Medicare and PEBB Program benefits

Learn about how your PEBB Program retiree plans work with Medicare

How and when should I apply for Medicare?

When you or your covered dependents become entitled to Medicare, the person entitled to Medicare must enroll and maintain enrollment in Medicare Part A and Part B to remain eligible for PEBB Program retiree coverage.

If you are receiving benefits from social security or the Railroad Retirement Board (RRB), you will automatically get Medicare Part A and Part B starting the first day of the month you turn 65, in most cases.

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.

No later than 60 days after you or your covered dependents enroll in Medicare Part A and Part B, you must send the PEBB Program a copy of either:

  • the Medicare ID card
    or
  • a letter from the Social Security Administration that shows the effective date of Medicare Part A and Part B coverage.

Mail a photocopy of the Medicare card or letter to:

PEBB Program Health Care Authority
P.O. Box 42684
Olympia, WA 98504-2684

The PEBB Program will reduce your premium to the lower Medicare rate, if applicable, and notify your health plan of your Medicare enrollment. If you were paying surcharges in addition to your premium, the surcharge(s) will automatically discontinue when you (the subscriber) enroll in Medicare Part A and Part B.

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

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

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
Note: You may choose to purchase a Medicare Advantage plan from a private insurance company or enroll in one of the PEBB Program plans, if eligible for PEBB Program retiree coverage. The PEBB Program offers Medicare Advantage plans with Group Health (ClearCare) and Kaiser Permanente (Kaiser Senior Advantage). If you do not live in an area that offers the Advantage plan, Group Health and Kaiser will enroll you in the Medicare coordination of benefits (COB) plans. Uniform Medical Plan (UMP) offers a Medicare COB plan. If you choose to enroll in Medicare Advantage with a private insurance company, you forfeit your right to enroll in PEBB Program retiree insurance.

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
Note: If you choose to enroll in the PEBB Program 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 Program 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)

What are my PEBB Program options when I become eligible for Medicare?

Medicare Parts A and B with the Group Health Medicare Advantage plan or Kaiser Senior Advantage plan (Medicare Part C plans)

  • The advantage plans include additional benefits not covered by Medicare (e.g. prescription, vision, hearing).
  • The advantage plans include prescription drug coverage (you won’t need to enroll in a Medicare Part D plan).
  • Advantage plans manage all of the paperwork for claims with Medicare.

Medicare Parts A and B with coordination of benefits (COB) plan – UMP Classic Medicare plan

  • Group Health and Kaiser will automatically enroll you in their COB plan if you do not live in an Advantage plan area.
  • The COB plans include additional benefits not covered by Medicare (e.g. vision, hearing).
  • The COB plans include prescription drug coverage (you won’t need to enroll in a Medicare Part D plan).
  • You or your provider must submit claims to both Medicare and the COB plan. See How does Medicare work with PEBB retiree benefits below.

Medicare Parts A and B with Premera Medicare Supplement Plan F

  • 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.
  • Does not include prescription drug coverage so you may need a Medicare Part D plan.
  • The PEBB Program does not offer a Medicare Part D plan so you must shop for a Part D plan from a private insurance company. Refer to the Medicare and You handbook.

What do I need to know when on PEBB Program retiree benefits and Medicare?

  • The PEBB Program requires you and your enrolled dependents to enroll in and maintain enrollment in Medicare Part A and Part B, if entitled, in order to enroll in and retain PEBB retiree coverage.
  • The Medicare Advantage and COB plans include creditable prescription drug coverage.
  • If you are not enrolled in Premera Blue Cross and you or your enrolled dependents enroll in Medicare Part D you may lose your PEBB Program coverage.
  • The PEBB Program does not offer Medicare Part D plans.

How does Medicare work with PEBB Program retiree benefits?

  • Medicare pays first (primary payer) and PEBB Program coverage pays second (secondary payer)
  • The primary payer (Medicare) pays up to the limits of its coverage
  • The secondary payer (PEBB Program) only pays if there are costs the primary insurer didn’t cover
  • The secondary payer (PEBB Program) may not pay all of the uncovered costs
    Note: Medicaid and TRICARE never pay first for services covered by Medicare. They only pay after Medicare, employer group health plans, and/or Medicare supplemental insurance have paid.

Can I enroll in a CDHP and Medicare?

No. If you are enrolled in a CDHP with an HSA when you or a covered family member become entitled to Medicare Part A and Part B, you must choose a new medical plan that is not a CDHP. The PEBB Program must receive your request no later than 60 days after the Medicare enrollment date.

If your covered dependent(s) become entitled to Medicare Part A and Part B, you must either:

  • Choose a medical plan that is not a CDHP and keep your Medicare dependent enrolled in PEBB coverage. Your annual deductible and annual out-of-pocket maximum will restart with your new plan.
    OR
  • Remove your family member from your PEBB Program coverage before he or she enrolls in Medicare Part A and Part B. The family member will not qualify for COBRA or other continuation coverage through the PEBB Program.

What should I consider when choosing a plan to go with Medicare Parts A and B?

  • Are the services you need covered?
  • How much are premiums, deductibles and other costs?
  • How much do you pay for services like hospital stays and doctor visits?
  • Do your doctors and other health care providers accept the coverage? Are they part of the plans network?
  • Do you need to purchase a Medicare Part D prescription drug plan? Does the plan cover the medications you are currently taking?
  • Are you satisfied with the quality of care and services given by the plan?
  • Are the doctors and other health care providers conveniently located?
  • If you travel, are you covered in another state or outside the US? See When you travel, does your health care come along?

Are there more resources?

Medicare 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