The PEBB Program’s annual open enrollment is November 1 through 30. Learn more.

Medicare and PEBB Program benefits

Learn about how your PEBB retiree plans work with Medicare.

How and when should I apply for Medicare?

When you or your covered dependent(s) become entitled to Medicare, you or your dependent entitled to Medicare must enroll and maintain enrollment in Medicare Part A and Part B to remain eligible for PEBB retiree health plan coverage. You should apply for Medicare three months before turning age 65.

Once you or your Medicare-entitled dependent(s) enroll in Medicare Part A and Part B, you must send us proof of the enrollment. Send us one of the following documents 30 days before turning age 65, so we can properly adjust your premium (or if delayed, no later than 60 days after turning age 65):

  • A copy of the Medicare card showing the effective date of Medicare Part A and Part B.
  • A copy of all the pages of the Medicare entitlement letter showing the effective date of Medicare Part A and Part B.
  • A copy of the Medicare denial letter from Social Security if not entitled to Medicare.

Write your name and the last four digits of your (the subscribers’) social security number on the copy so we can identify t your account. Mail to:

Health Care Authority
PEBB Program
PO Box 42684
Olympia, WA 98504-2684

We will reduce your medical premium to the lower Medicare rate, if applicable, and notify your medical plan of your Medicare enrollment. If you are paying premium surcharge(s) in addition to your monthly medical premium, the premium surcharge(s) will end automatically 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 medical plan.

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 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 about premiums and how to pay them

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
  • Medicare Advantage plans manage all of the paperwork for claims with Medicare
  • There is a premium for most Medicare Advantage plans

Note: You may choose to purchase a Medicare Advantage plan from a private insurance company or enroll in one of the PEBB plans, if eligible for PEBB retiree insurance coverage. PEBB offers Medicare Advantage plans with Kaiser Permanente NW (Kaiser Senior Advantage) and Kaiser Permanente WA. If you do not live in an area that offers a Medicare Advantage plan, Kaiser Permanente NW and Kaiser Permanente WA will enroll you in the Medicare coordination of benefits (COB) plans. Uniform Medical Plan (UMP) Classic offers a Medicare COB plan. If you choose to enroll in a Medicare Advantage plan with a private insurance company, you forfeit your right to enroll in PEBB retiree insurance coverage. Reasons you can defer PEBB retiree insurance coverage are on the Deferring coverage webpage.

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 individuals 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, except Premera Blue Cross Medicare Supplement Plans 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 2 months.)

Note: If you choose to enroll in PEBB retiree insurance coverage and also enroll in Medicare Part D, you may only enroll in Premera Blue Cross Medicare Supplement Plan G. The PEBB Program does not offer a Medicare Part D plan and you are not required to enroll in it.

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

Medicare supplement plans do not offer prescription drug coverage, so you will also need to purchase a Part D Medicare prescription drug plan on the open market as the PEBB Program does not offer a Part D plan.

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

Please contact Medicare for coverage questions as Medicare is the primary payer. Premera Blue Cross Medicare Supplement Plan G only pays when Medicare pays for services billed under Medicare Part A and Part B.

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

Medicare Parts A and B with the Kaiser Permanente NW Senior Advantage plan or Kaiser Permanente WA Medicare Advantage plan (Medicare Part C plans)

  • The Medicare Advantage plans include additional benefits not covered by Medicare (e.g. vision, hearing).
  • The Medicare Advantage plans include prescription drug coverage (you won’t need to enroll in a Medicare Part D plan).
  • The Medicare Advantage plans manage all of the paperwork for claims.
  • Kaiser Permanente NW and Kaiser Permanente WA will automatically enroll you in their coordination of benefits (COB) plan if you do not live in a Medicare Advantage plan service area.

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

  • 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 Blue Cross Medicare Supplement Plan G

  • 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 to get your prescriptions, unless you have other creditable prescription drug coverage.
  • 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 retiree benefits and Medicare?

  • When you or your covered dependent(s) 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 retiree health plan coverage. 
  • Once you or your Medicare-entitled dependent(s) enroll in Medicare Part A and Part B, you must send the PEBB Program proof of the enrollment (a copy of the Medicare card showing the effective date of Medicare Part A and Part B or a copy of all pages of the entitlement letter showing the effective are of Medicare Part A and Part B).
  • The Medicare Advantage and COB plans include creditable prescription drug coverage.
  • If you are not enrolled in a Premera Blue Cross Medicare Supplement plan offered by the PEBB Program and you or your enrolled dependents enroll in Medicare Part D you may lose your PEBB coverage.
  • The PEBB Program does not offer Medicare Part D plans.

How does Medicare work with PEBB retiree benefits?

  • Medicare pays first (primary payer) and PEBB coverage pays second (secondary payer)
  • The primary payer (Medicare) pays up to the limits of its coverage
  • The secondary payer (PEBB) only pays if there are costs the primary insurer didn’t cover
  • The secondary payer (PEBB) 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. Medicare Advantage plans pay Medicare covered claims  as long as you see an approved plan provider.

Can I enroll in a CDHP or UMP Plus plan and Medicare Part A and Part B?

No. If you are enrolled in a consumer-directed health plan (CDHP) with a health savings account (HSA) or a UMP Plus plan and you or a covered dependent becomes entitled to Medicare Part A or Part B during the year you must change to another PEBB medical plan or remove the Medicare-eligible dependent from your PEBB health plan coverage. The PEBB Program should receive your enrollment/change form 30 days before the Medicare enrollment date, but must receive it no later than 60 days after the Medicare enrollment date.

See additional information below about the CDHP and UMP Plus plans. The effective date of the change in the medical plan will be the first of the month following the date the medical plan becomes unavailable or the date the form is received, whichever is later. If that day is the first of the month, the change in the medical plan begins on that day. Since a medical plan change is required and enrollment in Medicare Part A and Part B may lower your premium, we encourage you to submit your change form promptly to avoid any delays.  Additionally, if you are enrolled in a CDHP with an HSA, you will be liable for any tax penalties resulting from contributions made to your HSA when you are no longer eligible.

If the member entitled to Medicare Part A and Part B is

You must:

You (the subscriber)

Choose a new medical plan that is not a consumer-directed health plan (CDHP) or UMP Plus plan. Your annual deductible and annual out-of-pocket maximum will restart with your new medical plan.

Your covered dependent

Either:

  • Choose a new medical plan that is not a CDHP or UMP Plus plan and keep your Medicare dependent enrolled in PEBB medical coverage. Your annual deductible and annual out-of-pocket maximum will restart with your new plan.

OR

  • To keep your CDHP or UMP Plus plan, remove your dependent from your PEBB medical coverage before they enroll in Medicare Part A and Part B. The removed dependent will not qualify for PEBB 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

  • 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

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