Medicare and PEBB Program benefits

Learn about how your PEBB employee benefits work with Medicare.

How and when do I apply for Medicare?

When you or your covered dependents become entitled to Medicare, the person entitled to Medicare should contact the nearest Social Security office to ask about the advantages of immediate or deferred enrollment in Medicare Part B. Medicare will not penalize you for delaying enrollment in Medicare Part B when covered by employer-sponsored health care.

If you are age 65, still working and enrolled in PEBB benefits through your employer, you may choose to:

  • Sign up for Medicare Part A at age 65 since most people do not pay a premium for Part A and Part A may help pay some costs not covered by your PEBB health plan.
  • Wait to sign up for Medicare Part B while covered by PEBB benefits as an employee since there is a premium for Part B and benefits may be of limited value while enrolled in a group health plan. If you are not working more than 3 months after turning age 65, use caution make sure you aware of the initial enrollment timelines to enroll in Part B. The Medicare Initial Enrollment Period trumps any Special Enrollment Period. Contact Social Security for advice
  • Decline employee benefits to enroll in Medicare instead.

Medicare guidelines direct that registered domestic partners who are ages 65 and older must have Medicare as their primary insurer, if entitled.

To sign-up for Medicare Part A and Part B:

  • Contact Social Security three months before you turn 65 (if you worked for a railroad, contact RRB to sign up).
  • The initial enrollment is seven months. It begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65.
  • If you wait until the last four months of the initial enrollment period to sign up your coverage will be delayed.

Entitlement to Medicare also qualifies as a special open enrollment event, allowing you to change your health plans.

If you waive the PEBB medical plan, you can reenroll during the November annual open enrollment (for coverage effective January 1 of the following year) or if you have a special enrollment event that allows the change. However, you will remain enrolled in PEBB dental, life, and long-term disability coverage.

How does Medicare work with PEBB employee benefits?

If you’re on Medicare and PEBB  employer-sponsored benefits, PEBB medical plans provide primary coverage, and Medicare coverage is ordinarily secondary. PEBB coverage as the primary pays up to the limits of its coverage then Medicare as the secondary payer only pays if there are costs not covered by the primary payer that are within the Medicare-approved amounts.

There are circumstances where Medicare would be the primary payer even when you are enrolled in employer-sponsored benefits. Review the Medicare and Other Health Benefits: Your Guide to Who Pays First for an explanation of those circumstances.

Complete the Initial Enrollment Questionnaire (IEQ) to let Medicare know that you have other employer-sponsored group health coverage. This will insure that your medical bills are paid correctly and on time. Medicare will send you the form when you contact Social Security about 3 months before you turn 65. The form may also be completed online at MyMedicare.gov.

Note: Medicaid and TRICARE never pay first for services covered by Medicare. They only pay after employer group health plans and Medicare.

What are the different parts of Medicare and what do they cover?

Medicare Part A – Hospital Insurance

  • Helps cover inpatient care in hospitals
  • Helps cover care in a skilled nursing facility, hospice, and home health care
  • For most retirees, there is no premium for Medicare Part A. Contact Medicare with questions

Medicare Part B – Medical Insurance

  • Helps cover doctors’ and health care providers’ services, outpatient care, durable medical equipment, and home health care
  • Helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse
  • There is a premium for Medicare Part B. Contact Medicare with questions

In most situations, employees and their spouses can elect to defer Medicare Part B enrollment, without penalty, up to the date the employee terminates employment or retires. Contact your nearest Social Security office for information on deferring or reinstating Medicare Part B. If your entitlement is due to a disability, contact a Social Security office regarding deferred enrollment.

Medicare Part C – Medicare Advantage

  • Medicare-approved private insurance plans
  • Most Medicare Advantage plans cover Medicare prescription drug coverage (Medicare Part D)
  • Some Medicare Advantage plans include additional benefits
  • Advantage plans manage all of the paperwork for claims with Medicare
  • There is a premium for Medicare Part C

Medicare Part D – Prescription Drug Coverage

  • Helps cover the cost of prescription drugs
  • May help lower your prescription drug costs and help protect against higher costs
  • Part D plans are run by Medicare-approved private insurance companies
  • There is a premium for Medicare Part D

Medicare Part D is available to people enrolled in Medicare Part A and/or Part B. It is a voluntary program that offers prescription-drug benefits through private plans. These plans provide at least a standard level of coverage set by Medicare.

All PEBB medical plans available to employees provide creditable prescription drug coverage. This means the plans provide prescription drug benefits that are as good as or better than Medicare Part D coverage. After you become entitled to Medicare Part A and/or Part B, you can keep your PEBB coverage and not pay a late enrollment penalty if you decide to enroll in a Medicare Part D plan later. (To avoid a premium penalty, you cannot be without creditable drug coverage for more than 63 days.)

If you do enroll in Medicare Part D, your PEBB  medical plan may not coordinate prescription-drug benefits with your Medicare Part D plan. If you enroll or cancel enrollment in Medicare Part D, you may need a “notice of creditable coverage” to prove continuous prescription-drug coverage. Call the PEBB at 1-800-200-1004 to request one.

Note: If you choose to enroll in the PEBB retiree coverage, you only need to enroll in Medicare Part D if you choose to enroll in the PEBB Program Medicare supplement plan (Premera Blue Cross Medicare Supplement Plan F). The PEBB Program does not offer a Medicare Part D plan.

What is Medicare Supplement Insurance (Medigap)?

A Medicare supplement plan, or Medigap plan, can help pay for some of the health care costs that Medicare Part A and B don’t cover, such as copayments, coinsurance and deductibles.

Each supplement plan is identified by a letter A through N. All plans offer the same basic benefits and some offer additional benefits.

Supplement plans do not offer prescription drug coverage, so you will also need to purchase a Part D Medicare prescription drug plan.

You may choose to purchase a Medicare supplement plan from a private insurance company or enroll in the supplement plan the PEBB Program offers, if eligible for PEBB retiree coverage. The PEBB Program offers Premera Blue Cross Medicare Supplement Plan F. There is no prescription drug coverage with this plan so a Part D prescription drug plan is also needed unless you have other creditable drug coverage (e.g., VA)

Can I enroll in a CDHP and Medicare?

No. Once enrolled in Medicare (Part A and/or Part B), contributions cannot be made to an HSA. The three PEBB CDHP plans have an automatic HSA contribution from your employer. You must change plans if you are in the CDHP and on Medicare. You have 60 days from the date you get Medicare to change plans. It is recommended that you apply to change your plan prior to your 65th birthday.

It is recommended that you change plans during the annual open enrollment prior to the year you turn 65. If you wait to change plans when you get Medicare mid-year, the out-of-pocket maximum and deductibles will restart, possibly resulting in additional expense to you and your family.

Are there more resources?

Contact

For general information about eligibility, enrollment, or premiums
The PEBB Program

For specific benefit questions, verifying your doctor or other provider contracts with the plans, verifying a plans drug formulary, ID cards, and claims
The plans