Medicare & Your Health Benefits

Medicare & Your Health Benefits


Welcome to the Medicare and Your CalPERS Health
Benefits webinar. In this webinar, we’ll cover information you may need to know regarding
how your CalPERS health benefits coordinate with Medicare. In this presentation, we’ll
cover how and when you should enroll in Medicare and the Medicare reimbursement available to
State employees. We’ll also cover CalPERS health plans that coordinate with Medicare
and some resources where you can find more information.
Let’s start with a brief overview of Medicare. Medicare is a federal government health insurance
program which is administered by the Center for Medicare and Medicaid Services or CMS
for short. The Social Security Administration is responsible for determining Medicare eligibility,
enrollment and premiums. Medicare is for individuals who are 65 years
or older. It also may apply to those who are under age 65 with certain Social Security
approved disabilities and for those who are diagnosed with ESRD or ALS. Medicare is comprised of several parts. There’s
Part A Hospital insurance, Part B Medical insurance, Part C Medicare Advantage Health
Plan and Part D Prescription drug insurance. It’s important to understand that Medicare
does not cover all medical expenses or the cost of most long-term care, so let’s break
these parts down a little further. Medicare Part A is hospital insurance that
helps cover inpatient care in a hospital, or skilled nursing facility after a hospital
stay and some home health care or hospice care. Part A is free for most people if you’ve
worked at least 10 years in a Social Security Medicare-covered employment. Part A can also
be purchased but isn’t required. You may also qualify through a current, former,
or deceased spouse and the spouse only needs to be 62 years of age. If you’re under age
65, you may qualify for premium-free Part A due to a disability or if you have ESRD
or ALS. Part B is medical coverage. It helps pay for
doctors’ services, outpatient hospital care, and some other services not covered by Part
A. The Medicare Part B premium amount is determined annually by the Social Security Administration.
If you are already receiving Social Security benefits, you should enroll in Medicare Parts
A and B. You can begin signing up 3 months before your 65th birthday. You are required
to pay a premium for Part B. Some people are eligible for Part B before
age 65 if they qualify based on being deemed disabled by Social Security. If you’re retired
but not yet drawing your Social Security Benefits, you’re required to enroll during the Initial
Enrollment Period. You have a seven-month period in which to sign up for Part B. If
you’re eligible at age 65, your initial enrollment period begins three months before
your 65th birthday which includes the month you turn age 65 and ends three months after
that birthday. You may also enroll if you retire after age 65 when your health coverage
as an active employee ends. If you do not apply when you’re first eligible
for Medicare at age 65 or once your active employer group health coverage ends, you may
apply during the General Enrollment Period. This period is January 1 through March 31
of each year. The effective date of Part B is July 1st of the same year in which you
applied for the Medicare Part B benefit. The longer you wait to enroll, the more you’ll
pay. A federally mandated penalty of 10% is added to the monthly premium for each 12-month
period that you could have enrolled but didn’t. Please keep in mind that this is not a one-time
penalty, it’s a permanent increase to your monthly Part B premiums. There’s only one
opportunity to enroll each year if you miss the initial chance. It’s important to understand
that you will still need to purchase part B if you will qualify for A in the future
through a spouse. Medicare Part C is a Medicare Advantage Health
Plan that’s approved by the Centers for Medicare & Medicaid Services. These plans
coordinate benefits directly with Medicare and basically encompass parts A, B and usually
Part D. For 2019, Kaiser Permanente Senior Advantage, UnitedHealthcare Group Medicare
Advantage PPO Plan and Anthem Medicare Preferred are the Part C plans offered through CalPERS.
Medicare Part D is the Prescription Drug Benefit. CalPERS-sponsored health plans include prescription
drug coverage that’s comparable to Part D. Our Medicare Plans automatically enroll
you. You may receive multiple solicitations by mail regarding enrollment into a Part D
plan. As a CalPERS member you should not enroll in any Medicare Part D plans outside of CalPERS.
If you do so, you’ll lose your CalPERS health coverage.
Now let’s talk about the Medicare enrollment process. State law requires that if you’re
eligible for Part A, you must enroll in both Medicare Parts A and B and be placed into
a CalPERS Medicare plan. If this requirement is not met, you’ll be cancelled from your
CalPERS health coverage. If you are not entitled to Medicare Part A,
then you have two choices. You can provide proof of ineligibility for Medicare Part A
and remain in a CalPERS Basic health plan. Or you can elect to purchase Part A. If you
do this, then you’ll be required to enroll in Medicare Part B as well and coordinate
your CalPERS health benefits with Medicare. It’s important to understand that if you
are eligible for Medicare, you must enroll, or your CalPERS health coverage will be terminated.
If you’re already retired, you’ll receive notifications from us before your 65th birthday.
Although regulations require CalPERS to provide one notice to enroll in Medicare, we’ll
send you a total of four notices. The first notice is sent four months prior to the 65th
birth month. The second notice is sent 2 months prior to
your 65th birth month. And the final reminder is sent one month prior to the 65th birth
month. With each of these notices, you’re sent a health plan options flyer which gives
information regarding the Medicare plans available to you, as well as an ineligibility of Medicare
Status form. This is the form members complete if they do not qualify for Medicare or are
covered under an active health plan. If a member does not respond to the first
three notices, a cancelation notice is sent on the 1st day of their 65th birth month and
a health cancelation is set on their account for the 1st of the following month. If you
are enrolled in Medicare A & B prior to the final reminder notice, which comes 30 days
before your birthday, then nothing is required on your part. We will work with the Centers
for Medicare and Medicaid Services to automatically transfer you to a CalPERS Medicare health
plan. If you aren’t enrolled prior to age 65 or
we don’t receive notifications from CMS, then you will need to complete a Certification
of Medicare Status form and submit it with a copy of your Medicare A & B card.
There are two reasons that you may need to complete the Ineligibility of Medicare Certification
form. The first reason is if you’re still working beyond age 65 and covered by an active
group health plan through you or your spouse. You’ll still receive the required first
notice of 4 months prior to your 65th birthday that we mentioned earlier. However, because
you’re still on an active health plan, you defer your Medicare enrollment until you retire.
The next notice is sent to you the month after your retirement date and the Medicare final
reminder goes out a month after that. Both notices will be accompanied by the health
plan options flyer and ineligibility of Medicare status form. If no response is received, you’ll
receive a cancelation notice one month after the final reminder and your health benefits
will be canceled effective the 1st of the following month.
The other reason you would complete the form is that you are claiming Medicare ineligibility
because you don’t qualify based on your work record, or that of your spouse. Let’s
talk about what you need to do if you retire after age 65. Once you retire and if eligible,
you must enroll in Part B. This is the special enrollment period. Once you retire, within
60 days of separation from the health plan, you’ll need to contact Social Security and
enroll into Medicare Part B. You’ll then need to submit the Certification of Medicare
Status Form along with a copy of your Medicare card or eligibility letter from Social Security.
Failure to enroll in Part B and notify us will result in automatic cancelation of your
health coverage. Any forms or documentation you submit should include your CalPERS ID
number. This is your unique identifier for doing business with CalPERS. You can find
this number on your my|CalPERS account under the Profile tab, then select the Personal
Information link. For 2019, not all CalPERS health plans will
coordinate with Medicare. Let’s review the ones that do. CalPERS offers two types of
Medicare coordinated health plans, supplement to Medicare plans, and Managed Medicare plans,
or Medicare Advantage. CalPERS offers three supplements to Medicare
plans: PERS Select, PERS Choice, PERSCare. These plans are considered Preferred Provider
Organizations or PPO’s. Once enrolled in these plans, Medicare becomes your primary
provider and your CalPERS plan becomes the supplement to Medicare. PERS Choice and PERSCare
are both available worldwide. As stated earlier, there are three Managed
Medicare plans. There is Kaiser’s managed Medicare plan, Kaiser Permanente Senior Advantage.
There’s the UnitedHealthcare Group Medicare Advantage PPO Plan. It will allow you to receive
care from any provider who accepts Medicare. You’ll be able to use it in all 58 California
counties and anywhere in the United States and its territories. And there’s Anthem
Medicare Preferred. Please use the Health Plan Search by Zip Code tool on our website
to find out which plans are available in your area.
So you may need to change your health plan at some point. There are four permitting events
that allow you to change your Medicare plan. The first permitting event is when you first
become eligible for Medicare, for example, if you retire after age 65. You can change
it during the CalPERS health “Open Enrollment” period which is held during the fall each
year. The changes become effective January 1st of the new year. You can change your plan
when you retire. And finally, you can change your plan when
you move. The change can be made 31 days prior to and up to 60 after your move. It’s important
to understand that the basic plan you’re on may not have a Medicare option. You should
review our website to find out which ones are available to you.
State and California State University employees may be eligible for a reimbursement of their
Medicare premiums. If you’re a State of California or CSU retiree enrolled in a Medicare
plan, you may be entitled to reimbursement of a portion of your Part B premium. The reimbursement
would be the difference between the contribution the State pays and your health plan’s premium,
not to exceed the amount of the part B premium. If your health plan’s premium is greater
than the state’s contribution, then there would be no reimbursement. Also, the reimbursement
may not include any late enrollment penalties. Public Agency and School retirees are not
entitled to reimbursement from CalPERS. Contact your former employer to see if benefits exist.
You may be eligible for an increased reimbursement for your Part B Premium based on the Income
Related Monthly Adjustment Amount or IRMAA. The Part B premium amount that you pay may
vary based on your Social Security income. Most people pay a standard premium but, if
you have a higher income you may pay more for your Part B premium. Social Security adjusts
the premiums annually. In mid or late fall of each year, CMS will send you a Medicare
beneficiary letter advising you of your new benefit amounts, which includes your Part
B premium. You must submit a written request to us each year, with a copy of your benefit
notification letter to receive payment. Otherwise, you will only be reimbursed up to the standard
amount. Let’s finish up with some resources that
can provide you with additional information. One of the best resources you can use is the
CalPERS website. If you select the Retirees tab, you can find information on your CalPERS
retirement and health benefits, and of course Medicare. For information related to your
own health benefits including coverage type, premium and dependent information, you can
review the Health Plan Summary page in your own my|CalPERS account. A new feature available
through your account is that you can now upload your Medicare documents. And finally, the
website for the Centers for Medicare and Medicaid Services which oversees the Medicare program
at cms.gov. There are several publications that provide
information regarding your health benefits. The CalPERS Medicare Enrollment Guide covers
how Medicare works with your health benefits, and when you need to enroll in a CalPERS Medicare
plan. The Health Benefit Summary explains the differences between HMO and PPO plans.
The Health Program Guide which talks about Basic and Medicare health plan eligibility,
enrollment, and choices and the Evidence of Coverage publications review the terms and
conditions of coverage including benefits, covered services, and co-payment information
for each health plan. If you’re unable to find the information
you need on the websites, you can contact us in the following ways. You can send a secure
message through your own my|CalPERS account. You’ll be notified by email that you have
a response waiting for you in the Message Center. You can reach us at 888-CalPERS or
888-225-7377. Our representatives are available from 8-5 Monday through Friday and in most
cases, they can assist you in a single call. The busiest times to call us are the first
of the month, Mondays and the day after a holiday. For questions regarding Medicare,
you can contact the Social Security, the Medicare hotline at 800-772-1213. Another resource
for help with Medicare issues is the Health Insurance Counseling and Advocacy Program
at 800-434-0222. Our presentation today was intended to give
you a better understanding of how Medicare coordinates with your CalPERS Health Benefits.
We hope this information has been beneficial to you.
Thank you for taking time out of your day to attend this informative presentation and
I hope you have a great day.