription drugs. Sometimes called prescription drug plans, or PDPs, Part D is a separate plan that adds drug coverage to Original Medicare. While anyone who qualifies for Medicare can enroll in Part D, PDPs are optional and only available through private insurance companies approved by Medicare.
You will pay a monthly premium, and must meet a deductible. You will also need to pay either a set amount per prescription (copayment) or a percentage of the cost (coinsurance).
As an APWU Health Plan member, there is no need for you to enroll in Medicare Part D. If you are enrolled in Medicare and are not enrolled in a Medicare Advantage plan (Part C), you will be automatically enrolled in the Medicare PDP for APWU Health Plan.
To get Medicare, you must be a U.S. citizen or legal resident who has lived in the country for at least five consecutive years. The federal health insurance plan is for people who:
You can enroll in Medicare at specific times. The Initial Enrollment Period is a seven-month period that starts three months before the month you turn 65 and ends three months after the month you turn 65.
After you enroll, you can change your coverage during Medicare Open Enrollment, October 15 – December 7.
To explore your enrollment options and access helpful resources, visit the official Medicare website of the United States government.
To sign up for Medicare Part A (hospital insurance) and/or Medicare Part B (Medical Insurance), you need to contact the Social Security Administration (SSA).
You need to sign up through Social Security (or, in some cases, through the Railroad Retirement Board) so they can verify your eligibility for Medicare. They will also check to make sure you paid Medicare taxes long enough to get Part A without having to pay a monthly premium.
If you’re 65 or older, you can sign up for Medicare online and enroll in Parts A and B, or in Part A only. You can delay Part B if you’re already covered through an employer group health plan.
If you have previously declined or never signed up for Part B, you can sign up for Part B only.
For more information, contact the SSA:
Social Security Administration
1-800-772-1213
1-800-325-0778 (TTY)
Monday – Friday, 8 am – 7 pm
f you or your spouse are employed and have APWU Health Plan, the Health Plan is your primary coverage and Medicare is secondary. If both you and your spouse are retired, Medicare is your primary coverage and APWU Health Plan is secondary.
Part A (hospital insurance)
In general, if you have Part A as your primary insurance, you do not need to get precertification for a hospital stay. However, a stay must be precertified prior to the 90th day of confinement in a benefit period.
Part B (medical coverage)
With Part B, Medicare pays first, and APWU Health Plan pays second. When Medicare is primary and you have the High Option, most of your medical expenses are covered 100% because your deductible and coinsurance are waived for covered services. With the Consumer Driven Option, deductibles and coinsurance are not waived, but you can use your PCA to be reimbursed for your Part B premiums.
Medicare participating doctors and suppliers
Medicare usually pays 80% for covered services after you satisfy the Part B annual deductible. As long as services represent a covered benefit, the High Option pays the Part B deductible and the 20% coinsurance, which means you’re covered 100%. With the Consumer Driven Option, if you have benefit dollars in your Personal Care Account, the Medicare deductible and coinsurance will be paid.
Part D
Prescription drug program (PDP)
As a retiree covered under the Postal Service Health Benefits (PSHB) Program or Federal Employees Health Benefits (FEHB) Program, you will be automatically enrolled in our Part D prescription drug program (PDP).
The Medicare PDP is not available to retirees covered under the FEHB Program who enroll in the Consumer Driven Option.
Yes, when you enroll in both Medicare Part A and Part B, our High Option plan can help maximize your healthcare coverage and get your medical bills paid 100%.
Medicare generally doesn’t pay for hospital or medical services outside the United States, Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
However, the High Option covers you around the world. When you have services outside of the U.S., you’ll probably have to pay the bill at the time of service and submit the bill to APWU Health Plan for reimbursement.
As a High Option member, you can receive Medicare Part D coverage at no extra cost through the Express Scripts Medicare Prescription Drug Plan (PDP) Employer Group Waiver Plan (EGWP).
If you are enrolled in Medicare and are not enrolled in a Medicare Advantage plan (Part C), you will be automatically enrolled in the Medicare PDP for APWU Health Plan.
The plan is a prescription drug benefit for Medicare-eligible annuitants and family members covered under the Postal Service Health Benefits (PSHB) Program or Federal Employees Health Benefits (FEHB) Program.
With this Medicare Part D coverage, you have access to:
For details about the Medicare PDP, contact Express Scripts Medicare at 1-844-818-8790, 24 hours a day, 7 days a week.
As a Consumer Driven Option member, you can receive Medicare Part D coverage at no extra cost through the UnitedHealthcare MedicareRX Part D plan.
If you are enrolled in Medicare and are not enrolled in a Medicare Advantage plan (Part C), you will be automatically enrolled in the Medicare PDP for APWU Health Plan.
The plan is a prescription drug benefit for Medicare-eligible annuitants and family members covered under the Postal Service Health Benefits (PSHB) Program.
With this Medicare Part D coverage, you have access to:
The Medicare PDP is not available to Consumer Driven Option members covered under the Federal Employees Health Benefits (FEHB) Program.
To learn more about the Medicare Part D prescription drug plan, contact UnitedHealthcare MedicareRx Part D at 1-888-201-4265, 8 am – 8 pm local time, Monday – Friday.
Yes, the UnitedHealthcare® Medicare Advantage (PPO) for APWU Health Plan enhances your coverage under the Postal Service Health Benefits (PSHB) Program or Federal Employees Health Benefits (FEHB) Program by reducing or eliminating cost-sharing for services.
To qualify for enhanced Medicare Advantage benefits you must be retired, enrolled in APWU Health Plan High Option, and enrolled in Medicare Parts A and B.
Benefits of our Medicare Advantage plan include:
To find out if you’re eligible to enroll in the Medicare Advantage plan, call 1-855-383-8793, or 711 (TTY), 8 am – 8 pm CT, Monday – Friday.
Medicare Advantage plans are Part C plans that are offered by private insurers like UnitedHealthcare. They offer all the benefits of Original Medicare Part A and Part B. Many Medicare Advantage plans include prescription drug coverage (Part D) and typically include additional benefits, features, and programs. You must remain enrolled in Medicare Part A and Part B to be eligible for a Medicare Advantage plan.
APWU Health Plan has been serving retirees since 1960. Retirees make up a big portion of our plan population, and they are very important to us. We thank you for your service to our country and now it’s our turn to take care of you. APWU Health Plan designed this Medicare Advantage plan in collaboration with UnitedHealthcare to provide an enhanced level of benefits that focus more closely on senior health and well-being.
The UnitedHealthcare Medicare Advantage for APWU Health Plan offers all the benefits of Original Medicare Part A and Part B, plus prescription drug coverage (Part D) and additional benefits, such as a $100 monthly Medicare Part B subsidy, a Renew Active® fitness benefit, UnitedHealthcare® HouseCalls, and much more.
This is a custom Group Medicare Advantage (PPO) plan designed exclusively for APWU Health Plan’s High Option members. This plan is different and should not be confused with individual UnitedHealthcare Medicare Advantage plans that might be available in the area.
Typically, enrollment in a Medicare Advantage plan would cause a suspension or termination of PSHB Program or FEHB Program coverage. However, the Medicare Advantage for APWU Health Plan was designed for PSHB Program and FEHB Program retirees to allow you to retain your status in these programs.
No, you must remain enrolled in the APWU Health Plan to be eligible for the Medicare Advantage plan. If you suspend your APWU Health Plan coverage, you will also be terminated from the Medicare Advantage plan.
There is no additional cost to enroll in the Medicare Advantage plan. You will continue to pay your APWU Health Plan High Option premium as well as your Medicare Part B premium. You will receive a Medicare Part B subsidy of $100 per month when enrolled in the Medicare Advantage plan.
Dependents who are not Medicare eligible or Medicare primary will remain on the APWU Health Plan High Option plan.
Yes, this plan offers nationwide coverage.
To learn if your provider is in the network, go to retiree.uhc.com/apwuhp.
Network providers have a contract with UnitedHealthcare. Out-of-network providers do not have a contract. With APWU Health Plan, you have the flexibility to see any provider (in or out of the network) at the same cost share, as long as the provider has not opted out of Medicare and accepts the plan. Also, when you go out-of-network for care, the plan pays providers just as much as Medicare would have paid.
You will pay the same cost share in or out of the network, so there is no balance billing. However, if your provider bills you, please call UnitedHealthcare customer service at 1-855-383-8793, TTY 711, 8 am – 8 pm CT, Monday – Friday.
Yes, coverage is available outside of the United States.
Yes, this plan offers dental coverage.
Your UnitedHealthcare member ID card will arrive approximately 2 weeks after your enrollment has been submitted and confirmed. You will use your UnitedHealthcare Group Medicare Advantage member ID card for all covered medical and prescription drug services.
You may need a new prescription. Your Home Delivery pharmacy is OptumRx, a UnitedHealth Group company. The Quick Start Guide that you receive following your enrollment in the plan will include OptumRx contact information.
If you had a Medicare Part D plan or coverage through PSHB or FEHB that included prescription drug coverage, you had what is known as “creditable coverage.” Creditable coverage means that your prescription drug coverage was at least as good as, or better than, what Medicare requires.
If you had creditable prescription drug coverage through another source, such as a spouse’s employer plan, you should have received a certificate of creditable coverage. This certificate is generally provided prior to tax season.
If you were eligible for Medicare Part D and you did not have any prescription drug coverage for more than 63 days, Medicare will determine if you need to pay a late enrollment penalty (LEP) for the length of time you were eligible but did not have Part D coverage. You may submit an appeal to have this LEP removed if you had creditable coverage. You will receive a letter from UnitedHealthcare if Medicare has reported a gap of more than 63 days with instructions on how to appeal this and provide proof of creditable coverage.
IRMAA stands for Income-Related Monthly Adjustment Amount. Similar to Medicare Part B, high-income earners will pay more for their Medicare Part D coverage.
If you are a member of a Medicare plan that includes prescription drug coverage and your modified adjusted gross income on your IRS tax return from 2 years ago is above a certain limit, you may pay an additional amount for Medicare Part D coverage. The extra amount is paid directly to Social Security, not to your plan. If you are subject to IRMAA, Social Security will send you a letter. The letter will explain how they determined the amount you must pay and the actual IRMAA.
Neither APWU Health Plan nor your health plan determine who will be subject to IRMAA. Therefore, if you disagree with the amount you must pay, contact the Social Security Administration:
This is a summary of benefits and features offered by the APWU Health Plan. All benefits are subject to the definitions, limitations, and exclusions set forth in the Plan’s Brochure (RI 71-004).
The information provided is for general informational purposes only and is not intended to be medical advice or a substitute for professional health care. You should consult an appropriate health care professional for your specific needs and to determine whether making a lifestyle change or decision based on this information is appropriate for you. Some treatments mentioned may not be covered by your health plan. Please refer to your benefit plan documents for information about coverage.
Health plan coverage provided by or through UnitedHealthcare Insurance Company, UHC of California and UnitedHealthcare Benefits Plan of California. Administrative services provided by United Healthcare Services, Inc., Optum Rx or OptumHealth Care Solutions, Inc. Behavioral health products are provided by U.S. Behavioral Health Plan, California (USBHPC).
Administrative services provided by United HealthCare Services, Inc. or their affiliates.
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