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Guidelines - III.H REDEEM SeniorSaver Sharing Limitations

REDEEM SeniorSaver is for those aged 65 and over. It is a sharing program designed to be secondary to Medicare Part A, Part B, and if applicable Medicare Advantage plans. These are the specific exclusions and limits:

  1. REDEEM SeniorSaver members can share items covered by Medicare Parts A and B after Medicare first applies its coverage and the individual has met the AUA.
  2. REDEEM SeniorSaver members can share prescription bills when they have Medicare Part D and only after Medicare applies its coverage and the individual has met the AUA.
  3. A provider must purchase blood products for the REDEEM SeniorSaver member requiring a blood transfusion. Those costs are shareable.
  4. Inpatient acute care hospitalization for REDEEM SeniorSaver members:
    1. Days 1-60: Medicare covers these costs.
    2. Days 61-150: Medicare covers a significant portion of costs, the balance is shareable.
    3. Days 151-beyond: Ineligible for sharing.

The exception to the above would be any bill related to services declared as not eligible for sharing in Section III.G.