Healthcare Cost Assistance for
Medicare
Helping you afford the care you need.
Benefit Summary
For eligible homecare and personal support workers who have Medicare, Healthcare Cost Assistance benefits will help with the costs of:
- Monthly premiums for Medicare Part B (up to $148.50/month in 2021)
- Monthly premiums for Medicare Part D, Supplemental or Advantage plans (up to $44/month in 2021)
- Out-of-pocket expenses, such as deductibles, co-payments, coinsurance and prescriptions for services covered by Medicare (up to $6,500 in 2021)
Reimbursement amounts may change from year to year.
If you are eligible for Healthcare Cost Assistance benefits, you will receive a Benefit Convenience Card (a Mastercard debit card) to pay for your covered out-of-pocket medical expenses. The card will come from Ameriflex (the Benefits Convenience Administrator).
Important Things to Know
- If you’re over 65 (or turning 65 in the next three months) and not already receiving a monthly check from Social Security, you need to sign up to get Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). You can sign up online at ssa.gov/benefits/medicare/ or by phone at 1-800-772-1213.
- If you are under 65 and you are eligible for Social Security due to disability, you may also be eligible for Medicare. You should be notified by Social Security of your eligibility status along with your next steps.
- Remember that Carewell SEIU 503 Healthcare Cost Assistance is not employer-sponsored or group health insurance coverage. If you incorrectly report to the Social Security Administration that you have group coverage, your Medicare enrollment could be delayed.
- If you have been utilizing the Benefit Convenience Card to pay premiums for a Marketplace plan, one major difference as you switch to Medicare is that you can no longer use the Benefit Convenience Card for Medicare premiums. Instead you will need to request reimbursement of your Medicare premiums. More information can be found in the Reimbursements tab below.
Check your Eligibility
This information is for Medicare recipients: seniors over the age of 65 as well as adults under 65 with disabilities. The Social Security Administration determines your eligibility for Medicare benefits.
To see if you qualify for Healthcare Cost Assistance, please complete this eligibility questionnaire.
Enrollment
Steps to Enroll
In order to enroll in Healthcare Cost Assistance, you will need to:
Fill out the required Medicare paperwork
These forms give the Carewell SEIU 503 Benefits team and its partners legal permission to assist you with researching, enrolling and maintaining your Medicare Plan (Medicare Supplement, Advantage or Part D plan).
Submit a reimbursement claim form
Submit a reimbursement claim form to the Benefits Administrative Office with evidence of your Part B premium and evidence of your Part D, Supplemental, or Advantage plan premiums, if any.
Medicare Reimbursement Form (Digital)
For proof of Part B, use your annual Social Security letter. The most common proof for Part D, Advantage, or Supplemental premiums is the invoice showing the premium amount for that plan.
Optional
If you would like to receive your Medicare reimbursement via direct deposit, please fill out this direct deposit form and upload a voided check securely using DocuSign.
Direct Deposit Form (Digital)
Enrollment Confirmation
You will know you are enrolled in Healthcare Cost Assistance for your Medicare coverage when:
- You get a check in the mail or a direct deposit into your bank account for your premiums from the Benefits Administrative Office.
- You receive a Benefit Convenience Card in the mail to pay for your out-of-pocket medical expenses.
- You receive a welcome packet in the mail from the Carewell SEIU 503 Benefits Administrative Office with information about your coverage, privacy policies, and Frequently Asked Questions about using the Benefit Convenience Card.
If you have not received your reimbursement for Medicare premiums by the 10th of the month, please call the Benefits Administrative Office at 1-844-507-7554, option 3, option 2.
Please feel free to call to verify your eligibility for Healthcare Cost Assistance at 1-844-507-7554, option 3, option 2.
Benefit Details
Use This Benefit
Using Your Card
Use your Benefit Convenience Card for out-of-pocket expenses covered by your Medicare Part B, Part D, Supplemental and Advantage plans, such as deductibles, co-payments, coinsurance, and prescriptions. You may be asked to show proof of your expenses, so keep your Explanation of Benefits and all receipts.
You cannot use the Benefit Convenience Card:
- for Medicare premiums (see below for information on the reimbursement process for Medicare premiums);
- for dental care, vision care and hearing services;
- for medical expenses received by your spouse or dependents.
Make an appointment
Please check with your healthcare provider before making an appointment to make sure your provider is covered by Medicare and services will be covered under your Medicare coverage.
Keep Your Benefit
To ensure you continue receiving Healthcare Cost Assistance benefits, please remember to:
- Turn in your timesheets and/or payroll vouchers at the end of each pay period.
- Avoid recording zero hours of eligible working hours — also known as bargaining unit hours — for two months in a row. Going two months with zero hours of work could result in you losing your eligibility for Carewell SEIU 503 benefits, including Healthcare Cost Assistance.
- Keep your personal information up-to-date with Carewell SEIU 503 and your employer (state, county, or brokerage)
- Pay your premiums to your insurance carrier on time, or your carrier may terminate your plan
- Check and respond to mail from Carewell SEIU 503, your insurance carrier, Ameriflex, and the Social Security Administration
- Stay current on your tax filing
Reimbursements
Medicare Premium Reimbursements
If you have not received your reimbursement for Medicare premiums by the 10th of the month, please call the Benefits Administrative Office at 1-844-507-7554, option 3, option 2.
Medicare Reimbursement Claim Form (Digital)
Use the Medicare Reimbursement Claim Form for reimbursements for your Medicare premium costs.
You will need to submit a reimbursement claim form with evidence of your premiums for Part B, and your premiums for Part D, Supplemental or Advantage plans, if any. This needs to be submitted to the Benefits Administrative Office when you first become eligible for Healthcare Cost Assistance, and every time your premium amount changes (usually once a year).
Out-of-Pocket Reimbursements
Ameriflex Reimbursement Form (PDF)
If you have any out-of-pocket expenses you paid out of your own funds (for example, any services you received after becoming eligible for Healthcare Cost Assistance but before receiving your Benefit Convenience Card), please submit a reimbursement claim form to the Benefits Administrative Office with a copy of your receipt or Explanation of Benefits.
Direct Deposit
We recommend signing up for direct deposit so that you can receive your reimbursement more quickly: if you complete the direct deposit form, your reimbursement will be posted to your account by the end of the following month. If you expect reimbursement by check, it will take another 5 to 15 business days for the post office to deliver the check. If it has been longer than that since you submitted your reimbursement information, you can check on the status of your reimbursement by emailing ohcwt@vimly.com or calling 1-844-507-7554, option 3, option 2.
Renewal
In order to continue receiving Healthcare Cost Assistance for your Medicare coverage, please remember to:
- Complete a new reimbursement claim form for your Part B premium if your premium has changed – along with evidence of your new premium amount.
- Complete a new reimbursement claim form every year if you have a Part D, Supplemental and/or Advantage plan, with evidence of your new premium amounts.
- Submit the Medicare paperwork again if you made any change to your coverage (like adding a Part D or Advantage plan).
The Social Security Administration generally announces new Part B premiums in November, and if you have an Advantage, Part D or Supplemental Plan, you should receive your new bill in December. Please complete the steps above as soon as you know your new premiums.
Contact Information
Benefits Administrative Office
1-844-507-7554, option 3, option 2
Reasons to contact the Benefits Administrative Office:
- To verify your eligibility for and enrollment into Carewell SEIU 503 Healthcare Cost Assistance for your Medicare coverage
- Questions about reimbursements
Valley Insurance Professionals
1-503-480-0499 (extension 7)
Reasons to contact Valley Insurance Professionals:
- If you are transitioning to Medicare coverage: your initial enrollment period starts 3 months before your 65th birthday, or your disability Part B effective date, and extends for 3 months afterwards – call anytime in between to discuss your Medicare plan options!
- If you want to enroll into a Part D, Supplemental or Advantage plan – you can generally sign up for those plans either during your initial enrollment period or between October 15 and December 7.
Social Security Office
Contact the Social Security Office to enroll into Medicare Part A and B coverage. Contact the Social Security Office as soon as your initial enrollment period begins, 3 months before your 65th birthday.
Apply online: www.ssa.gov/benefits/medicare
Apply by phone: 1-800-772-1213 from 7 am to 7 pm, Monday – Friday. If you are deaf or hard of hearing, you can call at TTY 1-800-325-0778.
Ameriflex
1-888-868-3539
When calling, please identify yourself as a Homecare or Personal Support Worker receiving Carewell SEIU 503 benefits, and also have your Benefit Convenience Card with you.
Click here to learn more about the Ameriflex mobile app
Reasons to contact Ameriflex:
- To check the balance on your Benefit Convenience Card, review your payment history, order a replacement card, etc.
- If your Benefit Convenience Card was declined and you were unable to make a payment
SHIBA (the Senior Health Insurance Benefit Assistance program)
SHIBA’s webpage on the Oregon.gov site
Contact SHIBA for guidance on:
- How to enroll into Medicare
- How to meet deadlines and avoid penalties
- Rights and protections
- Coverage and exclusions
- Rules to obtain benefits
- Costs associated with Medicare
Note: SHIBA counselors are most likely unaware of Carewell SEIU 503 benefits and are unqualified to answer questions about them.
Frequently Asked Questions
Read common questions about Healthcare Cost Assistance for Medicare coverage. See the FAQs page for more information.
Information for people transitioning to Medicare
If you are currently enrolled in a Marketplace plan, you will need to take steps to end your Marketplace plan the day before your Medicare plan starts. The agents at Valley Insurance Professionals may be able to help you with that – call 1-844-503-7348 for assistance. Also, if you already have a Benefit Convenience Card, please hold onto your Card. You will continue to use it for covered Medicare co-pays, coinsurance, deductibles and prescriptions as long as you remain eligible for Healthcare Cost Assistance. You cannot use your Benefit Convenience Card for your Medicare premiums.
How much money is on my Card?
The Benefit Convenience Card is pre-loaded with the annual amount for paying medical and prescription co-pays, deductibles and coinsurance expenses for covered services and prescriptions. In 2021, that amount is $6,500, but this may change from year to year.
Does my leftover balance roll over into the next year's amount?
No. The maximum amount you can be reimbursed for covered expenses incurred in each calendar year is the set amount for that calendar year. Any portion that is not used for a calendar year cannot be rolled over for payment of expenses incurred in a future calendar year.