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

Medicare Initial Enrollment Period

If you are receiving a Social Security check:

  • Social Security automatically enrolls you in Medicare Parts A and B, and
  • Social Security mails you a Medicare

If you are not receiving a Social Security check:

  • You will need to sign up for Medicare in person at a Social Security office or online at ssa.gov/medicare.

Medicare charges a lifetime penalty of 10% for each 12-month period you are eligible for Medicare Part B but do not sign up for it.

The penalty does not apply when you are enrolled in an employer health plan. See “Working Past Age 65”.

To have your Medicare coverage effective the month you turn 65, sign up as soon as you are eligible. When you enroll during the last four months of your Initial Enrollment Period, your Medicare coverage is delayed.

See below for more details.

Signing Up for Medicare

Medicare Part A – Enroll in premium-free Part A if you are eligible. Eligibility is based on your work record, or a spouse’s or former spouse’s work record. If Social Security says you are not eligible to receive Part A for free, and you are enrolling in the SERS Medicare coverage, do not sign up for Medicare Part A. Your SERS Medicare Advantage plan covers your Part A services.

Medicare Part B – Everyone must enroll in Part B, and everyone pays a monthly premium. Your Part B premium is deducted from a Social Security check, or you pay it directly to Medicare. The 2018 premium for most new enrollees is $134 per month.

Working Past Age 65

If you are covered by an employer health plan, either from your own or your spouse’s current employment, you can delay enrolling in Medicare Parts A and B. When you decide to stop working, you have a one-time Special Enrollment Period of up to eight months after your employer coverage ends to enroll in Medicare.

To enroll, fill out an Application for Enrollment in Medicare Part B (CMS-40B) and the Request for Employment Information (CMS-L564) forms. Ask your employer to complete the Request for Employment Information form and return it to you. This form is proof that you delayed your Medicare Part B enrollment because you had employer coverage, and you will not be subject to a late enrollment penalty.

Contact your local Social Security office for these forms or download them at www.SSA.gov.

If you have Medicare Part A only or receive a Social Security check, you cannot file your Medicare Part B application any earlier than 30 days before the month you want your coverage to begin. If you do not have Medicare Part A and have not started receiving Social Security benefits, you can file your application up to three months before you want coverage to begin.

Call your local Social Security office to schedule an appointment to file your application. It is advisable to request a date-stamped copy of the application for your records.

Working only a few months past your 65th birthday:

If you stop working and enroll in Medicare within three months after you reach age 65, your Medicare Part B coverage will be delayed. This is because Medicare considers you to be in your Initial Enrollment Period and filing after your birthday month causes a delay in coverage. Remember, a delay in benefits means you may have a gap in coverage, depending on when your employer coverage ends. To avoid a coverage gap, sign up for Medicare during the three months prior to your 65th birth month, or enroll in your employer’s COBRA coverage.

 

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.