Jordan Ellis
The NEA Retiree Health Program offers plans to supplement Medicare coverage for NEA members. Original Medicare consists of Part A (hospitalization) and Part B (medical coverage). Medicare Part A covers roughly 80% of hospital costs, and the NEA Retiree Health Program covers the remaining 20% of expenses not covered by Medicare. NEA members can also benefit from the NEA In-Hospital Plan, which provides cash to pay for extra expenses incurred during a hospital stay.
| Characteristics | Values |
|---|---|
| Medicare Part A | Hospitalization |
| NEA's Medicare Supplement | Covers the 20% of expenses not covered by Medicare |
| NEA's Medicare Supplement | Covers pre-existing conditions |
| NEA's Medicare Supplement | Offers nationwide coverage |
| NEA's Medicare Supplement | Offers additional discounts on dental, chiropractic, vision, hearing care and vitamins |
| NEA's Medicare Supplement | Offers lower rates than most popular Medicare Supplement Programs |
| NEA's Medicare Supplement | Offers guaranteed acceptance for members over 65 |
| NEA's Medicare Supplement | Offers freedom to choose your own doctors and hospitals |
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What You'll Learn
The NEA Plan is not an HMO
The NEA Plan offers a range of benefits to its members, including competitive rates on health insurance, term life insurance, and long-term care insurance. The NEA Members Insurance Trust selected United American Insurance Company to underwrite the program due to its reliable history of serving policyholders.
NEA's health benefit experts provide guidance and assistance on a wide range of issues, including employer-sponsored health plans, retiree health coverage, Medicare, and Medicaid. They have put together a worksheet to help members think through their health care options and make informed decisions when selecting or changing plans.
The NEA Retiree Health Program provides coverage for the roughly 20% of expenses not covered by Medicare. This includes pre-existing conditions if you are replacing an existing plan. The program also offers nationwide coverage that keeps pace with Medicare's annual changes, and your benefits automatically increase to cover any gaps in Medicare coverage.
In addition to the retiree health program, NEA offers an In-Hospital Plan, which provides cash to pay for extra expenses incurred during a hospital stay, and an Excess Major Medical Plan, which covers extraordinary medical expenses not covered by your current insurance. NEA also provides supplemental health plans designed to supplement existing insurance protection, matching the standard A through J Medicare supplement plans.
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NEA Retiree Health Program covers Medicare gaps
The National Education Association (NEA) is committed to advancing the cause of public education. It works closely with state and local NEA affiliates to secure quality, affordable, and comprehensive health care coverage for its members and their families.
The NEA Retiree Health Program provides coverage for the roughly 20% of expenses not covered by Medicare. If you’re over 65, you and your spouse/domestic partner are guaranteed acceptance during open enrollment. You can stay in control of your medical care with your choice of doctors and hospitals. The program helps pay for expenses not covered by Medicare, and you’re covered for pre-existing conditions if you’re replacing an existing plan. You’ll receive nationwide coverage that keeps pace with Medicare’s annual changes, and your benefits automatically increase to cover Medicare’s gaps.
The NEA Retiree Health Program offers supplemental coverage that helps pay for the roughly 20% of expenses not covered by Medicare, plus discounts on dental care, chiropractic care, vision care, hearing care, and vitamins. The program also provides extra discount programs for drugs, dental, hearing, and vision care that you won't find on other Medicare supplement plans, at no extra cost.
The NEA Plan is not an HMO, so you can choose your own doctors and hospitals. You cannot be turned down due to health reasons, and no physical exam is ever required. You don’t have to answer any health questions when you sign up during open enrollment periods or when enrolling in Medicare Part B for the first time.
The NEA Retiree Health Program’s rates are, on average, lower than the nation’s most popular Medicare supplement program. The NEA Members Insurance Trust evaluates the plans offered and the premium rates annually to ensure they remain competitive. In most states, your premium rate is determined by your age when you enroll.
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Part B claims information is received directly from Medicare
The NEA Retiree Health Program is a supplementary insurance plan for retirees over 65. It covers the roughly 20% of expenses not covered by Medicare, including pre-existing conditions. The program offers nationwide coverage, and beneficiaries can choose their own doctors and hospitals.
The NEA Members Insurance Trust selected United American Insurance Company to underwrite the program. Part B claims information is received directly from Medicare, meaning there is virtually no need for the beneficiary to file. With "Automatic" Claims Filing (ACF), most claims are handled automatically when doctors accept Medicare assignment.
ACF is paperless, and electronic claims may be paid as soon as 13 days after the date the claim is received by Noridian. For paper claims, the timeframe for payment is substantially longer, with "clean" paper claims (those submitted with all required information and without errors) paid as soon as 29 days after the date the claim is received by Noridian.
If a claim hasn't been filed on your behalf, contact your doctor, provider, or supplier and ask them to file a claim for the service or supply. If you had to pay out of pocket for services or supplies because your doctor, provider, or supplier refused to submit a claim, you will need to submit your own claim.
If you have Original Medicare, you'll need to mail your claim form, itemized bill, and supporting documents to the address for your state, which is listed on the Medicare Administrative Contractor Address Table within the claim form.
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Medigap policies supplement Part A and B coverage
Medicare Supplement Insurance, also known as Medigap, is extra insurance that can be purchased from a private health insurance company to help cover out-of-pocket costs in Original Medicare (Part A and Part B). Medigap policies are designed to supplement the coverage provided by Original Medicare, filling in some of the gaps in coverage that exist under Parts A and B.
To be eligible to purchase a Medigap policy, you must generally have Original Medicare, including Part A (Hospital Insurance) and Part B (Medical Insurance). When you buy a Medigap policy, both Medicare and the Medigap policy will each pay their share of covered healthcare costs. It's important to note that Medigap policies are standardized, meaning that the benefits offered by insurance companies must be the same across different companies. However, the costs of Medigap policies can vary, so it's important to compare policies before purchasing one. Additionally, Medigap policies do not cover any healthcare costs for your spouse, and separate policies must be purchased for each individual.
Some specific Medigap plans, such as Plans F and G, offer high-deductible options in certain states, while Plans K and L have specific provisions for approved services before and after meeting the out-of-pocket yearly limit and Part B deductible. Plan N, on the other hand, covers 100% of the costs of Part B services, except for copayments for certain office and emergency room visits.
The NEA Retiree Health Program is one example of a Medigap policy that supplements Medicare coverage. This program offers competitive premium rates and provides coverage for expenses not typically covered by Medicare, such as pre-existing conditions and extended care. It also provides nationwide coverage, automatic benefit increases to match Medicare's changes, and additional discounts on dental, chiropractic, vision, hearing, and vitamin care. The NEA program also includes the NEA MemberCare In-Hospital Plan, which provides cash benefits of up to $120 per day to cover extra expenses during hospital stays.
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Part A covers hospitalization
Medicare Part A, also known as hospital insurance, covers inpatient hospital care, skilled nursing facility (SNF) care, home health care, and hospice services. Inpatient hospital care is covered after you are formally admitted to a hospital by a physician. You are covered for up to 90 days each benefit period in a general hospital, plus 60 lifetime reserve days. Medicare also covers up to 190 lifetime days in a Medicare-certified facility.
Medicare Part A covers room and board and a range of services provided in a skilled nursing facility, including the administration of medications, tube feedings, and wound care. You are covered for up to 100 days each benefit period. The benefit period begins the day you are admitted to a hospital or SNF and ends once you have been out of the facility for 60 consecutive days.
Home health care is covered by Medicare Part A if you are homebound and require skilled care. Skilled care is medically necessary care that must be performed or supervised by a skilled professional, such as a registered nurse or licensed therapist. You are covered for up to 100 days of daily care or an unlimited amount of intermittent care. To qualify for Part A home health care coverage, you must have spent at least three consecutive days as a hospital inpatient within 14 days of receiving home health care.
The NEA Retiree Health Program is a supplement to Medicare, providing coverage for the roughly 20% of expenses not covered by Medicare. This includes expenses incurred while in the hospital, such as paying for pre-existing conditions, nationwide coverage, and additional discounts on dental, chiropractic, vision, hearing care, and vitamins. NEA also offers an Auto & Home Insurance Program with exclusive rates and excellent service, as well as a Term Life Insurance Plan.
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Frequently asked questions
Medicare Part A covers hospitalization.
The NEA Plan is not an HMO. It allows you to choose your own doctors and hospitals.
The NEA Plan offers lower rates on average than most popular Medicare Supplement Programs. The NEA Plan also covers the 20% of expenses not covered by Medicare.
In 2021, there was a benefit-period deductible of $1,484 for Part A. However, costs can vary depending on the length of a hospital stay and the type of facility.
The NEA Medicare Supplement Plan provides NEA members and their spouses aged 65 and older with coverage for hospital and medical expenses not covered by Medicare.
