Seniors – Health Care Cost Share

Healthcare FOR SENIORS

Do you have an option for senior adults 65 and older?

Yes. Adults over the age of 65 with Medicare Parts A and B can be members of Impact Health Sharing.
Adults over the age of 65 with Medicare Parts A and B. Eligible medical bills for members 65 or older are eligible for sharing with no co-share amount. Sharing is secondary to Medicare and is based on the difference between the Medicare allowable charges and the actual amounts paid by Medicare. The member must submit a copy of the Medicare Explanation of Benefits, in order for Impact to process bills.

The Pre-Existing Medical Condition limitations do not apply to members 65 years old and older.

Members 65 and older must have Medicare Part D for prescription costs to be eligible for sharing. All sharing will be secondary to Medicare.

Not eligible for sharing:

How do I access care if I have Medicare Parts A & B?

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.

Do I have to upload bills from Medicare if I am 65+?

Yes. Here’s how.
All medical bills should first be submitted to Medicare. Medicare will send you a Medicare Summary Notice (MSN) or Explanation of Benefits (EOB).

The EOB 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:

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.

For instructions on how to upload the forms and to access the forms please visit our forms page here: https://www.impacthealthsharing.com/forms

How do prescriptions work for Seniors 65+ with Medicare?

After your PRA has been met, the prescription amount may be shared as follows…
After your PRA (Primary Responsibility Amount) of $1000 is met prescriptions may be shared as follows:

For prescription costs to be eligible for Sharing, members must also have Medicare Part D as well.
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.

Is there a deductible for those with Medicare?

Impact is not insurance and members do not have deductibles but instead a Primary Responsibility Amount.
Since Impact Health Sharing is not insurance, terms like deductible are not used. The PRA – Primary Responsibility Amount works similarly.

Senior Members (65+) are responsible for their Primary Responsibility Amount (PRA) of $1000 before Impact members share the portion of your Eligible Medical Bills that Medicare allows but does not pay completely. Items like Co-pays, Deductibles, Hospitalization, Skilled Nursing Facility Care, and Out-of-country Urgent Care. With sharing secondary to Medicare, this program is an incredible option for seniors.