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, the person entitled to Medicare must enroll and maintain enrollment in Medicare Part A and Part B to remain eligible for PEBB retiree insurance 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 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 the last four digits of the subscribers’ social security number on the copy so we can identify your account. Mail to:

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

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

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 retirees 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

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

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 coverage. PEBB offers Medicare Advantage plans with Kaiser Permanente WA (formerly Group Health) and Kaiser Permanente NW (Kaiser Senior Advantage). If you do not live in an area that offers the Advantage plan, Kaiser Permanente WA and Kaiser Permanente NW will enroll you in the Medicare coordination of benefits (COB) plans. Uniform Medical Plan (UMP) offers a Medicare COB plan. If you choose to enroll in Medicare Advantage with a private insurance company, you forfeit your right to enroll in PEBB retiree insurance.

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

Note: If you choose to enroll in the PEBB retiree coverage, you only need to enroll in Medicare Part D if you choose to enroll in the PEBB Medicare supplement plan (Premera Blue Cross Medicare Supplement Plan F). The PEBB does not offer a Medicare Part D plan.

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

Supplement plans do not offer prescription drug coverage, so you will also need to purchase a Part D Medicare prescription drug 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 coverage. The PEBB offers Premera Blue Cross Medicare Supplement Plan F. There is no prescription drug coverage with this plan so a Part D prescription drug plan is also needed unless you have other creditable drug coverage (e.g., VA)

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

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

  • The advantage plans include additional benefits not covered by Medicare (e.g. prescription, vision, hearing).
  • The advantage plans include prescription drug coverage (you won’t need to enroll in a Medicare Part D plan).
  • Advantage plans manage all of the paperwork for claims with Medicare.

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

  • Kaiser Permanente WA (formerly Group Health) and Kaiser Permanente NW will automatically enroll you in their COB plan if you do not live in an Advantage plan area.
  • 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 Medicare Supplement Plan F

  • 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.
  • 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?

  • PEBB requires you and your enrolled dependents to enroll in and maintain enrollment in Medicare Part A and Part B, if entitled, in order to enroll in and retain PEBB retiree coverage.
  • The Medicare Advantage and COB plans include creditable prescription drug coverage.
  • If you are not enrolled in Premera Blue Cross and you or your enrolled dependents enroll in Medicare Part D you may lose your PEBB coverage.
  • PEBB 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.

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 when you or your covered dependent(s) become entitled to Medicare Part A and Part B, you must change plans. 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.

If the person 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 covered family member

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 family member from your PEBB medical coverage before he or she enrolls in Medicare Part A and Part B. The family member will not qualify for COBRA or other 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