General Tips for Working Members Age 65 and Older
Four months before your 65th birth month you will receive a letter from CalPERS titled “Important Information Concerning Health Coverage at Age 65.” This notice contains information regarding the CalPERS Medicare enrollment requirements. We encourage you to carefully review and save this letter for future reference.
We recommend you also review and save all mail received from the Social Security Administration (SSA), as it will contain valuable information regarding your Medicare enrollment.
You may remain enrolled in a CalPERS Basic (non-Medicare) health benefits plan until retirement. When you retire, you'll no longer be eligible to remain in a CalPERS Basic (non-Medicare) health plan if you are eligible for Medicare Part A at no cost.
Medicare Part A
While working, you may enroll in Medicare Part A by applying online with SSA, contacting SSA at 1 (800) 772-1213, or by visiting your local Social Security office. Call first to make an appointment.
- Refer to Apply Online for Medicare – Even if You are Not Ready to Retire (PDF) and the Medicare (PDF) publication for additional resources.
Medicare Part A will be premium-free if you:
- Worked for at least 10 years (40 quarters) in Social Security/Medicare-covered employment;
- Are eligible through the work history of a current, former, or deceased spouse; and/or
- Have End-Stage Renal Disease (ESRD), Amyotrophic Lateral Sclerosis (ALS), or a Social Security-qualified disability and meet certain SSA requirements.
Enrolling in Part A may save you money:
- If you enroll in Part A, your current CalPERS Health Plan will continue to be the primary payer of your insurance claims and Medicare Part A will be a secondary payer. As a secondary payer, Medicare pays up to their allowable amount of costs not covered by your CalPERS health insurance, potentially reducing your out-of-pocket costs.
- But, there are limitations to be aware of: Part A only covers inpatient care in a hospital, skilled nursing care, hospice, and some home health. Therefore, remaining in a CalPERS health plan and enrolling in Medicare Part A will only help defray cost sharing for those covered services up to the allowable amount based on the Medicare fee schedule.
- However, you may want to consider delaying Medicare Part A until a later date if you contribute to a Health Savings Account (HSA) or if you will have to pay a premium to enroll in Part A.
Medicare Part B
The SSA establishes a Medicare Part B premium amount annually, which must be paid to SSA to remain enrolled in Part B. If you receive SSA benefits, the Medicare Part B premium will be deducted from your SSA benefits; otherwise, the SSA will bill you quarterly.
The standard Medicare Part B premium applies to everyone; however, you may be assessed an additional Income Related Monthly Adjustment Amount (IRMAA) if your modified adjusted gross income reported on your IRS tax return is above a certain amount.
You may defer Medicare Part B enrollment because you are still working.
- To defer, you should communicate this to SSA by contacting them at (800) 772-1213.
- This will ensure that you avoid a late enrollment penalty when you decide to retire and enroll in Medicare Part B upon retirement.
If you choose to enroll in a Medicare Part B while still actively working, you will remain in a CalPERS Basic (non-Medicare) health benefits plan and your CalPERS Employer Group Health Plan will be the primary payer, and Medicare becomes the secondary payer.
When You Decide to Retire
For a smooth transition from a CalPERS Basic to a CalPERS Medicare health benefits plan, you are encouraged to enroll into Medicare Parts A & B prior to or within 30 days of retirement. Timely enrollment allows us to receive notification of your enrollment electronically and automatically transition you into a CalPERS Medicare health benefits plan. You will not need to send any additional documentation to us if:
- Your enrollment is more than 30 days from retirement, you may be required to provide supporting Medicare documentation (i.e., Medicare card or entitlement letter) to CalPERS.
- Your CalPERS Basic health plan has a corresponding Medicare health plan, you will be automatically transitioned to the CalPERS Medicare plan with your carrier. If your Basic plan does not have a corresponding Medicare plan, you will be transferred into UnitedHealthcare (HMO). If UnitedHealthcare is not available where you live, you will be transferred into PERS Choice (PPO).
You have 60 days from the date of enrollment in a CalPERS Medicare plan to elect a different plan by contacting CalPERS at 888 CalPERS (or 888-225-7377).
You're able to enroll in Medicare Parts A & B online with SSA by contacting SSA at (800) 772-1213 or by visiting your local Social Security office. Call first to make an appointment.
You may enroll in Medicare Part B by completing the following forms and applying directly with SSA.
- Since you worked beyond age 65, you will need to have a Request for Employment Information (Form CMS-L564) completed by your health benefits officer.
- Application for Enrollment in Medicare Part B (Medicare Insurance) (Form CMS-40B).
- Return completed forms to your local Social Security office by mail or fax them to (833) 914-2016.
Medicare Enrollment Periods
The SSA has three Medicare enrollment periods:
- Initial Enrollment Period
When you're turning 65, you have a seven-month period to sign up for Part A and/or Part B. This Initial Enrollment Period begins three months prior to the month you turn 65 and ends three months after the month you turn 65.
- General Enrollment Period
If you're not enrolled in Medicare, you may sign up for Part A and/or Part B during a three-month period each year. The General Enrollment Period begins January 1 and ends March 31. Your coverage begins the following July 1.
- Special Enrollment Period
If you and/or your spouse are currently working and covered by an employer group health plan from that current employer, you may be eligible to sign up for Part A and/or Part B during a Special Enrollment period, an eight-month period that begins the month after the employment ends or the group health coverage ends, whichever happens first. Contact the SSA for more information.
Avoiding Late Enrollment Penalties
If you’re 65 or older and covered under an employer group health plan, either from your own or your spouse’s current employment, SSA will allow you to enroll in Medicare Part B without a late-enrollment penalty if you're eligible to enroll during a Special Enrollment period.
When retiring after age 65, you are encouraged to immediately enroll in Medicare Part B with SSA during your Special Enrollment Period.
- While the Special Enrollment Period is eight months, the window to enroll in a CalPERS Medicare health plan is only 30-60 days post-retirement, so immediate action is strongly encouraged.
- If CalPERS does not receive your Medicare Part A and B information within 60 days, your health benefits will be canceled.