Medicare and PEBB benefits while employed

Keeping PEBB medical when you enroll in Medicare

You can keep your current PEBB medical plan when you enroll in Medicare, unless you have a consumer-directed health plan (CDHP) with a health savings account (HSA). 

If you're enrolled in a CDHP, you should change your medical plan when you enroll in Medicare. You cannot contribute to an HSA while enrolled in Medicare. If you do, you may get a tax penalty. Enrolling in Medicare creates a special open enrollment that allows you to change your medical plan. 

Contact HealthEquity, Inc. for more information about how Medicare enrollment affects your HSA.

The parts of Medicare

Medicare has four main parts: 

• Part A – Hospital Insurance
• Part B – Medical Insurance
• Part C – Medicare Advantage
• Part D – Prescription Drug Coverage

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. 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 care.
• Home health care.

As a public employee, you will be automatically enrolled in Medicare Part A if you are age 65 or older and receiving Social Security benefits.

Medicare Part A has no monthly premium if you or your spouse worked and paid Medicare taxes for at least 10 years. 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 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 that you pay directly to Medicare.

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, bundle your Medicare Part A and Part B coverage. They often include Part D as well as other additional benefits. These plans manage and process all medical claims on behalf of members.

As a public employee, you may not waive PEBB medical to enroll in a Medicare Advantage plan.

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. The PEBB medical plans available to you meet or exceed Medicare's minimum standard of coverage (also known as "creditable prescription drug coverage).
• You can enroll in both Medicare Part D plan and a PEBB medical plan.
  If you enroll in a Medicare Part D plan, you must present your PEBB insurance card and your Medicare Part D card to the pharmacy. Contact your PEBB medical plan to see if they will coordinate prescription drug benefits with your Part D plan on your behalf.
• When you enroll in Medicare Part A or Part B, you can keep your PEBB employee insurance coverage and not pay a Medicare Part D late enrollment penalty if you later decide to enroll in a Medicare Part D plan. To avoid a premium penalty, you cannot be without creditable prescription drug coverage for more than 63 days.
• The PEBB Program does not offer standalone Medicare Part D plans.

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

Medicare supplement plans do not offer prescription drug coverage. This means a Medicare Part D plan will also need to be purchased on the open market.

As a public employee, you may not waive PEBB medical to enroll in a Medicare supplement plan.

Enrolling in Medicare

In most cases, employees and their spouses covered under a PEBB medical plan can defer enrollment in Medicare Part B and enroll in Part B later, after employment ends, without a late enrollment penalty.

If you are eligible for premium-free Medicare Part A, you can enroll in Medicare Part A anytime after you’re first eligible for Medicare. If you are receiving a monthly Social Security benefit, you cannot defer Medicare Part A. You can sign up for Medicare Part B during a special enrollment period when you terminate employment or retire.

Waive PEBB medical or remove a Medicare-eligible dependent

You can waive PEBB medical if you are enrolled in other employer-based group medical, a TRICARE plan, or Medicare Part A and Part B (Original Medicare) coverage. You must enroll in PEBB dental, vision, life, accidental death and dismemberment, and long-term disability insurance, if offered. You may not waive enrollment in PEBB medical if you are enrolled in PEBB retiree insurance coverage.

You may choose to remove a dependent who enrolls in Medicare Part A and Part B as a special open enrollment event.

When you retire

If you retire and are eligible for and enroll in PEBB retiree insurance coverage, you and your covered dependents must enroll and stay enrolled in Medicare Part A and Part B, if eligible. Medicare will become primary coverage, and PEBB medical becomes secondary coverage. Learn how Medicare works with retiree benefits.

You cannot waive PEBB employee medical and stay enrolled in PEBB retiree insurance coverage. Your PEBB retiree insurance coverage will be automatically deferred or automatically disenrolled by the PEBB Program. You will not be required to submit any forms.

Medicare resources

• Medicare
  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.
  Phone: 1-800-772-1213
• 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.
  Phone: 1-800-562-6900