- What CHM program works best with Medicare?
Participating in the Gold level's CHM SeniorShare™ program combined with Brother’s Keeper is the best option.
CHM SeniorShare™ offers the highest level of cost support and helps with medical bills incurred from inpatient or outpatient hospital incidents and surgery; medical testing; physical therapy and home healthcare (up to 45 visits per illness); incident-related doctor’s office visits; and incident-related prescriptions. CHM shares up to $125,000 per illness for any of the health issues mentioned above.
Adding Brother’s Keeper to your Gold program means that there’s no limit to the dollar amount of bills eligible for sharing through CHM. (Some limitations may apply for illnesses pre-dating your Brother's Keeper membership. See the Guidelines for more information.)
Silver or Bronze are good programs; however, sharing at these levels includes only medical bills incurred in a hospital (the Personal Responsibility amounts for Silver and Bronze are $2,500 and $5,000 per incident, respectively).
- How does the CHM SeniorShare™ program work with Medicare?
Members eligible for Medicare—for example, those qualifying for Social Security disability—and members 65 or older must have Medicare Part A and Part B (or a Medicare Advantage Plan) to be considered Medicare-participating members who can receive full sharing eligibility.
Otherwise, CHM shares up to 20 percent of the total eligible medical expenses that were incurred during months in which members were 65 or older but did not participate in Medicare (regardless of the reason), and the balance becomes the member’s responsibility.
Likewise, CHM shares up to 20 percent of eligible medical expenses when Medicare-participating members receive treatment from a non-participating Medicare provider.
Expenses incurred by members who choose to travel outside of the country for the purpose of undergoing testing or treatment are ineligible for sharing.
- If I have both Medicare and CHM, what happens when I incur medical bills?
Medicare-age members should follow these important steps:
- Submit the complete Medicare Summary Notice (MSN) or Explanation of Benefits (EOB) for incident-related medical expenses.
- Submit itemized bills only for expenses incurred for medical services or prescriptions from non-Medicare participating providers.
- Complete the Sharing Request Packet, which includes the Sharing Request Form, Medical Release Information Form, and Letter of Explanation. Do not submit the Medical Bill Worksheet.
- Instead of submitting the Medical Bill Worksheet, please note directly on your MSN or EOB which charges belong to your submitted incidents and indicate additional discounts applied.
- What about Personal Responsibility and out-of-pocket costs?
As always, medical bill discounts are applied to your Personal Responsibility amount, an advantage that often brings your out-of-pocket costs to $0. The same is true with Medicare or Medicare Advantage Plans. The amount that either plan pays toward your eligible medical bills applies to your CHM Personal Responsibility. The CHM staff will make any adjustments needed and will send you the correct amount of funds when your bills are shared.
- Does CHM share bills for nursing home expenses?
According to the CHM Guidelines, bills for nursing homes are ineligible for sharing. Long-term care insurance is a great option for people who may need nursing home benefits. More information about costs is available by contacting your insurance agent.
- Does CHM share bills for travel expenses?
Medical transportation and traveling expenses are defined separately in the CHM Guidelines. At the Gold level, bills for medical transportation are eligible for sharing when that medical transport was:
- necessary to preserve the member's life, limb, or eyesight, and
- the transport was either from the site of the emergency to the closest medical facility, or between medical facilities because the sending facility lacked the capability of providing the appropriate level of care.
Medical transportation bills on the Silver and Bronze levels are not eligible for sharing. Travel expenses are not eligible for sharing at any level.
- Will CHM help with my medical costs if I’m traveling and need emergency medical care?
Sharing is similar regardless of where you are traveling. Medical bills will be shared if they meet CHM’s Guidelines.
If you are traveling or serving outside of the United States, please note that CHM cannot send any correspondence outside of the U.S., and that all medical bills must be translated to English and foreign currency must be converted to U.S. dollars.
- What happens if I receive treatment from a doctor or hospital that doesn’t accept Medicare?
CHM offers members flexibility in choosing providers. However, when Medicare-participating members receive treatment from a non-participating Medicare providers, please note that CHM will share up to 20 percent of eligible medical expenses. For the most extensive healthcare provision, please choose providers who accept Medicare.
- Do Bring-a-Friend credits still apply if I have both Medicare and CHM?
A great advantage of being a CHM member is that you can receive a free month of membership for each new membership you bring into CHM. Members who participate in Medicare are included. Referring a friend can earn you one free month participation when your friend submits their third monthly financial gift.