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Medicare Plus (Plan J or HJA)

Provider Type

  • Physicians
  • Participating Physician Groups (PPG) 
    (does not apply to HSP)
  • Hospitals
  • Ancillary

If the member has conversion or Medicare Plus (Plan J or HJA) coverage:

  • Medicare is primary
  • The plan is always secondary

Medicare Plus (Plan J or HJA) is non-group coverage for Medicare beneficiaries who have lost eligibility through group or conversion plans.

Medicare Plus is available to subscribers and their spouses when:

  • They are age 65 or older.
  • Their previous group or conversion coverage has ended.
  • They are covered by both Parts A and B of Medicare (current employment does not affect eligibility for Medicare Plus).
  • They are not enrolled in another HMO plan through a Medicare HMO contract.

When the plan discovers that a Plan J or HJA member is not covered through both Parts A and B of Medicare or that the member is enrolled in another HMO plan through a Medicare HMO contract, the plan cancels the member's Plan J or HJA coverage.

Application for Medicare Plus must be made within 31 days of the member's last date of group or conversion coverage.

Last Updated: 10/30/2019