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What to do if you're

Enrolling in Medicare

If you're like most people, when you turn 65, whether you’re still working or you're already retired, you 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.

Please note: As you approach age 65 you will begin receiving Medicare plan offers from various health and prescription drug plans outside of UC, and even from carriers UC offers, such as Kaiser. These offers are for an individual Medicare plan which may not cover all the benefits offered by your UC group plan, so consider carefully before making any plan changes. You may only be enrolled in one Medicare plan at any one time. If you have any questions, please contact the Retirement Administration Service Center (RASC)

2

Enroll in Medicare when you turn 65. 

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

Ninety (90) days before your 65th birthday, RASC will send you a letter with information about enrolling in Medicare. 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-gender and opposite-gender) 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.

If you turn 65 and you’re already retired, enrolling in Medicare isn’t optional. If you are eligible for premium-free Part A and you don’t enroll in Part A and B before your 65th birthday, you could lose your UC-sponsored medical coverage and be charged penalties by RASC and lifelong penalties by Medicare. Ninety (90) days before you turn 65, RASC will send you the Medicare forms you'll need to fill out, along with the date UC needs you to enroll in Medicare and return the forms. Sending in the information by this date allows for the timely processing of your enrollment into the Medicare plan.

It usually takes about three weeks from when you apply before you receive your Medicare card in the mail. If you are running out of time to get your Medicare card before UC’s deadlines, you may be able to download a Benefit Verification Letter from the Social Security website, My Social Security, within about three business days of applying. Your Benefit Verification Letter includes the information you need (including your Medicare Health Insurance claim number (HICN) and coverage effective dates) to complete all of your required paperwork.

To keep your UC-sponsored coverage, you’ll need to pay your Medicare Part B premiums without interruption and on time to maintain your Medicare enrollment. Depending on your income you may need to pay an additional premium for Part D as well. 

If you are required to pay a premium for Part A as a retiree, you are not required to enroll in Medicare Parts A and B. However, UC does require that you send in a denial letter from Social Security to keep your current coverage. 

3

Make sure you understand your costs.

Medicare Part A is usually premium-free, but there is a monthly premium for Part B coverage, paid to the Social Security Administration. This premium is usually deducted from your Social Security benefit, or you are billed quarterly. See the Medicare Fact Sheet and/or the Social Security website for standard rates.

If your income has gone down, you may use form SSA-44 from the Social Security Administration (available at www.socialsecurity.gov/forms/ssa-44.pdf) to request a reduction in your income-related monthly adjustment amount.

The UC-sponsored medical plans coordinate Medicare Part D (prescription drug) coverage with the plan’s coverage. Most people are not charged a premium for Part D. However, as with Part B, you may pay a Part D premium based on your income. Check with Social Security to see if you are required to pay a Part D premium. These Medicare premiums are in addition to any premium you pay to UC for your UC insurance.

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-gender), 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).