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What to do if you're

Enrolling in Medicare

When you turn 65, whether you’re still working or already retired, almost everyone will become eligible to enroll in Medicare, the federal program to provide older adults and those with disabilities or permanent kidney failure with secure access to medical care. The rules are different for employees and retirees; so to be sure you enroll properly, avoid Medicare premium penalties and understand how Medicare works with your UC-sponsored medical plan, follow these steps.

1

Plan ahead.

If you’ll turn 65 in the next calendar year, it's time to make some decisions. If you'll be enrolled in UC retiree benefits when you become eligible for Medicare, review your Medicare medical plan options during Open Enrollment. The Medicare version of your current plan may have different benefits, doctors, service areas and behavioral health providers than the non-Medicare version. If you’d prefer a different Medicare plan than the one that corresponds to your current medical plan, Open Enrollment is the time to make the change. By moving into a different non-Medicare plan during Open Enrollment, you can easily transfer to that plan’s corresponding Medicare plan when you turn 65.

Some of UC’s retiree medical plans have Medicare versions (Kaiser Permanente CA, Health Net Blue & Gold) and some have a corresponding partner plan (UC Care, Core). If your existing retiree plan has a Medicare version or partner plan, you’ll be transferred into that plan when you turn 65, once Medicare has approved your enrollment form.

Non-Medicare Plans Corresponding Medicare Plans
UC Care UC Medicare PPO with Prescription Drugs
Core UC Medicare PPO with Prescription Drugs
Health Net Blue & Gold HMO Health Net Seniority Plus
Kaiser Permanente CA Kaiser Permanente Senior Advantage

If you’re a current retiree (or will become one before the next Open Enrollment) and are enrolled in UC Health Savings Plan or Western Health Advantage, which don’t have a corresponding Medicare plan, you have a 31-day Period of Initial Eligibility (PIE) when you turn 65 to enroll in any of the UC-sponsored Medicare plans in your service area:

  • Kaiser Permanente Senior Advantage
  • Health Net Seniority Plus
  • UC Medicare PPO with Prescription Drugs
  • UC Medicare PPO without Prescription Drugs*
  • UC High Option Supplement to Medicare**

* You are eligible to enroll in this plan if you have a creditable prescription drug plan outside of UC; you may be asked for proof of enrollment.
** You are eligible to enroll in this plan if you and all your covered family members are enrolled in Medicare.

If you did not pay into Social Security or paid less than 40 quarters (10 years of full-time employment), you will remain in your Non-Medicare plan as a retiree. You must send UC a Medicare denial letter before you turn 65 to continue your UC coverage and to avoid any penalties (currently $419.60/month). Contact Social Security to request this letter and to see if you may be eligible for Medicare under a spouse, former spouse or deceased spouse.

2

Enroll in Medicare when you turn 65. 

As long as you’re still employed, this isn’t a UC or Medicare requirement, since your UC medical plan will continue to be your primary coverage.  However, most employees do enroll in Part A since there is no cost. People who are receiving a Social Security benefit are automatically enrolled in Medicare Parts A and  B. If you do not want Part A or Part B while employed, contact Social Security. If you're in the UC Health Savings Plan, you should not enroll since the IRS does not allow Medicare enrollees to have a Health Savings Account; this pertains to any Medicare-eligible enrolled family members as well.

A few months before your 65th birthday UC will send you a letter with the information you need. Remember, you and/or your spouse can hold off on enrolling in Medicare as long as you’re working — just be sure to enroll when you retire. However, domestic partners (same-sex and opposite-sex) are usually not eligible to defer enrollment into Part B without incurring late enrollment penalties. These individuals are advised to contact Social Security three (3) months before turning age 65 to inquire about Part B enrollment options and whether late enrollment penalties apply if enrollment is deferred.

For retirees or your eligible family members, UC will send you the Medicare forms you'll need to fill out. If you are eligible for premium-free Part A and you don’t enroll in Part A and B by your 65th birthday, you could lose your UC-sponsored medical coverage and be charged UC penalties and lifelong penalties by Medicare. To keep your UC coverage, you’ll need to pay your Medicare Part B premiums on time to maintain your Medicare enrollment. Depending on your income (see chart in Step 3 below), you may need to pay a premium for Part D as well. 

3

Make sure you understand your costs.

While Medicare Part A is usually premium-free, most people will pay a premium for Part B and may pay a premium for Part D. These premiums are income-based. They are set by Medicare, not UC, and are payable to the Social Security Administration. Many people have the Medicare cost deducted from their Social Security benefit; others are billed by Social Security.

The Social Security Administration announced in 2015 that there would be no Social Security cost of living increase for 2016. As a result, most people with Medicare Part B are "held harmless" from any increase in premiums in 2016 and will pay the same monthly premium paid in 2015  $104.90.

Some Medicare Part B beneficiaries are not protected by the "hold harmless" provision, including those not collecting Social Security benefits; those who will enroll in Part B for the first time in 2016; dual eligible beneficiaries who have their premiums paid by Medicaid and beneficiaries who pay an additional income-related premium. Beneficiaries not protected by the “hold harmless” provision pay $121.80 in 2016.

The premiums below are for beneficiaries not protected by the "hold harmless" provision and are based on the modified adjusted gross income (MAGI) reported on their 2014 federal tax return.

Modified Adjusted Gross Income (MAGI) Part B monthly Premium*
amount/person
Part D monthly Premium*
amount/person
Individuals with MAGI of $85,000 or less; married couples with MAGI of $170,000 or less Standard premium = $121.80 $0.00
Individuals with MAGI of $85,001 to $107,000; married couples with MAGI of $170,001 to $214,000 Standard premium + $48.70 Your initial plan premium** + $12.70
Individuals with MAGI of $107,001 to $160,000; married couples with MAGI of $214,001 to $320,000 Standard premium + $121.80 Your initial plan premium** + $32.80
Individuals with MAGI of $160,001 to $214,000; married couples with MAGI of $320,001 to $428,000 Standard premium + $194.90 Your initial plan premium** + $52.80
Individuals with MAGI above $214,000; married couples with MAGI above $428,000 Standard premium + $268.00 Your initial plan premium** + $72.90

* These premium amounts are set by Medicare, not the university.
** For most UC retirees, the initial Part D plan premium will be $0.

In addition, it’s likely that you’ll pay a premium for your UC retiree health coverage. That amount depends on the plan’s premium and how much UC contributes toward your premium, based on your prior years of service.

4

Make sure you understand how your UC medical plan works with Medicare.

In general, Medicare pays first and UC’s retiree plans cover some of the cost Medicare doesn’t cover. Depending on the UC plan you choose, you may pay a co-payment or some portion of the cost that neither Medicare nor the UC-sponsored plan pays. If you use services that Medicare doesn’t cover, such as hearing aids, your UC plan may cover a portion of the cost. Be sure to verify coverage under your UC plan and follow your UC plan rules when obtaining services not covered by Medicare.

If you and/or your family members (excluding domestic partners) are covered under a UC employee plan or enrolled in TRICARE for Life, Medicare will be secondary to your UC medical plan. For domestic partners (same- and opposite-sex), Medicare will pay primary to your UC medical plan. 

5

Assign your Medicare benefits to your UC-sponsored retiree medical plan.

Whether you’re enrolled in a UC-sponsored retiree medical plan with a Medicare version or partner plan or enrolling in a Medicare plan during a Period of Initial Eligibility (PIE), you’ll need to fill out the appropriate form to assign your Medicare benefits to your Medicare plan. As a retiree this occurs when you turn 65; as a UC employee this occurs when you retire and you are 65 or older. 

Non-Medicare Plans Retiree Medicare Plans Required Forms
UC Care or Core UC Medicare PPO with Prescription Drugs Medicare Prescription Drug Plan Enrollment Form for UC Medicare PPO (UBEN 123)
Health Net Blue & Gold HMO Health Net Seniority Plus Medicare Advantage Enrollment/Election Form for Health Net (UBEN 125)
Kaiser Permanente CA Kaiser Permanente Senior Advantage Medicare Advantage Enrollment/Election Form for Kaiser (UBEN 127)

Remember, if your health plan doesn't have a corresponding Medicare plan, you have a 31-day PIE to enroll in a new plan and assign your Medicare benefits when you turn 65.

In most cases, once you complete the required form and Medicare approves your enrollment, you will transfer to your medical plan’s Medicare plan.  There may be differences between your current non-Medicare plan and your new Medicare plan: your doctor, specialists, behavioral health provider, prescription drug formulary and how you pay for these drugs may change.

6

Check with your doctor and specialists to see if they take Medicare patients.

To receive benefits under any UC-sponsored Medicare plan (including behavioral health), you must use a provider who accepts Medicare. For Kaiser or Health Net, this Medicare provider must also be within their associated network. If you see a doctor outside of your provider network or one who does not take Medicare members or will only render services under a “private contract” directly with you, neither Medicare nor your UC-sponsored medical plan will cover the services. Check with your current providers to see whether you need to change your doctor or be prepared to self-pay for these services.

7

Read the fine print.

If you’re over 65 and returning to work at UC; if you’re not covered by Social Security; if you have a domestic partner who’s covered under your UC benefits; or if you have any questions about Medicare as it applies to your situation, take a close look at UC’s Medicare Fact Sheet for information about these and other situations related to Medicare and your UC-sponsored medical plan. You may also contact the Retirement Administration Service Center (RASC).