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Medicare

General Tips for Working Members Age 65 and Older

Four months before your 65th birth month you’ll 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.

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’ll have to pay a premium to enroll in Part A.

Medicare Part B Premiums

Each year, the Centers for Medicare & Medicaid Services (CMS) announces the Medicare Part B premium amount. CalPERS sets the standard Medicare Part B premium reimbursement amount on January 1 based on the amount determined by the CMS. According to the CMS, most Medicare beneficiaries will pay the standard Medicare Part B premium amount.

However, if your Modified Adjusted Gross Income (MAGI) as reported on your IRS tax return is above the set threshold established by the CMS, you’ll pay the standard Medicare Part B premium amount plus an additional Income-Related Monthly Adjustment Amount (IRMAA). If you’re required to pay an IRMAA, you’ll receive a notice from the Social Security Administration (SSA) advising you of your Medicare Part B premium cost for the following calendar year, and how the cost is calculated.

You may defer Medicare Part B enrollment because you are still working. Contact the SSA at (800) 772-1213 to defer. 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 Medicare Part B while still actively working, you’ll 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.

New CMS Medicare Enrollment Requirement

Effective January 1, 2023, the CMS is requiring Medicare enrollment requests to include race and ethnicity data. This requirement is part of CMS’ commitment to address health inequities in the health care system.

CalPERS is fulfilling the requirement to ask for race and ethnicity information by directing members and dependents to submit their race and ethnicity information through their Health Demographic Profile by either logging into their myCalPERS account or by visiting Health Demographic Profile.

Providing race and ethnicity data is at the discretion of members and their dependent(s); CalPERS can't deny any coverage if information isn't provided.

Reimbursement of Premiums

State & CSU

Active state or California State University (CSU) employees and their dependents enrolled in a CalPERS Medicare health plan may be eligible for a reimbursement of all or part of their Medicare Part B premium(s).*

  • If you’re receiving Part B reimbursement from CalPERS and are no longer paying a Part B premium to the SSA, contact CalPERS immediately to stop the Part B reimbursement.
  • If you receive a Part B reimbursement from CalPERS for coverage periods that you didn’t pay Part B premiums to the SSA, you’ll be required to reimburse CalPERS.

* Some exceptions apply based on bargaining unit and first hired date. For additional information, refer to the CalPERS Medicare Enrollment Guide available on the CalPERS website.

Public Agency

California law doesn’t provide reimbursement of Medicare Part B premiums for active members of contracting public agencies. If you're an active employee from a contracting public agency enrolled in a CalPERS Medicare health plan, you may contact your employer to ask if this benefit is provided to you.

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 won't 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’ll automatically transition to the CalPERS Medicare plan with your carrier. If your Basic plan doesn't have a corresponding Medicare plan, you’ll transfer into UnitedHealthcare (HMO). If UnitedHealthcare isn't available where you live, you’ll transfer 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 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. 

Medicare Enrollment Periods

The SSA has three Medicare enrollment periods:

  1. 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.
     
  2. ​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. Starting in January 2023, your coverage will start the month after you sign up.​
     
  3. 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. The CMS also has special enrollment periods for individuals who meet the exceptional conditions created by emergency or disaster, health plan or employer error, formally incarcerated individuals, termination of Medicaid coverage, and other exceptional conditions evaluated on a case-by-case basis. 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 doesn't receive your Medicare Part A and B information within 60 days, your health benefits will be canceled.

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