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Medicare FAQs

Questions about Medicare and how it works with UC-sponsored plans? We’ve compiled a list of questions commonly asked by prospective and current retirees. You can also learn more about Medicare at medicare.gov.

Keep this information in mind when you consider your health plan choices during Open Enrollment in the fall. Even if you’re happy with your current plan, it’s always a good idea to understand all of your options as costs and benefits may change from one year to another.

What exactly is Medicare, and what are its components?

Medicare is the federal health insurance program for people 65 and over, and it plays an important role in covering your health care costs as you age. Medicare also covers some people under 65 who have received disability benefits.

Medicare has four parts: A, B, C and D. You must pay the federal government a premium for Medicare Part B, and possibly other parts of Medicare; the amount depends on your income. These premiums are separate from the premiums you pay to UC. See below and medicare.gov/your-medicare-costs for more information.

Part A covers hospital care, skilled nursing and hospice care and home health services. Most people don’t pay a premium for Part A because you or your spouse or ex-spouse have worked full-time for 10 years and paid for it through Medicare taxes.

Part B covers outpatient medical services. Everyone enrolled in Medicare must pay a monthly premium to the federal government for Part B. For those with higher incomes, this premium is indexed to your modified adjusted gross income.

Part C is another term for “Medicare Advantage,” a type of Medicare-approved plan offered by private insurance companies that combines Medicare Parts A, B and D benefits. If you enroll in a Medicare Advantage plan, Medicare pays your insurance company a set amount and the company approves and pays for your care.

Part D covers prescription drugs. The cost for Medicare Part D is folded into UC-sponsored Medicare plans, except for UC Medicare PPO without Rx. If you are paying a higher Part B premium due to your income (see information on Part B), you will also pay a Part D surcharge to the federal government.

How do UC’s Medicare plans work with Medicare?

UC sponsors five Medicare plans for eligible retirees who live in California, and they work in different ways to increase your coverage over the standard 80% usually covered by Medicare.

Kaiser Permanente Senior Advantage and UC Medicare Choice are Medicare Advantage (Part C) plans (see What exactly is Medicare above). The insurance company that offers the Medicare Advantage plan receives a set amount from Medicare to pay for and manage your care; you pay a set copay for some services. You’ll work directly with your physician and the plan if you have questions about whether a certain service or medication will be covered.

UC may refund a portion of the Part B premium you pay to Medicare if UC’s contribution to your retiree medical benefits is more than the total cost of your premium. You’ll see the exact amount on your retiree benefit (pension) statement under “Medicare Part B Reimbursement.”

UC High Option Supplement to Medicare, UC Medicare PPO and UC Medicare PPO without Prescription Drugs are Medicare Supplement plans; your care is governed by Medicare’s rules. When you receive services, your provider submits claims to Medicare first, and then your claims are forwarded to your plan to cover even more of your costs.

What are other differences between UC’s Medicare plans, and how do I choose what’s best for me?

Kaiser Permanente Senior Advantage (administered by Kaiser Permanente) is a Medicare Advantage Health Maintenance Organization (HMO) plan with a closed network of providers. This is a good fit if you want lower out-of-pocket costs, like having one doctor manage your care, and if you are comfortable with out-of-network coverage only in emergencies.

UC Medicare Choice (administered by UnitedHealthcare) is a Medicare Advantage Preferred Provider Organization (PPO) plan that offers access to any provider, in-network or out-of-network, at the same cost to you (as long as providers accept this plan and Medicare). Because this is a Medicare Advantage plan, your physician may need prior authorization from UnitedHealthcare for some services. This is a good fit for those who want lower premium and out-of-pocket costs and want the flexibility to see providers both in and out-of-network — for the same out-of-pocket costs.

UC High Option Supplement to Medicare (administered by Anthem Blue Cross), is a Medicare Supplement PPO plan. It usually has the highest premium of UC’s plans, because it covers 100% of the cost for Medicare-covered services (after a small yearly deductible).

UC Medicare PPO (administered by Anthem Blue Cross) is also a Medicare Supplement PPO plan. It’s a best fit if you want direct access to Medicare providers without need for referrals and you are willing to pay variable costs per service (usually about 4% of the costs for covered services).

UC Medicare PPO without Prescription Drugs (administered by Anthem Blue Cross) is offered to those who have Medicare-coordinated health insurance that covers prescription drugs through a non-UC plan (another employer or former employer). It is similar to the UC Medicare PPO, except your Part D coverage comes from another plan. You must provide proof of your Part D coverage to enroll.

During Open Enrollment in the fall, UC’s print and online materials will help you compare each plan’s costs, benefits, services, co-pays, annual out-of-pocket maximums, prescription drug costs and copays and more. Your health care facilitator is another valuable resource in helping you choose the right plan.

Why should I choose a UC Medicare plan instead of one of the other Medicare plans I see advertised?

You may already be receiving ads for commercial health plans and you can probably just recycle them. If you’re eligible for UC retiree health benefits, a UC Medicare plan is likely to be your best option.

Because UC values its retirees and their service, it is projected to contribute over $300 million to health plans (Medicare and non-Medicare) for retirees and their family members in 2021. UC has also negotiated with insurance companies on your behalf to ensure these plans offer as much protection as possible, with an upper limit on your out-of-pocket costs (from $1,050- $1,500, depending on the plan) and help with appeals if you need it.

Medicare Part D for prescription drugs is folded into your UC Medicare plan (except for the UC PPO without Prescription Drugs). If you enroll in these commercial Medicare health and/or Medicare Part D prescription plans, your UC Medicare plan will be terminated automatically.

How much do retirees pay for their health plan premiums?

It depends on the plan, who you cover, and the number of years of your UC service. Currently, UC shares the monthly cost of medical and dental coverage with retirees, up to a UC maximum that varies each year depending on overall costs. Under “graduated eligibility,” retirees may be eligible to receive from 5% to 100% of UC’s maximum contribution.

Retirees may also pay a premium for Medicare Part B and D, depending on their income and the plan they choose.

This year, I am being billed by Medicare for a higher Part B premium than last year. Why?

It is possible that the Part B premium increased, and/or that the modified adjusted gross income you reported on your 2019 tax return was higher than the previous year. The same is true for Part D monthly premiums. The premium amounts are set by Medicare, not UC, and they increase depending on your income. There are appeal procedures that can be directed to Medicare.

What happens if I don’t pay my Part B and/or Part D premiums to Medicare?

You could end up paying more for medical coverage, and you may lose your UC-sponsored medical plan altogether. If you drop Medicare Part B and/or Part D, you will be temporarily enrolled in the non-Medicare version of your current UC-sponsored plan, which is more expensive than the Medicare-coordinated plan, and it may cost you more in medical claims costs. Any “Part B Reimbursement” previously paid to you by UC will end, so your pension payment may decrease. You may also be subject to additional costs, including bills from UC for the Part B payments paid to you when you were not enrolled, a non-refundable $419.60 monthly offset to cover higher non-Medicare costs to the university and permanent late enrollment penalties from Medicare when you re-enroll.

If you are having financial difficulty in paying your Medicare Part B or D premiums, there are Medicare Savings Programs to help you. Visit Medicare.gov/talk-to-someone or call 1-800-633-4227 for the number and location of your Medicare office.

Are there UC retirees over age 65 who are not eligible for Medicare?

If you are a long-term faculty and staff, or a Safety Member, who has not made contributions to Social Security, you may not be eligible for premium-free Medicare Part A — unless you are eligible through a spouse, former spouse or other work credit from a different employer. You may continue to be enrolled in one of UC’s non-Medicare medical plans by submitting your denial letter from the Social Security Administration to the UC Retirement Administration Service Center (with a UBEN 100 formPDF).

I’m a retiree under age 65. Since I’m not yet eligible for Medicare, I’m enrolled in a UC non-Medicare plan. How do I sign up for Medicare when I’m eligible?

If you’re a retiree and covered by a UC medical plan, UC will send you a Medicare information packet with enrollment instructions three months before your 65th birthday. The same is true for anyone you cover who is about to turn 65. In general, Medicare and UC require enrollment at age 65. You need to enroll in Medicare Part A and B. Medicare Part D enrollment will be handled by your plan, except for the plan without prescription drug coverage.

I’m a UC retiree and I’d like to cover my partner. Can we continue to have UC coverage if one of us is eligible for Medicare and the other is not?

UC offers combinations of coverage for families with some members who are eligible for Medicare and some who are not. For example, if you are enrolled in UC Care, your Medicare-eligible spouse could enroll in UC Medicare PPO. There is a separate premium table for these combinations, which is available during Open Enrollment.

My spouse and I are thinking of moving out of California. Can we keep our UC plan?

There’s a lot to think about if you’re considering a move – including what it might mean for your health insurance coverage. It’s a good idea to talk to someone before you move.

If you and everyone you cover with UC insurance are in Medicare and you move to another U.S. state, you’ll transition to the Medicare Coordinator Program, administered by Via Benefits. You won’t have the option to stay in your UC Medicare plan. Through the Medicare Coordinator Program, licensed Via Benefits advisors work with eligible UC retirees to find the Medicare medical and prescription drug plans available where they live that work best for them. These plans are not affiliated with UC.

Your enrollment in an individual medical plan through Via Benefits is paired with a Health Reimbursement Account (HRA), with a maximum annual contribution from UC of $3,000 per person. In many cases, the HRA funds provided by UC will cover the cost of the premiums as well as some additional out-of-pocket health care costs (such as Medicare Part B premiums and copays for your medical care). Any costs above $3,000 are the enrollee’s responsibility and subject to the plan’s out-of-pocket limits.

Retirees must enroll through Via Benefits if all conditions below apply:

  • You have a non-California home (residence) address on file
  • You are eligible for UC retiree health insurance and receive a monthly retirement benefit
  • All family members you cover by UC health insurance are at least 65 years old and eligible for Medicare.

If you have questions about the program, you can contact Via Benefits at 855-359-7381 (TTY: 711), Monday through Friday, 5 a.m. to 6 p.m. (PT) or visit ucal.us/medicarecoordinator for more information.

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