Medicare and turning age 65

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.

You 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.
• Inpatient care in skilled nursing facilities.
• Hospice care.
• Home health care.

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

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 when eligible.

There is a premium for Medicare Part B that you pay directly to Medicare. This is in addition to your monthly premium for PEBB retiree insurance coverage.

Contact Medicare with questions about Part B 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 PEBB retiree, you and your dependents can enroll in a PEBB Medicare Advantage plan. The PEBB Program offers several Medicare Advantage with Prescription Drug 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.

Using 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 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:

• 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 PEBB medical plans, except Premera Medicare Supplement Plan G, include Medicare Part D or prescription drug coverage that is as good as or better than Medicare Part D, meaning they 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 medical 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.

Contact Medicare with questions.

Why do I need PEBB if I have Medicare?

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

Medicare Part A covers 100% of costs for inpatient hospital care for the first 60 days after your annual deductible is met. Medicare Part B covers 80% of Medicare approved services only. Medicare enrollees without other coverage may face substantial health care costs.

Steps to take

Apply for Medicare Part A and Part B, then send us proof of Medicare so you can enroll in a PEBB Medicare plan.

Step 1: 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 requires 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.

What if I live outside the U.S.?

Members must have a permanent residential address within the United States or U.S. territories. If you become eligible for Medicare and permanently reside outside of the U.S. you will be automatically deferred from PEBB retiree insurance coverage. If your dependent becomes eligible for Medicare, they will be terminated from 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).

Step 2: Select a PEBB retiree medical plan

The following are Medicare plan options for retirees. You can also use our online medical benefits comparison tool to compare the PEBB Medicare plan benefits. 

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

Choosing a PEBB Medicare plan to go with Parts A and B

To choose the best PEBB Medicare plan for you or your dependent, ask yourself the following questions:

• 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.

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 medical plans?

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

Medical plan enrollment exceptions

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 be enrolled 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.

Step 3: Send us proof of Medicare and enroll in a PEBB Medicare plan

Once you or your dependent enroll in Medicare Part A and Part B, you must send us proof of the enrollment with a form to enroll in a PEBB Medicare plan.

Forms must be received before your coverage effective start date

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).

What to submit 

• 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.

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

Where to 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.

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