CalPERS

FAQs - CalPERS and Medicare

I have decided I do not want Part B benefits. Will this affect my CalPERS Medicare health plan?

Yes, you must have Medicare Part B to participate in a CalPERS Medicare health plan. If you cancel or choose not to enroll in your Part B coverage, then you will lose your CalPERS health coverage.

If you do not sign up for Medicare Part B when you turn 65 and decide to sign up for it later, you may have to pay a federal Part B penalty surcharge. If you choose to sign up for it later, this means that you will pay more for every month of your Part B coverage. Contact the Social Security Administration (SSA) at (800) 772-1213 or TTY at (800) 325-0778 for more information about the Part B penalty surcharge.

If I am retired from the State of California and the monthly State contribution is more than the plan’s premium, can I get money back when I enroll in a CalPERS Medicare health plan?

To continue your health insurance coverage with the State of California when you become eligible for Medicare (generally, at age 65), you will need to enroll in Medicare and transition to a CalPERS Medicare health plan. This is required if you are eligible to enroll in Medicare Part A at no cost to you. You must also pay a Medicare Part B premium to the SSA, as well as an increased assessment for Medicare Part B and Part D if your income level exceeds a federal threshold.

If you are a State or CSU retiree, you may be eligible for a reimbursement of all or part of your Medicare Part B premium. The amount is limited to the difference between your employer contribution and the cost of your plan's premium up to the amount of your Part B premium. Your reimbursement will be automatically calculated and will appear on your retirement warrant as a credit. If you are paying an increased Medicare Part B premium due to your income level, please send a copy of the entire Social Security notice showing your increased Medicare Part B premium. Staff will process your request, and if there are funds available you will see an increased reimbursement credit on your retirement warrant. Send the copy of your notice to:

CalPERS
Health Account Services
Attn.: Medicare Program
P.O. Box 942715
Sacramento, CA 94229-2715

California law does not provide for reimbursement of Medicare Part B premiums for retirees of contracting public agencies. If you are retired from a contracting public agency, you may contact your former employer to ask if this benefit is provided to you.

California law does not provide for reimbursement of Medicare Part D premiums.

How do I switch to a CalPERS Medicare health plan after retirement?

First, sign up for Medicare Part B as soon as you qualify. Although most people qualify when they turn age 65, some people under age 65 may qualify due to a disability. Once enrolled, mail the following information:

  • A copy of your Medicare card or Letter of Entitlement from SSA
  • A completed Certification of Medicare Status (PDF) form and any supporting documentation noted on the form.

Mail this information to:

CalPERS
Health Account Services
Attn.: Medicare Program
P.O. Box 942715
Sacramento, CA 94229-2715

Your new CalPERS Medicare plan will start on the first day of the month following your Medicare effective date or the first day of the month after CalPERS receives your documentation.

I lost my CalPERS health benefits because I stopped my Part B insurance. How can I get my CalPERS benefits back?

Immediately contact the SSA to see if you can reinstate your Medicare Part B, either without a lapse in coverage or on a prospective basis. If this is not possible, you can only enroll during the SSA's annual General Enrollment period with an effective date of the following July 1. Some SSA offices will process your request outside of the General Enrollment period, but your effective date will still be the following July 1. You may request re-enrollment in a CalPERS Medicare plan based on the effective date of your Medicare coverage.

I didn't pay the increased amount for my Medicare Part D insurance. What will happen to my CalPERS benefits?

Immediately contact the SSA to see if you can reinstate your Medicare Part D, either without a lapse in coverage or on a prospective basis. Medicare Part D is your prescription drug coverage, and if you have lost your Medicare Part D enrollment, you will pay out of pocket for your prescription drug coverage. If you enroll in a non-CalPERS Medicare Part D prescription drug plan, you will lose all of your CalPERS health coverage.

My spouse is 65 and not retired. I have my health insurance through my spouse. When should I enroll in Part B?

If your spouse is actively employed and you and your spouse are covered by an employer group health plan through that active employment, you may defer enrollment in Medicare Part B until your spouse either retires or loses the employer group health coverage through active employment. The SSA provides a special enrollment period after loss of employer group health coverage from active employment when you can enroll in Medicare Part B without penalty.

Be sure to enroll in Medicare Part B as soon as your spouse retires or loses employer group health coverage through active employment and contact CalPERS to transition to a Medicare health plan. If you delay enrollment in Medicare Part B, you may have to pay SSA a late-enrollment penalty in addition to the Part B monthly premium.

Before I retired, I was enrolled in a Basic HMO plan. What do I need to do to change to an HMO Medicare Managed Care plan?

You may change health plans when you turn age 65 and transition from a Basic plan to a Medicare plan. Enrolling in a Management Care plan involves two steps. First, notify CalPERS of your intention to enroll in a Medicare Managed Care plan. Second, complete and return the carrier's election form to finalize your transition. The carrier may send you an enrollment kit that includes the election form; if you did not receive one, contact the carrier directly.

I am Medicare eligible, retired from CalPERS and returning to work. Can I continue my CalPERS Basic health plan coverage?

You may continue your enrollment in a CalPERS Basic health plan if you receive your health coverage through employment status and not as a retiree through retirement status. You may also remain enrolled in a CalPERS Basic health plan if you are eligible to defer your Medicare enrollment.

You may be able to defer Medicare enrollment if you are Medicare eligible and are covered by an employer group health plan (yours or your spouse's). If you defer enrollment, you will be able to enroll during a special enrollment period after either your employment or your employer group health coverage ends.

Where can retirees find more information on Medicare?

CalPERS offers a publication entitled CalPERS Medicare Enrollment Guide (PDF) that explains how Medicare works with a member's CalPERS health benefits plan. Members can print out this publication, order it by mailing in their pre-paid postcard attached to their rate sheet inside their Open Enrollment packet, call CalPERS at 888 CalPERS (or 888-225-7377) or visit my|CalPERS.

Dated: 09-16-2013