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How can I find out if my doctor or other provider participates in Medicare?

To find out if your provider participates in Medicare, you can ask your provider or can visit the Medicare.gov website at www.medicare.gov/physiciancompare/search.html to search for your doctor. You can find additional information about Medicare, including the CMS “Medicare and You” brochure, on the Medicare.gov website at www.mymedicare.gov or by calling Medicare at 1-800-MEDICARE. TTY users should call 1-877-486-2048, 24 hours a day, seven days a week.

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What info is needed for me to be enrolled in one of the new UHC Group Medicare Advantage plans?

There is certain information you must provide and actions you must take before you can be enrolled in the new university-sponsored Medicare Advantage plans. Although sponsored by the university, because this coverage replaces your current Medicare Part A and Part B coverage, your enrollment must be approved by the Centers for Medicare and Medicaid (CMS) – the federal agency that is responsible for the administration of Medicare Advantage plans – before coverage becomes effective. CMS will approve enrollment into a Medicare Advantage plan if an individual: 

  • Is enrolled in Medicare Parts A and B,
  • Provides a Health Insurance Claim Number (HICN)/Medicare Claim Number,
  • Has a permanent U.S. street address (no P.O. Box) on file, and
  • Is not within the 30-month coordination period for end-stage renal disease.

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Why do I need to provide my HICN/Medicare Claim Number and street address when I enroll?

This is a critical step in continuing your university retiree medical coverage. If you have already provided your HICN/Medicare Claim Number to the university and have a current permanent U.S. street address on file with the university, you will not need to provide this information again. For most individuals, the university has the information.

Under CMS rules, individuals must provide the following information before CMS will approve their enrollment in a Medicare Advantage plan such as the university-sponsored UHC Group Medicare Advantage plans:

  • Health Insurance Claim Number (HICN)/Medicare Claim Number
  • Street Address (other than a P.O. Box)

To facilitate the collection of this information, the university will be contacting those Medicareeligible retirees and their covered Medicare-eligible dependents who do not have HICNs/Medicare Claim Numbers and/or street addresses on file with instructions on how to provide that information.

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How can I check if the university has my Health Insurance Claim Number (HICN)/Medicare Claim Number?

The university will send out a letter requesting this information from those retirees or their eligible dependents who do not already have HICNs on file with the university.

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What if I don’t enroll in Medicare Parts A and B?

The Centers for Medicare and Medicaid Services (CMS) require you to be enrolled in Medicare Parts A and B, and that you continue to pay your Part B premium (as you do today if you are already enrolled in Medicare), to participate in a Medicare Advantage plan such as the new university-sponsored UHC Group Medicare Advantage plans. Therefore, to remain eligible for your university retiree medical coverage, you must remain enrolled in Medicare Parts A and B. If you are a pre-1990 university retiree, or retired from the Federal Civil Service or the Missouri State Retirement System and have not previously enrolled in Medicare or are not eligible to enroll in Medicare, please contact that the university to discuss your plan options.

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If I am already enrolled in a Medigap plan, can I still enroll in the Medicare Advantage plan?

Medigap (Medicare Supplement) plans are intended to supplement Medicare parts A&B. Since the university-sponsored Medicare Advantage plans replace Medicare, you would not receive any benefits from your Medigap (Medicare Supplement). Therefore, there may be no value in continuing your Medigap (Medicare Supplement) plan.

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If I am enrolled in another Medicare Advantage plan, can I enroll in the university-sponsored plan?

No. CMS does not allow retirees to enroll in two Medicare Advantage plans. You will need to choose between your current plan and the university-sponsored UHC Group Medicare Advantage plans; you cannot be covered under both. 

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I am an LTD recipient enrolled in Medicare, will I need to enroll in the university-sponsored plans?

Long Term Disability (LTD) recipients will not enroll in the University-sponsored UHC Group Medicare Advantage plans for 2017. They will continue to be eligible to remain enrolled in the medical plans offered to active employees: the PPO Plan, Custom Network Plan, and Healthy Savings Plan.

Plan options for LTD recipients in 2018 will be different; stay tuned for more Annual Enrollment information.

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Will I still need two ID cards to see healthcare services?

No. When receiving care under your university-sponsored UHC Group Medicare Advantage plan, you will only need to use one medical ID card – your Medicare Advantage ID card – instead of two – your Medicare ID card and the ID card for your university-sponsored plan. Beginning in 2017, you will only need to present your new Medicare Advantage ID card when you receive medical services. You will not need to show your original Medicare ID card, although you should keep it in a safe place for your records. Note that you will still need to use your Express Scripts prescription ID card to obtain prescriptions.

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Will I have the same ID card as my covered eligible dependent?

No. You each will receive your own university-sponsored Medicare Advantage ID card – with your own unique ID number – from UHC in December.

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What are the options available under the new university-sponsored UHC Group Medicare Advantage Plan?
  • The university-sponsored Medicare Advantage Base Plan, or
  • The university-sponsored Medicare Advantage Enhanced Plan.

Both plans offer the same flexibility to see providers in or out of network at the same cost, $0 deductible, no requirement to select a primary care provider, and a referral is not necessary to see a specialist. The university-sponsored Medicare Advantage Base Plan is primarily a co-payment plan, while the university-sponsored Medicare Advantage Enhanced Plan has no member out-of-pocket expense for covered services. However, you do pay an additional premium cost for the Enhanced Plan.

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Will there be separate deductibles for Medicare Part A, Part B, and the university-sponsored plans?

No. With the new university-sponsored UHC Group Medicare Advantage plans, you are no longer subject to the Medicare Parts A and B deductibles. If you are enrolling in the university-sponsored Medicare Advantage Base Plan, there is no annual deductible. If you are enrolling in the university-sponsored Medicare Advantage Enhanced Plan, you will no longer have an annual deductible to satisfy either.

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How will the deductible work under the university-sponsored Medicare Advantage Base Plan?

Under the university-sponsored Medicare Advantage Base Plan, most covered services are not subject to an annual deductible or co-insurance. This means that for most covered services, you only will pay your share of the cost – generally a copay – when you receive services. For those covered services that do not have a co-payment assigned, you will only pay the applicable co-insurance for that service since there is no annual deductible. Here’s an example: Let’s say you need a walker on January 2, 2017, which is considered durable medical equipment and is subject to the $0 deductible and co-insurance. The walker costs $110. There is no annual deductible and your coinsurance for the walker is 20%. You would pay $22 or 20% of the $110. In this case, the plan would pay $88.

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Will my vision coverage be affected as a result of this change?

No, your vision coverage will remain the same. Please visit http://umurl.us/vision for more information on the University’s Vision Plan.

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Will my dental coverage be affected as a result of this change?

No, your dental coverage will remain the same and will continue to be administered by Delta Dental. Please visit http://umurl.us/dental for more information on the university’s Dental Plan.

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Do the university-sponsored UHC Group Medicare Advantage plans include coverage for hearing aids?

The university-sponsored Medicare Advantage plans include a $500 hearing aid allowance every 36 months. Members will submit a claim to UHC and be reimbursed up to the $500 amount.

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Will retirees still be able to use the hearing aid discount available from TruHearing through VSP?

If a member uses the discount provided by the TruHearing program, they may still submit a claim for reimbursement up to $500 to UHC. Please visit http://umurl.us/hearing for more information on TruHearing.

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Is there a difference in reimbursement between original Medicare and Medicare Advantage plans?

The university-sponsored Medicare Advantage plans are employer-sponsored group Medicare Advantage plans; therefore, members are not limited to utilizing network providers and can see any Medicare-willing provider. Non-network providers are reimbursed up to the Medicare-allowed amount. Therefore, a non-network provider will receive the same reimbursement as they receive under original Medicare. See the chart in question 1 to determine how your claim will be processed for providers who accept Medicare but are not in the UHC Group National PPO Network.

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Are some Medicare Advantage plans restrictive? Do the university-sponsored plans have restrictions?

The university-sponsored UHC Group Medicare Advantage plans are employer-sponsored group Medicare Advantage plan; therefore, the plans do not carry the same limitations as individual Medicare Advantage plans have, such as, limited service areas, network restrictions, limited benefits, etc. The UHC Group Medicare Advantage plans represent a national solution that offers in- and out-of-network coverage at the same copay for members. You are not restricted to a limited service area. You do not need to select a primary care physician, and no referral is needed to see a specialist. The plans cover all of the benefits of Original Medicare and also have some added benefits and clinical programs to help members manage their health more effectively. You still retain the rights and protections of Medicare.

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What does it mean that the university-sponsored Medicare Advantage plans are “medically managed”?

Just as the university plans do now, the university-sponsored UHC Group Medicare Advantage plans will include programs and outreach designed to help retirees and their covered Medicare dependents receive preventive care and generally live a healthy lifestyle. Upon enrolling in one of the UHC Group Medicare Advantage plans, you may receive a call from UHC to discuss your care needs. Please accept this call as it helps ensure that UHC can best support your medical care needs. In cases where more serious care is needed or chronic conditions exist, the university-sponsored UHC Group Medicare Advantage plans will help retirees and their covered eligible dependents actively manage those conditions and help ensure they have access to appropriate resources to help them treat the condition. You have the ability to opt-out of these services if you desire.

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Can I still get a second opinion without a referral under the Medicare Advantage Plans?

Members can receive a second opinion, if needed. Members are not limited to utilizing network providers and can see any Medicare-willing provider.

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Do ALL copays and coinsurance go toward the Maximum-Out-of-Pocket (MOOP)? If not, which do?

Out-of-pocket amounts such as co-payments or co-insurance for Medicare-covered services all count towards the maximum out-of-pocket. Non-Medicare services, such as routine podiatry, routine vision, and routine chiropractic service, do not apply toward MOOP.

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I received a Health Survey from UHC. Do I need to complete it? Will it affect my coverage or costs?

After your enrollment is effective in one of the university-sponsored UHC Group Medicare Advantage plans, you will receive a Health Survey. The Health Survey is a short questionnaire asking general questions about your health, and responding to the survey allows UHC to identify and recommend wellness and health-improvement programs for which you might qualify. UHC will attempt to reach you two times by phone to complete the survey, or if you wish, you may complete the survey on paper and return it to UHC. This survey is optional and your participation will not affect your coverage or your costs, but we encourage you to complete it as it will help UHC guide you toward programs and information that could be helpful to you.

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Can I drop my coverage under the university-sponsored UHC Group Medicare Advantage plans?

Yes, you will be able to change your election and opt out of a university-sponsored UHC Group Medicare Advantage plan during Annual Enrollment or at any time during the year. If you drop or cancel your coverage, you will not be able to re-enroll at a later date. 

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Will it affect my future enrollment if I drop coverage under the new university-sponsored plan?

The university-sponsored UHC Group Medicare Advantage plans are employer-sponsored group Medicare Advantage plans; therefore, they do not carry the same limitations as individual Medicare Advantage plans. Because these are group plans, the member has more flexibility in moving from a university-sponsored Medicare Advantage plan back to Original Medicare and may do so without any restrictions or penalty. If a retiree or dependent cancels their university coverage, they will return to Original Medicare and may enroll in an individual Medicare Advantage, Medigap (Medicare Supplement) plan separate from the university. They will also need to enroll in a Part D Prescription Drug Plan separate from the university to avoid paying a penalty.

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Can I enroll in another Medicare Advantage plan if I drop coverage under the new university plan?

Yes. Because this is a group Medicare Advantage plan if a retiree or Medicare-eligible dependent terminates from the university-sponsored Medicare Advantage plan, he/she has a Special Election Period in which he/she can enroll into an individual Medicare Advantage plan.

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Are there resources about if I opt-out of the University-sponsored Medicare Advantage plan?

Each year, all Medicare members receive a “Medicare & You” booklet from Medicare that explains the various Medicare components and guidelines, including plan types. Since the university-sponsored UHC Group Medicare Advantage Plans are group plans, the university retains the ability to renew the plans in future years or return to a Medicare Fee-for-Service arrangement. In addition, each state has a State Health Insurance Assistance Program (SHIP) that can assist Medicare members with understanding their Medicare plan options and benefits. In Missouri, the SHIP program is CLAIM. Visit https://www.missouriclaim.org for more information. For states outside of Missouri, visit https://www.shiptacenter.org/ to find your local SHIP.

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Will I still be able to drop university coverage and enroll in a Medigap policy at any time?

Once a retiree or dependent is enrolled for the 01/01/2017 effective date, he/she can disenroll from a university-sponsored UHC Group Medicare Advantage plan by contacting the university at any time during the year. This disenrollment will trigger the member to go back to Original Medicare, and they can enroll in a Medigap (Medicare Supplement) plan outside of the university as a secondary coverage. They will also need to enroll in a Part D Prescription Drug Plan separate from the university to avoid paying a penalty. It is important to note that once a retiree or covered dependent chooses to dis-enroll from their university medical coverage, they cannot enroll at a later time. If a retiree chooses to drop or opt-out of university medical coverage, their covered dependent(s) will be also be dis-enrolled at that time.

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If I am enrolled in MO HealthNet or other state Medicaid program, how will my coverage coordinate?

Your university-sponsored UHC Group Medicare Advantage plan will be your primary coverage. Your Medicaid coverage will process claims after the Medicare Advantage plan has processed your claims. UHC will cross-over those claims.

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Will my spouse/eligible dependent also be covered under the new university-sponsored plan?

If you and your spouse/eligible dependent(s) are Medicare eligible, then you may elect coverage for yourself and any covered Medicare-eligible dependent(s) under the options for Medicare-eligible members:

  • The university-sponsored Medicare Advantage Base Plan, or
  • The university-sponosred Medicare Advantage Enhanced Plan.

If you are Medicare eligible but your spouse/eligible dependent is not Medicare eligible (e.g., is under age 65), then you may elect coverage for yourself under the options for Medicare-eligible retirees (see above) and coverage for your spouse/eligible dependent under the options for non-Medicare-eligible members:

  • The Retiree Health PPO, or
  • The Healthy Savings Plan, a qualified high-deductible health plan,

If you are not Medicare eligible but your spouse/eligible dependent(s) is Medicare eligible, then you may elect coverage for yourself under the options for non-Medicare-eligible members and coverage for your spouse/eligible dependent(s) under the options for Medicareeligible members.

If your dependent has previously dropped the university medical coverage provided to you as a retiree, they cannot re-enroll at this time.

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How will the out-of-pocket-maximum work if my spouse and I both enroll in a Medicare Advantage Plan?

If you and your spouse are Medicare eligible and enroll in one of the new Medicare Advantage plans, you will each have a separate annual out-of-pocket maximum. This means that amounts you pay out of pocket for your care will only count toward your annual out-ofpocket maximum and not your spouse’s. Similarly, amounts you pay out-of-pocket for your spouse’s care will only count toward your spouse’s annual of-of-pocket maximum. CMS does not allow out-of-pocket maximums to coordinate for a family in Medicare Advantage plans.

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How will the out-of-pocket-maximum work between the Medicare Advantage plan and other plans?

If you are enrolled in one of the university-sponsored UHC Group Medicare Advantage plans, amounts that count toward the deductible and out-of-pocket maximum in that plan will not apply toward the deductible and out-of- pocket maximum in the Retiree Health PPO Plan or the Healthy Savings Plan in which your spouse/eligible dependent is enrolled. Similarly, amounts that count toward the deductible and out-of-pocket maximum for your spouse/eligible dependent in the Retiree Health PPO Plan or the Healthy Savings Plan will not apply toward the deductible and out-of-pocket maximum in the new Medicare Advantage plans.

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How much do the university-sponsored UHC Group Medicare Advantage plans cost?

Your specific monthly premium for your university-sponsored Medicare Advantage plan is available on the Annual Enrollment letter that was mailed to retirees on September 16, in advance of the Annual Enrollment period (Oct 17-October 31, 2016). Your premium is determined by the plan that you enroll in and the university subsidy that you receive based on your age and years of service at retirement.

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Do I still need to continue to pay my Medicare Part A and Part B premium?

Yes. You will still need to pay your Original Medicare Part B premiums, in addition to the premiums for the university-sponsored UHC Group Medicare Advantage plan that you elect. In most cases there is no premium requirement for Original Medicare Part A. If however you are not eligible for no-cost Medicare Part A coverage and are paying for this coverage today, you will be required to continue to pay this premium, as well.

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Will Medicare premiums continue to be automatically deducted from my Social Security check in 2017

Yes, your Medicare premium will continue to be deducted from your Social Security check.

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Will my retiree medical premium continue to be deducted from my university pension check in 2017?

Yes. Your premium for your university-sponsored UHC Group Medicare Advantage plan will continue to be deducted from your university pension check. If your premium is not currently deducted from your pension and you are billed directly for your university medical premiums, that process will continue.

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How does government funding affect how much I pay for contributions?

Medicare Advantage plans, like the new university-sponsored UHC Group Medicare Advantage plans, receive subsidies from the federal government. The amount of this subsidy is one of the factors taken into account when determining the monthly contribution cost to participate in the university-sponsored UHC Group Medicare Advantage plans.

Because these government subsidies are expected to decrease over time, Medicare Advantage plans with high-quality ratings will receive “bonus” payments to help offset the decreases. The Centers for Medicare and Medicaid Services (CMS) have given UHC a rating of four stars for 2017 based on the Five-Star Quality Rating System for Medicare Advantage plans, for their strong commitment to quality. Medicare evaluates plans based on a 5 Star rating system. Star Ratings are calculated each year and may change from one year to the next. This high-quality rating should help keep your contributions down as a result of the additional bonus payments. The university will continue to monitor premium costs, as it has done in the past, to ensure that the medical plan options remain affordable for retirees and the university.

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Where do I go for more information about my medical insurance as a retiree?

You may call the UHC University of Missouri System dedicated toll-free number at 1-866- 899-5903, TY 711, from 8:00 a.m. – 8:00 p.m. in your local U.S. time zone, seven days a week. You may also contact the UM System Human Resources Service Center at 573-882- 2146, toll-free at 800-488-5288, or via email at retirement@umsystem.edu. Representatives are available Monday through Friday from 8:00 a.m. – 5:00 p.m., Central Time.

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Will prescription drug coverage change with the new university-sponsored Medicare Advantage plans?

The university will continue to provide a Medicare Part D Prescription Drug (PDP) plan through Express Scripts. The change to a university-sponsored UHC Group Medicare Advantage Plan for retiree medical coverage does not impact the prescription drug coverage provided through Express Scripts. Beginning January 1, 2017, the university will move to a fully-insured PDP plan through Express Scripts. The university will continue to be responsible for determining plan benefits, such as deductibles, co-payments/co-insurance, and out-of-pocket limits for the prescription plan.

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Will the prescription drug formulary be the same as it currently is?

Each year, even without plan changes, medications move on and off of the formulary and within formulary tiers as patents expire or generic alternatives become available. 

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Will there be more restrictions such as prior authorization, quantity limits, and step therapy?

The university already utilizes all of the standard Part D Prescription Drug plan utilization programs available through Express Scripts under the current Part D plan. Express Scripts will continue to use the same utilization programs currently in use. 

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If I am currently receiving “extra help,” will I continue to receive it?

Yes. If you are currently receiving “extra help” with your Medicare prescription drug costs, you will continue to receive it. You do not need to do anything additional for “extra help” to continue. For more information on “extra help,” visit https://www.ssa.gov/medicare/prescriptionhelp/.

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How will the new university-sponsored UHC Group Medicare Advantage PPO plans work?

As long as your doctor, hospital, or other provider participates in (i.e., accepts payment from) Medicare, you will receive the same level of coverage whether or not the provider is a member of the UHC Group PPO Network. The university-sponsored group Medicare Advantage Base Plan and Medicare Advantage Enhanced Plan provide the flexibility to see providers in or out of network at the same cost. The following chart describes how this works in various situations:

If your doctor/provider... Then... Impact to You
  • Participates in Medicare
  • Is a member of the UHC Group PPO Network
The plan will pay for the covered services or care you receive and your provider submits the claim to UHC. You pay your share of the cost (e.g., your deductible and/or your copay).
  • Participates in Medicare
  • Is NOT a member of the UHC Group PPO Network but is willing to submit your claim to UHC
The plan will pay for the covered services or care you receive and your provider submits the claim to UHC (same as above). You pay your share of the cost (e.g., your deductible and/or copay).
  • Participates in Medicare
  • Is NOT a member of the UHC Group PPO Network and is NOT willing to submit your claims to UHC
The plan will pay for the covered services or care you receive. You may be responsible for filing for reimbursement; contact UHC for assistance. You may need to pay the entire cost out-of-pocket and submit your claim to UHC for reimbursement. If your provider is not willing to submit your claims to UHC, contact UHC’s university-dedicated toll-free number at 1-866-899-5903, TTY 711, from 8:00 a.m. – 8:00 p.m. in your local U.S. time zone.
  • Has fully opted out of (does not participate in) Medicare
Services you receive through that provider will not be covered under the universitysponsored Medicare Advantage plans. Federal regulations bar payments to providers who have fully opted out of Medicare. You pay the entire amount for any services received from the provider. Generally, the provider asks you to sign a contract confirming this.

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