Medicare and PEBB benefits while employed
You are not required to enroll in Medicare while still working. If you choose to enroll, you and your dependents turning age 65 will keep PEBB medical as primary coverage, with Medicare coverage as secondary.
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Medicare Part A and Part B are provided to you by the federal government. Other parts of Medicare are offered through private insurance companies and follow rules set by Medicare. You will sign up for Parts A and B on the Social Security Administration website.
- Medicare Part A – Hospital Insurance
Medicare Part A helps cover:
- Inpatient care in hospitals.
- Skilled nursing facilities care.
- Hospice services.
As a public employee, you will be automatically enrolled in Medicare Part A, if you are eligible, once you start receiving Social Security payments.
Medicare Part A has no monthly premium if you or your spouse paid Medicare taxes for a certain amount of time while working. Contact Medicare with questions.
- Medicare Part B – Medical Insurance
Medicare Part B helps cover:
- Provider office visits.
- Outpatient care.
- Preventive services.
- Durable medical equipment.
As a public employee, you may choose to delay enrollment until you retire or leave employment. However, if you plan to retire within three months of turning age 65, you should apply for Part B to start when you turn age 65.
Federal rules may not allow state-registered domestic partners to delay enrolling in Part B without a penalty. If your partner will soon turn age 65, contact the Social Security Administration.
There is a premium for Medicare Part B. Contact Medicare with questions about premiums and how to pay them.
- Medicare Part C – Medicare Advantage
Medicare Part C, also known as Medicare Advantage plans, generally includes Parts A, B, and D. Some Medicare Advantage plans include additional benefits. These plans manage all the paperwork for claims with Medicare. There is a premium for most Medicare Advantage plans.
As a public employee, you do not need to enroll in Medicare Advantage.
- Medicare Part D – Prescription Drug Coverage
Medicare Part D helps cover the cost of prescription drugs. It is a voluntary program available to people enrolled in Medicare Part A and Part B.
As a public employee, you should know:
- You do not need Medicare Part D with PEBB medical plans. PEBB medical plans meet or exceed Medicare's minimum standard of coverage (also known as "creditable prescription drug coverage).
- The PEBB Program does not offer stand-alone Medicare Part D plans.
There is a premium for Medicare Part D.
- What is Medigap (Medicare Supplement Insurance)?
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.
Medicare supplement plans do not offer prescription drug coverage. This means you will also need to purchase a Medicare Part D plan on the open market, since the PEBB Program does not offer a stand-alone Part D plan.
Each Medicare supplement plan is identified by a letter A through N. All plans offer the same basic benefits, and some offer extra benefits. The PEBB Program only offers Premera Blue Cross Medicare Supplement Plan G. Plan G only pays when Medicare pays for services billed under Medicare Part A and Part B. You also have the option of purchasing a Medicare supplement plan from a private insurance company. If you choose to purchase a private plan, you may lose your right to enroll in PEBB retiree insurance coverage.
As a public employee, you do not need to enroll in a Medicare Supplement Plan.
Do I need to provide proof of Medicare enrollment?
No. You do not need to provide proof of Medicare enrollment if you are still working.
You will need to provide proof when you retire and enroll in PEBB retiree insurance coverage.
Do I need to enroll in Part D?
You do not need Medicare Part D with PEBB medical plans. PEBB medical plans include prescription drug coverage that is as good as or better than Medicare Part D. If you or your dependent enrolls in a stand-alone Part D plan, your PEBB medical plan may not coordinate prescription drug benefits with that plan. However, you may want to explore a Part D plan if you waive PEBB medical in favor of Medicare.
Can I keep my PEBB medical plan when I turn age 65?
Yes, unless you have a consumer-directed health plan. Employees and dependents becoming eligible for Medicare can choose to keep PEBB medical as primary coverage, with Medicare coverage as secondary, if they enroll in Medicare.
I have a consumer-directed health plan. What should I do?
Enrolling in Medicare creates a special open enrollment that allows you to change medical plans. If you are enrolled in a consumer-directed health plan (CDHP) with a health savings account (HSA), you should consider a plan change when you, the employee, enroll in Medicare. Employees cannot contribute to an HSA while enrolled in Medicare. If you do, you will face tax consequences.
If you are eligible for premium-free Medicare Part A but don't enroll when first eligible, your Part A will be enrolled retroactively six months before the month you apply for Medicare, but no earlier than the month you turn age 65. If you keep your CDHP past your Initial Enrollment for Medicare, plan carefully when to stop contributing to the HSA to avoid a tax penalty.
If your dependent enrolls in Medicare, however, you can still contribute to an HSA. Contact HealthEquity, Inc. UMP members call 1-844-351-6853 (TRS: 711); Kaiser Permanente members call 1-877-873-8823 (TRS: 711) for more information about how Medicare enrollment affects your HSA.
How do I waive PEBB medical or remove a Medicare-eligible dependent?
If you choose to waive PEBB medical in favor of Medicare coverage, you will continue PEBB dental, life, accidental death and dismemberment, and long-term disability insurance.
You may choose to remove a dependent who enrolls in Medicare Part A and Part B as a special open enrollment event.
If you retire and are eligible for PEBB retiree insurance coverage, you and your covered dependents must enroll and stay enrolled in Medicare Part A and Part B, if eligible, to keep a PEBB retiree health plan. Medicare will become primary coverage, and PEBB medical becomes secondary coverage. Learn how Medicare works with retiree benefits.
For general or claim specific information about Medicare.
Phone: 1-800-MEDICARE (1-800-633-4227)
- Medicare and You handbook available on the Medicare website or by calling Medicare to request a copy.
- Social Security Administration
For information on Medicare Part A or B eligibility, entitlement, and enrollment; replacement Medicare cards; change of name or address; premium questions; and to report a death.
- Statewide Health Insurance Benefits Advisors (SHIBA)
Through the Washington State Office of the Insurance Commissioner, SHIBA provides free, unbiased and confidential one-on-one help with your Medicare options and questions.