What is Medicare limiting and how does it affect my billing?

The APWU Health Plan coordinates payments to your medical provider with Medicare. This means that when the medical provider (doctor/hospital/lab) bills Medicare, the APWU obtains all the information we need to pay the bill directly from Medicare.  This streamlines the billing process for doctor’s offices. It ensures that insurance enrollees receive their maximum insurance benefits without filing additional paperwork.

Remember that for APWUHP Enrollees who are retired and have Medicare B, you pay nothing for Medicare covered procedures. 

The law requires the APWU Health plan base our payment for services at the “Medicare approved amount” regardless of whether or not our members over 65 are enrolled in Medicare.  This law is in place to keep Federal Employee Health Benefits (FEHB) costs low and plan premiums affordable for retirees. The law applies to all FEHB plans not just the APWU Health Plan.

You can read more about how our plan works with Medicare in our Blueprint to Medicare Flyer.