Medicare Basics

Medicare is health insurance for people who meet the following requirements:

  • Age 65 or older
  • Under age 65 with certain disabilities
  • Any age with end-stage renal disease requiring dialysis or a kidney transplant

Enrolling in Medicare

Medicare’s seven-month Initial Enrollment Period begins three months before the month you turn 65 and ends three months after your birth month. You want to sign up for Medicare when you first become eligible to ensure your Medicare coverage is not delayed, and starts the month you turn 65.

If you enroll in Medicare during your birth month or the three months after your birth month, your coverage will be delayed.

If you do not sign up during the Initial Enrollment Period, Medicare charges a lifetime penalty for each 12-month period you could have had Part B coverage.

If you are covered by your employer’s health plan or your spouse’s employer plan, the penalty does not apply. Once that coverage ends, contact Social Security within eight months to sign up for Medicare.

For more information:

Medicare Parts A, B, C, and D

Medicare Part A (hospital insurance) helps cover:

  • Inpatient care in hospitals
  • Skilled nursing facility care (not custodial or long-term care)
  • Hospice care
  • Home health care

Part A is premium-free for most people, based upon either their own work history or their
spouse’s work history in Social Security.

Medicare Part B (medical insurance) helps cover:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services

Everyone is eligible for Part B, and pays a monthly Part B premium. In 2018, the premium for new enrollees is $134.00 per month.

For more information, watch the video “Why It’s Important to Pay Your Part B Premium.”

Medicare Part C (Medicare Advantage Plans):

  • Includes Part A and Part B benefits
  • Offered by Medicare-approved private insurance companies that have contracts with Medicare
  • Usually includes prescription drug coverage (Part D)
  • Can include extra benefits, such as fitness memberships

Medicare Part D (prescription drug coverage):

  • Helps cover prescription drug costs
  • Run by private insurance companies

Purchased separately, unless you enroll in a Medicare Advantage plan that includes Part D.

For more information, watch the video “All About Medicare Part D.”

Medicare Coverage Choices

When you become eligible for Medicare, you have a choice to make on how to receive your coverage:

Original Medicare or a Medicare Advantage Plan

For more information, watch the video “Your Medicare Coverage Choices.”

Medicare and SERS’ Health Care Coverage

If you are enrolled in a non-Medicare plan through SERS, you will receive an “Approaching 65” packet three months prior to your 65th birthday.

This packet will contain information on enrolling in Medicare, as well as SERS Medicare plan information. Once you enroll in Medicare, SERS will transfer you from your non-Medicare plan into a SERS Medicare Advantage Plan. With SERS coverage, your premium with SERS will be reduced. You also will be eligible to receive $45.50 per month from SERS to help you pay your Medicare Part B premium.

If you previously waived SERS coverage, you have 90 days within becoming eligible for Medicare to enroll in a SERS Medicare Advantage plan. Call Health Care Services toll-free at 800-878-5853 for a health care application and current premiums.

If you waive SERS coverage when you become Medicare eligible, it is highly unlikely that you will be able to re-enroll in the future.

Medicare Part B Reimbursement

SERS retirees who are eligible for Medicare Part B and enrolled in SERS’ health care coverage are eligible to receive a Medicare Part B reimbursement. You must have SERS coverage to receive this benefit.

SERS currently reimburses eligible benefit recipients $45.50 per month to help pay Medicare Part B premiums. If your Medicare Part B coverage is cancelled, or your Part B premium is paid by any other source, such as your state, union, employer, Medicaid or other entity, you are not eligible for the reimbursement.

Reimbursement starts after SERS receives proof of Medicare Part B enrollment. The reimbursement is not retroactive.

Spouses and dependents are not eligible for this reimbursement.