Medicare and turning age 65

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 has four main parts:

Medicare Part A – Hospital Insurance

Medicare Part A helps cover:

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

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

For most, there is no premium for Medicare Part A. 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 PEBB retiree, you and your dependents are required to enroll in Part B.

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, generally includes Parts A, B, and D. All 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 and your dependents can enroll in a PEBB Medicare Advantage plan. The PEBB Program offers several Medicare Advantage with Part D plans. You or a dependent 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 – 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 PEBB retiree you should know:

• PEBB medical plans, except Medicare Supplement Plan G, meet or exceed Medicare's minimum standard of coverage (also known as "creditable prescription drug coverage").
• The PEBB Program does not offer standalone Medicare Part D plans.
• If you or your spouse or state-registered domestic partner enroll in a standalone Medicare Part D plan, your only PEBB medical plan option is Premera Blue Cross Medicare Supplement Plan G.
• If you or your dependent are enrolled in a PEBB plan with Part D and enroll in another Medicare plan, you may lose your PEBB retiree health plan coverage.

There is a premium for Medicare Part D. The Part D premium is included in the premium for PEBB plans that include 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. If you don’t have creditable drug coverage, 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 or your spouse or state-registered domestic partner 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.

If I have Medicare coverage, why would I also enroll in PEBB coverage?

Enrolling in PEBB retiree insurance coverage will help cover some of the remaining costs that Medicare does not cover.

The Centers for Medicare and Medicaid Services estimates that Medicare covers about half of enrollees’ medical expenses. Medicare enrollees without other coverage may face substantial health care costs.

What should I do when I am eligible for Medicare?

Apply for Medicare early

If you or a dependent is enrolled in PEBB retiree insurance coverage and become eligible for Medicare, it creates a special open enrollment event that allows you to change your medical plan. You may be able to enroll in a less expensive Medicare plan. Medicare has different timelines than the PEBB Program.

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

Members must have a residential address within the United States or U.S. territories. Those who become eligible for Medicare and live permanently outside of the U.S. will be automatically deferred from PEBB retiree insurance coverage.

To enroll in Medicare, visit the Social Security Administration’s Plan for Medicare webpage or call 1-800-772-1213 (TTY: 1-800-325-0778).

Send us proof of Medicare with forms to enroll in a Medicare plan

Once you or your dependent enrolls in Medicare Part A and Part B, you must send us proof of the enrollment with a form to enroll in a Medicare plan. We must receive your proof and any required forms no later than 30 days before you or your dependent turn age 65 (or if 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 in Benefits 24/7 or with your Retiree Election Form (form A).
• If you are enrolling in a PEBB retiree Medicare plan, submit proof in Benefits 24/7 or with your Retiree Change Form (form E). 
• If you are enrolling in a Premera Medicare Supplement Plan, also submit the Group Medicare Supplement Enrollment Application (form B). 

Send us a copy of the Medicare card or benefit verification letter showing the effective date of Medicare Part A and Part B. Write your name and last four digits of your Social Security number on the copy.

Note: If you or your dependent are determined not eligible for Medicare Part A or Part B, send a copy of the denial letter from the Social Security Administration.

Submit proof and forms

You can: 

• Upload your documents in Benefits 24/7.
• Send us a secure message through HCA Support, a secure website that allows you to log into your own account to communicate with us. You will need to set up a SecureAccess Washington (SAW) account to use this option.
• Fax to: 360-725-0771
• Mail to:
  Health Care Authority
  PEBB Program
  PO Box 42684
  Olympia, WA 98504-2684

What happens after I submit the required forms and 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.

Coverage effective date

The plan change will be effective the first of the month after the date the medical plan becomes unavailable, the date you make the change in Benefits 24/7, or the date we receive your form, whichever is later. If that date is the first of the month, the change in the medical plan begins that day. Exception: If you enroll in an MAPD or UMP Classic Medicare with Part D (PDP), coverage will start the first day of the month following the date you make the change in Benefits 24/7, or the date your form is received.

What are my medical plan options?

Compare the PEBB Medicare plan benefits. Here are your options:

Coordination of benefits

• UMP Classic Medicare with Part D (PDP)

Medicare Advantage with Part D

• Kaiser Permanente NW Senior Advantage with Part D
• Kaiser Permanente WA Medicare Advantage with Part D
• UnitedHealthcare PEBB Balance and PEBB Complete

Medicare Supplement Plan

• Premera Blue Cross Medicare Supplement Plan G

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 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 Benefits while traveling.

Do I need to enroll in Part D?

You do not need a standalone Medicare Part D plan unless you’re enrolling in Premera Blue Cross Medicare Supplement Plan G, which does not include prescription drug coverage. If you enroll in Plan G, you should consider enrolling in a standalone Medicare Part D plan to avoid a Part D late enrollment penalty in the future. All other PEBB medical plans include Medicare Part D or prescription drug coverage that is as good as or better than Medicare Part D.

FAQs

What if I'm enrolled in a CDHP or UMP Select?

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.

Can my dependents and I enroll in different plans?

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 with Part D	Will be enrolled in Kaiser Permanente NW Classic.
Kaiser Permanente WA Medicare Advantage with Part D	Will choose to enroll in Kaiser Permanente WA Classic, SoundChoice, or Value.
Premera Blue Cross Medicare Supplement Plan G UMP Classic Medicare with Part D (PDP) UnitedHealthcare PEBB Balance UnitedHealthcare PEBB Complete	Will be enrolled in UMP Classic.

Are there more 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