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APWU Health Plan FAQ

APWU Health Plan has been offering affordable, comprehensive coverage to postal workers, federal employees, and retirees since 1960. We’re here to help you choose a plan that’s right for you and make the most of your benefits.

If you can’t find an answer to your question, contact us to speak with a customer service representative:

1-800-222-2798 | 1-800-622-2511 (TTY)

Monday – Friday, 8:30 am – 6:30 pm ET

Displaying FAQs for Medicare

Does the Consumer Driven Option provide Part D pharmacy benefits if I’m enrolled in Medicare?

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:

• Low copays/coinsurance

• $2,000 out-of-pocket maximum

• Home delivery service

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.

Does the High Option provide worldwide coverage when I travel abroad?

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.

If I enroll in Medicare Part A and B, will the High Option cover 100% of my medical bills?

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%.

How does APWU Health Plan work with Medicare?

If 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.

How do I sign up for Medicare?

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

When is it time to enroll in Medicare?

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.

Who is eligible for Medicare coverage?

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:

Are age 65 and older
Have a qualifying disability and are any age
Have specific medical conditions

What is Medicare Part D?

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.

What is Medicare Part C?

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.

What is Medicare Part B?

Medicare Part B (medical insurance) helps cover the outpatient services you receive from doctors and other healthcare providers:

Doctor visits
Outpatient hospital care
Home health care not covered by Part A
Durable medical equipment (including wheelchairs, walkers, and hospital beds)

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.

What is Medicare Part A?

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.

What is Original Medicare?

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.

APWU Health Plan FAQ

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