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 $164.90/month in 2023)
Monthly premiums for Medicare Part D, Supplement, or Advantage plans (up to $50/month in 2023)
Out-of-pocket expenses, such as deductibles, copayments, coinsurance, and prescriptions for services covered by Medicare (up to $6,900 in 2023)

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). For more information about the Benefit Convenience Card and how to use it, click here.

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 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’ve been using the Benefit Convenience Card to pay premiums for a Marketplace plan, one major difference with Medicare is that you can no longer use the Benefit Convenience Card for Medicare premiums. Instead you’ll need to request reimbursement of your Medicare premiums. More information can be found in the Reimbursements tab below.

We’re offering online education events through Zoom to help you learn more about Carewell benefits!

Medicare and Healthcare Cost Assistance 101 – The first Friday of every month. (This event is only offered in English at this time.)

The Carewell Benefits team and our insurance partners, Valley Insurance Professionals, will review the basics of Medicare and how eligible Medicare participants can use the Healthcare Cost Assistance benefit.

Click here for more information.

Check Your Eligibility

This information is for Medicare recipients: Adults age 65 and older 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.

Go to questionnaire

A Carewell eligibility questionnaire on a mobile phone screen

Enrollment

Steps to Enroll

In order to enroll in Healthcare Cost Assistance, you will need to:

Fill out the required Medicare Healthcare Cost Assistance paperwork

Medicare Healthcare Cost Assistance Paperwork Forms (Online)

These forms give the Carewell SEIU 503 Benefits team and its partners legal permission to assist you with researching, enrolling in, and maintaining your Medicare plan (Medicare Supplement, Advantage, or Part D plan).

You have to fill out this paperwork when you first transition to Medicare coverage, and then again any time a change in plans is made.

Submit a reimbursement claim form

Submit a reimbursement claim form to Carewell SEIU 503 with evidence of your Part B premium and evidence of your Part D, Supplement, or Advantage plan premiums, if any.

Medicare Premium Reimbursement Claim Form (Online)

For proof of Part B, use your annual Social Security letter or CMS Medicare Premium Bill. The most common proof for Part D, Advantage, or Supplement 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 secure Direct Deposit Form with a photo of a voided check.

Direct Deposit Form (Online)

Carewell SEIU 503 can reimburse your Medicare premiums and expenses up to 12 months back, if you were eligible for Healthcare Cost Assistance benefits at the time.

For Medicare premium reimbursement, please submit a Medicare Premium Reimbursement Claim Form with:

- Proof of your premium payments up to 12 months back for your Part B, as well as Part D, Supplement, or Advantage plan premiums, if any.

For Medicare expense reimbursement, please submit an Ameriflex Reimbursement Claim Form with:

- Receipts showing your out-of-pocket medical expenses for services covered by Medicare and your Explanation of Benefits (EOB), up to 12 months back.

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 Carewell SEIU 503.
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 Carewell SEIU 503 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 15th of the month, please call Carewell SEIU 503 at 1-844-503-7348.

Please feel free to call to verify your eligibility for Healthcare Cost Assistance at 1-844-503-7348.

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, Supplement, and Advantage plans, such as deductibles, copayments, 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 0 hours of eligible working hours — also known as bargaining unit hours — for 2 months in a row. Going 2 months with 0 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 for 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 haven’t received your reimbursement for Medicare premiums by the 15th of the month, please call Carewell SEIU 503 at 1-844-503-7348.

Medicare Premium Reimbursement Claim Form (Online)
Use the Medicare Premium Reimbursement Claim Form for reimbursements for your Medicare premium costs.

You will need to submit a premium reimbursement claim form with evidence of your premiums for Part B, and your premiums for Part D, Supplement, or Advantage plans, if any. This needs to be submitted to Carewell SEIU 503 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 Claim Form (Online)

If you‘ve paid for any eligible out-of-pocket expenses with your own funds, you’ll need to submit a reimbursement claim form to Carewell SEIU 503. Please include a copy of your receipt or Explanation of Benefits. This can happen if you receive services after becoming eligible for Healthcare Cost Assistance but before receiving your Benefit Convenience Card.

Direct Deposit

Direct Deposit Form (Online)

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’s been more than 15 business days since you submitted your reimbursement information, you can check on the status of your reimbursement by calling Carewell SEIU 503 at 1-844-503-7348.

Renewal

To continue receiving Healthcare Cost Assistance for your Medicare coverage, please remember to:

Complete a new Medicare Premium Reimbursement Claim Form for your Part B premium if your premium has changed — along with evidence of your new premium amount.
Complete a new Medicare Premium Reimbursement Claim Form every year if you have a Part D, Supplement, and/or Advantage plan with evidence of your new premium amounts.
Submit the Medicare Healthcare Cost Assistance paperwork again if you need assistance from Valley Insurance Professionals (VIP) to add or change coverage for a Supplement plan, Part D, or Advantage plan.

The Social Security Administration generally announces new Part B premiums in November. If you have an Advantage, Part D, or Supplement plan, you should receive your new bill in December. Please complete the steps above as soon as you know your new premiums.

Losing Eligibility

Losing Carewell SEIU 503 benefits does not mean you’re losing your health insurance coverage! But at the end of your grace period month, your Benefit Convenience Card (BCC) will be turned off and you will have to start paying your own premiums and out-of-pocket medical expenses.

Don’t throw away your BCC! If you become eligible for Healthcare Cost Assistance benefits again, you’ll be able to use your card again.

What To Do After Regaining Eligibility

If you’re on Medicare, you should start receiving reimbursements for your premiums in the same amount as you did previously. If you were receiving HCA for Medicare in a past year (not the current year) and your premiums or any other information have changed, you’ll need to fill out the Medicare HCA paperwork and a Medicare Premium Reimbursement Claim Form. Once your documents are processed, you’ll start receiving premium reimbursements and you’ll be able to use the BCC for your out-of-pocket expenses.

If you kept your BCC, you should still be able to use it, unless the expiration date on the front has passed. Please note that Ameriflex, the BCC Administrator, issued new cards in July 2022. If you received your BCC before that date, it is no longer valid, regardless of its expiration date.

If you don’t have a valid BCC, call Carewell SEIU 503 at 1-844-503-7348 to order a new card.

If you have no medical coverage, you may not be able to enroll in a medical insurance plan on the Healthcare Marketplace until Open Enrollment, unless you qualify for a Special Enrollment Period. Open Enrollment usually begins on November 1 for coverage the following year. Until you enroll in an approved plan on the Marketplace, you would not be able to receive Healthcare Cost Assistance benefits.

Contact Information

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 three months before your 65th birthday, or your disability Part B effective date, and extends for three months afterwards — call anytime in this six-month period to discuss your Medicare plan options!
If you want to enroll in a Part D, Supplement, 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 in Medicare Part A and B coverage. Contact the Social Security Office as soon as your initial enrollment period begins, three 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.

Ameriflex online portal

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)

1-800-722-4134 (toll-free)

SHIBA’s webpage on the Oregon.gov site

Contact SHIBA for guidance on:

How to enroll in 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 not qualified 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.

You can also find more resources about Medicare on our Resources page.

Information for people transitioning to Medicare

If you’re currently enrolled in a Marketplace plan, you’ll 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 on to it. You can continue to use it for covered Medicare copays, coinsurance, deductibles, and prescriptions as long as you remain eligible for Healthcare Cost Assistance. However, you cannot use your Benefit Convenience Card for your Medicare premiums.

How much money is on my Benefit Convenience Card?

The Benefit Convenience Card is preloaded with the annual amount for paying medical and prescription copays, deductibles, and coinsurance expenses for covered services and prescriptions. In 2023, that amount is $6,900, 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 isn’t used for a calendar year cannot be rolled over for payment of expenses incurred in a future calendar year.