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:

• Treatment for members age 65 or older that is not Medicare-eligible.
• Treatment for members age 65 or older that arenot enrolled in Medicare.

The tobacco assessment does not apply to Seniors, but BMI assessment does.

The PRA for senior adults is $1,000 with no Provider Fee, no Co-Share, and no Preexisting limitation.

• 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.
• Members must submit their Part D EOB (Explanation of Benefits) to Impact here. Medicare will mail your Part D EOB monthly.

All medical bills (including prescriptions) 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::

• All your Part A and Part B-covered services or supplies billed to Medicare during the period
• What Medicare paid
• The maximum amount you may owe the provider

What should you do?

1. Create an online Medicare Account at medicare.gov
2. Once your account is created, you can download your MSN/EOB’s as often as you’d like.
3. 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.

Remember that first, you must pay your Primary Responsibility Amount (PRA) of $1000 before Impact members will share the portion of your Eligible Medical Bills that Medicare allows but does not pay completely.

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

For prescriptions to be eligible for sharing, members must have Medicare Part D.

Members must submit their Medicare Part D EOB to Impact through the Forms Section of your Member Center. Medicare will mail your Part D EOB monthly.