Medicare Plan Changes
You may request a change in health plans at the following times:
- During any CalPERS Open Enrollment period
- Within 60 days of the following events:
- Your retirement
- Enrollment in a Medicare health plan by you or your dependents
- Change in your residence or a move to a new health plan service area
When you retire, become Medicare eligible, and enroll in Medicare Part A and Part B, CalPERS will enroll you in a CalPERS Medicare health plan. As you transition from a CalPERS Basic health plan to a CalPERS Medicare health plan, you may remain with your current health carrier’s CalPERS sponsored Medicare health plan or you may change your health plan.
If your current CalPERS Basic health plan does not offer a CalPERS sponsored Medicare health plan, a health plan change is required to continue health coverage in a CalPERS group health plan.
Review the information below for specific details regarding plan availability and any actions you need to take. Visit Retiree Plans & Rates to view your health plan options. There you may also review each plan's Evidence of Coverage, and Summary of Benefits and Coverage with Uniform Glossary.
Medicare Health Plan Availability
CalPERS offers the following Medicare health plans:
- Kaiser Permanente Senior Advantage HMO Plan
(800-464-4000) - PERSCare, PERS Choice, PERS Select Medicare Supplement PPO Plans
- Includes enrollment in OptumRx Medicare Part D prescription drug plan
- UnitedHealthcare (UHC) Group Medicare Advantage PPO Plan
(888-867-5581)
New Enrollees
When you retire, become Medicare eligible, and enroll in Medicare Part A and Part B here is what you need to know about your transition to a CalPERS Medicare health plan.
| If | Then |
|---|---|
| You are currently enrolled in a CalPERS Basic health plan that has a corresponding Medicare health plan available | CalPERS will enroll you in your current health carrier's CalPERS sponsored Medicare health plan. |
| You are currently enrolled in a CalPERS Basic health plan that does not have a corresponding Medicare health plan available | CalPERS and UHC will work together to enroll you into UHC’s Medicare health plan. |
| You want to change your health plan | You may do so by providing your plan change request to CalPERS with your Medicare eligibility information or within 60 days of your enrollment in a Medicare health plan. |
| If | Then |
|---|---|
| You are currently enrolled in a CalPERS Basic health plan that has a corresponding Medicare health plan available | CalPERS will enroll you and your dependents in your current health carrier's combination plan.* |
| You are currently enrolled in a CalPERS Basic health plan that does not have a corresponding Medicare health plan available, have a dependent enrolled in a non-Medicare (Basic) plan, and your dependent resides in UHC's Basic plan's coverage area** | CalPERS and UHC will work together to enroll you into UHC's combination plan. (The Medicare plan is a Medicare Advantage PPO and the Basic plan is an HMO.) Use the UHC Search Tool to determine if your dependent's current provider accepts UHC';s Basic coverage. To find other options available in your area, use the Health Plan Search by ZIP Code. |
| You are currently enrolled in a CalPERS Basic health plan that does not have a corresponding Medicare health plan available, have a dependent enrolled in a non-Medicare (Basic) plan, and your dependent resides outside of UHC's Basic coverage area** | CalPERS and Anthem will work together to enroll you into the PERS Choice Medicare Supplement PPO combination plan.* To find other options available in your area, use the Health Plan Search by ZIP Code. |
| You are currently enrolled in a CalPERS Basic health plan that does not have a corresponding Medicare health plan available, have a dependent enrolled in a non-Medicare (Basic) plan, and you want to change your health plan | You may do so by providing your plan change request to CalPERS with your Medicare eligibility information or within 60 days of your enrollment in a Medicare health plan. |
* A combination plan means at least one family member is enrolled in a Medicare health plan and at least one family member is enrolled in a Basic health plan through the same health carrier. CalPERS requires all family members to have the same health carrier. View more on Combination Plans.
** Use the UHC Search Tool to determine if your dependent’s provider accepts UHC Basic coverage, if your dependent resides outside of UHC’s Basic plan coverage area, or to find providers by name, location, or medical groups/networks.
Resources
- A Guide to Changing Your Health Coverage
- Health & Medicare
- Health Plan Search by ZIP Code
- Plans & Rates
- Understanding Your Health Plan Statement (PDF)
Forms & Publications
- 2022 Health Benefit Summary (PDF)
- Health Benefits Plan Enrollment for Retirees (PDF)
- Health Program Guide (PDF)
- Medicare Enrollment Guide (PDF)
Frequently Asked Questions
- As a Medicare member with non-Medicare (Basic) dependents, do I have any other health plan options besides the UHC plans?
You and your dependent may also enroll in the Kaiser Permanente (if Kaiser offers both the Medicare and Basic plans in your area) or CalPERS PPO Medicare Supplement plans.
- If I'm enrolled in a Medicare plan and my dependent is in a non-Medicare (Basic) plan, if I move into the UHC Medicare Advantage PPO plan, will my dependent have to change plans as well?
Subscribers and their dependents must receive health benefits through the same health plan. If you switch to the UHC Medicare Advantage PPO plan, your dependent will move to the UHC Basic plan, Signature Value Alliance. However, if your dependent’s current provider accepts the UHC Basic plan, there will be no need to change providers.
- What are my out-of-pocket costs with the UHC Medicare Advantage PPO plan?
Members enrolled in the UHC Group Medicare Advantage PPO plan will have a co-pay of $10. Your co-pay will be same whether you live in California or out of state. Visit UHC to review plan benefits and costs.
- Will I be able to use my current non-Kaiser Medicare health care provider if I switch to the UHC Group Medicare Advantage PPO plan?
You can stay with your current Medicare provider. In the unlikely event your provider does not accept your coverage or isn’t contracted with UnitedHealthcare, contact UHC. Their staff will work to get your coverage accepted and ensure your services are paid for.
- Will my dependent and I have to change doctors if we move into the UHC plans?
Some people in combination plans may have to change doctors when they switch to the UHC Medicare and Basic plans, but the majority of people will not. A doctor who accepts Medicare and Basic coverage under our current non-Kaiser HMO plans will often also accept the UHC plans. Use the UHC Search Tool to find providers by name, location, or medical groups/networks.