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Medicare and turning age 65

When you or your dependent turns age 65 you are required to enroll in Medicare. Learn more about Medicare and what you have to do to keep your PEBB benefits.

Note: If you or your spouse or state-registered domestic partner is enrolled in Medicaid, please contact us, as this may affect your PEBB retiree health plan coverage.

What are the different parts of Medicare?

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 helps cover:

  • Inpatient care in hospitals.
  • Inpatient care in skilled nursing facilities.
  • Hospice services.

As a PEBB retiree, you are required to enroll in Part A.

For most, there is no premium for Medicare Part A. Contact Medicare with questions.

Medicare Part B helps cover:

  • Provider office visits.
  • Outpatient care.
  • Preventive services.
  • Durable medical equipment.

As a PEBB retiree, you are required to enroll in Part B.

There is a premium for Medicare Part B. Contact Medicare with questions about premiums and how to pay them.

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 PEBB retiree, you can enroll in a PEBB Medicare Advantage plan. You also have the option of purchasing a Medicare Advantage 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.

Learn more about these plans under What are my medical plan options?

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 PEBB retiree you should know:

  • Most PEBB medical plans, except Plan G, meet or exceed Medicare's minimum standard of coverage (also known as "creditable prescription drug coverage).
  • If you choose a UnitedHealthcare plan, it includes Medicare Part D.
  • The PEBB Program does not offer stand-alone Medicare Part D plans.
  • If you enroll in a Medicare Part D plan, your only medical plan option is Premera Blue Cross Medicare Supplement Plan G.

There is a premium for Medicare Part D.

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 PEBB retiree, you can enroll in Medicare Supplement Plan G. There is no prescription drug coverage with this plan. If you choose Plan G, you may have to enroll in Medicare Part D to get your prescriptions, unless you have other creditable drug coverage, like VA.

Contact Medicare with questions.

What must I do when I am eligible for Medicare?

Do I have to enroll in Medicare?

Yes. As a retiree, you or your covered dependent are required to apply for both Medicare Part A and Part B as soon as eligible to stay enrolled in a PEBB retiree health plan.

We encourage applying for Medicare three months before turning age 65. Doing so will make sure you enroll (or meet the requirements to stay enrolled) in PEBB retiree insurance coverage within our timelines.

To enroll in Medicare, call the Social Security Administration at 1-800-772-1213, TTY: 1-800-325-0778 or visit their website.

Can I change my plan? Yes. Enrolling in Medicare also qualifies as a special open enrollment event, allowing you to change your medical plan.

Do I need to provide proof of enrollment?

Yes. Once you or your dependent enrolls in Medicare Part A and Part B, you must send us proof of the enrollment. We must receive your proof no later than 30 days before you or your dependent turn age 65 (of it delayed, no later than 60 days after turning age 65). If you are enrolling in PEBB retiree insurance coverage for the first time, submit proof with your Retiree Election Form (form A).

Which documents act as proof of enrollment?

Send us a copy of the Medicare:

  • Card or entitlement letter showing the effective date of Medicare Part A and Part B.
  • Denial letter from Social Security if not entitled to Medicare.

Write your name and last four digits of your Social Security number on the copy.

How to submit proof

You can:

  • Send us a secure message. You must set up an account to use this feature. This helps protect your privacy and sensitive health information.
  • Fax to: 1-360-725-0771
  • Mail to:
    Health Care Authority
    PEBB Program
    PO Box 42684
    Olympia, WA 98504-2684

What happens after I submit proof of Medicare enrollment?

We will reduce your premium to the lower Medicare rate, if applicable. We will also notify your medical plan of your Medicare coverage. If you are paying premium surcharges, they will stop when you (the subscriber) enroll in Medicare Part A and Part B.

I'm turning 65 but still working. What do I do?

If you choose to enroll in Medicare, you and your dependents turning age 65 can keep PEBB or SEBB medical as primary coverage. Medicare coverage will be secondary.

Learn more about turning age 65 as a public employee or school employee.

What are my medical plan options?

In many cases, you and your dependents can stay enrolled in your current medical plan. If you choose to change medical plans, here are your options and instructions on how to enroll.

If available in your county of residence. See plans available by county.

How do I enroll?

If you are enrolled in PEBB retiree insurance coverage submit:

If you are not enrolled in PEBB retiree insurance coverage submit:

How long do I have to enroll?

You have seven months to enroll in a Medicare Advantage plan.

This seven-month period:

  • Starts three months before you or your dependent first enroll in Medicare Part A and Part B.
  • Ends three months after the month of Medicare eligibility, or before you or your dependent’s last day of the Medicare Part B initial enrollment period.

We must receive the forms no later than the last day of the month before the month you or your dependent enrolls in the Medicare Advantage plan.

When does coverage start?

The enrollment will be effective on the first of the month after we receive Form C.

Depending on your county of residence, Kaiser Permanente WA offers on of two plans. Original Medicare or Medicare Advantage. See plans available by county.

How do I enroll?

If you are enrolled in PEBB retiree insurance coverage submit:

If you are not enrolled in PEBB retiree insurance coverage submit:

How long do I have to enroll?

You have seven months to enroll in a Medicare Advantage plan.

This seven-month period:

  • Starts three months before you or your dependent first enroll in Medicare Part A and Part B.
  • Ends three months after the month of Medicare eligibility, or before you or your dependent’s last day of the Medicare Part B initial enrollment period.

We must receive the forms no later than the last day of the month before the month you or your dependent enrolls in the Medicare Advantage plan.

When does coverage start?

The enrollment will be effective on the first of the month after we receive Form C.

Plan G does not include prescription drug coverage, so you may want to enroll in a stand-alone Medicare Part D prescription drug plan to avoid being penalized in the future.

How do I enroll?

If you are enrolled in PEBB retiree insurance coverage submit:

If you are not enrolled in PEBB retiree insurance coverage submit:

How long do I have to enroll?

You have up to six months after the Medicare Part B enrollment date to enroll. Non-Medicare members will be enrolled in Uniform Medical Plan (UMP) Classic.

When does coverage start?

The enrollment will be effective the first of the month after we receive the required forms.

How do I enroll?

If you are enrolled in PEBB retiree insurance coverage submit:

If you are not enrolled in PEBB retiree insurance coverage submit:

How long do I have to enroll?

No later than 60 days after the date you enroll in Medicare.

When does coverage start?

The enrollment will be effective the first of the month after we receive Form A or Form E.

Medicare Advantage Prescription Drug (MAPD) plans include Medicare Part D prescription drug coverage.

How do I enroll?

If you are enrolled in PEBB retiree insurance coverage submit:

If you are not enrolled in PEBB retiree insurance coverage submit:

How long do I have to enroll?

You have seven months to enroll in a Medicare Advantage plan.

This seven-month period:

  • Starts three months before you or your dependent first enroll in Medicare Part A and Part B.
  • Ends three months after the month of Medicare eligibility, or before you or your dependent’s last day of the Medicare Part B initial enrollment period.

We must receive the forms no later than the last day of the month before the month you or your dependent enrolls in the Medicare Advantage plan.

When does coverage start?

The enrollment will be effective on the first of the month after we receive Form C. Non-Medicare members will be enrolled in UMP Classic.

Do I need to enroll in Part D?

You do not need to enroll in Medicare Part D prescription drug coverage. Most PEBB medical plans include prescription drug coverage that is as good as or better than Medicare Part D.

If you enroll in Premera Blue Cross Plan G you will need to sign up for a stand-alone Part D plan because Plan G does not include drug coverage. Doing so will help you avoid a Part D late enrollment penalty.

If you want to enroll in any other PEBB medical plan, you must disenroll from your Part D plan.

FAQs

If the person enrolling in Medicare is:

  • You (the retiree):
    • Choose a new medical plan. Your annual deductible and out-of-pocket maximum may restart with your new plan.
  • Your dependent and you want to keep them enrolled:
    • Choose a new medical plan. Your annual deductible and out-of-pocket maximum may restart with your new plan.
  • Your dependent and you want to keep your current plan:
    • Remove your dependent by submitting the Retiree Change Form (form E) before they enroll in Medicare Part A and Part B. They will not qualify for PEBB Continuation Coverage.

Generally, you and your dependents must enroll in the same medical plan. However, there are some exceptions, as listed in the table below.

If the person enrolled in Medicare enrolls in:

The non-Medicare members on your account:

Kaiser Permanente NW Senior Advantage

Will be enrolled in Kaiser Permanente NW* Classic.

Kaiser Permanente WA Medicare Plan

Will choose to enroll in Kaiser Permanente WA Classic, SoundChoice, or Value.

Premera Blue Cross Medicare Supplement Plan G
UnitedHealthcare PEBB Balance
UnitedHealthcare PEBB Complete

Will be enrolled in UMP Classic.

*Kaiser Foundation Health Plan of the Northwest (KFHPNW) offers plans in Clark and Cowlitz counties in Washington and select counties in Oregon.

  • 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 plan’s 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?
  • 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

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

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