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Medicare
  • Retaining District-Sponsored Medical Coverage
     
    To retain District-sponsored medical coverage for those retirees and/or their dependents turning 65 years of age, must enroll and remain enrolled in Medicare Parts A and B as well as enroll in a Medicare Advantage medical plan. Applying to Medicare 90 days prior to turning 65 years of age is highly recommended.
     

    Medicare is a national health care program for individuals who are age 65 and older (and certain other individuals).

     

    There are 3 main parts to Medicare:

    • Part A provides inpatient hospital coverage
    • Part B provides outpatient care coverage
    • Part D provides prescription drug coverage (all District plans include prescription drug coverage)

    Lack of Medicare coverage does not affect dental and vision plans.

To continue your medical benefits without interruption, complete the following steps.  Failure to complete all three steps stipulated below will result in the termination of medical benefits effective the first day of the month of your and/or your spouse/domestic partner’s 65th birthday.

Benefits Administration must receive the proper documentation by the end of the month prior to your and/or your spouse/domestic partner’s 65th birthday to continue your medical benefits.

You must notify Benefits Administration in writing if you are switching plans.  Include a written statement with the document(s) you are faxing or mailing.

Step 1
Obtain a Medicare Card from the Centers for Medicare and Medicaid Services (CMS) or your local Social Security Office by enrolling in Medicare Parts A and B. If not eligible for premium-free Medicare Part A, provide letter of ineligibility from CMS.

Step 2
Applicable only to Health Net Seniority Plus: Complete an application and submit it to Health Net. This form is found on the Form/Publications page.

Step 3
Send a copy of your Medicare Card (and if applicable Part A ineligibility letter) and written statement if switching medical plans to Benefits Administration.  Please write your Employee ID number on each document you are submitting.

It is recommended that you contact Medicare or the Social Security Administration at least three months prior to your and/or your spouse/domestic partner’s 65th birthday.

Medicare accepts applications in the following instances.

1. Initial Enrollment Period: Three months prior to, during the month of, or within three months after an individual’s 65th birthday.

2. Special Enrollment Period: Individuals 65 years of age or older who lose medical coverage under their own active employee medical plan or under their working spouse/domestic partner's medical plan.

3. General Enrollment Period: During the open enrollment period of January through March with coverage taking effect July 1st of the same year.

Note: Retirees and/or their spouse/domestic partners age 75 and older as of January 1, 2010 (born prior to January 1, 1935), were grandfathered-in at their current Medicare Part A and B enrollment levels.

  • Medicare Advantage Plans Available and Enrollment

     

     Anthem Blue Cross ABC  Kaiser Permanent  Health Net
           EPO Medicare Preferred PPO
    		Senior Advantage   Seniority Plus

    Medicare Advantage plans offered by the District include Kaiser Senior Advantage, Health Net Seniority Plus, and Anthem Medicare Preferred (PPO). Some providers and services may vary with Medicare Advantage plans. It is important to ensure your provider of choice is also a Medicare provider because the Medicare Advantage plans and Medicare will not pay for any services rendered by a non-Medicare provider.  

    For available retiree plans, please visit Retiree Health Plans/Providers page.

You must be enrolled in Medicare Parts A and B to qualify for this plan. Dependents who are over the age of 65 with Medicare Part B only or who are under the age of 65 will be enrolled/remain in Anthem Blue Cross EPO.

CMS requires Medicare participants to attest that they reside in the service area or provide a physical address if they have a P.O. Box address on file. The service area is defined as any physical address within the United States or certain U.S. territories. You must submit an attestation form to enroll in a Medicare Advantage plan, otherwise your medical and prescription coverage will terminate. Medicare participants with a P.O. Box address will be sent a P.O. Box Attestation Form.

Once you are enrolled in the Anthem Medicare Preferred (PPO), Anthem coordinates all of your care. Anthem Medicare Preferred PPO Medical plan does not have copays, coinsurance, or deductibles.  You must use a provider who accepts Medicare and the Anthem Medicare Preferred (PPO) in order for services to be covered by the plan. The plan will not pay for services from a provider who does not accept Medicare or has opted out of Medicare. So, if you receive care from one of these providers, you’ll have to pay the full medical bill without reimbursement.

If you are 65 or older and only have Medicare Part B, only Anthem Blue Cross EPO is available.

Prescription drug coverage for Medicare eligible retirees and dependents in all Anthem Blue Cross plans is provided by SilverScript, a CVS/SilverScript Caremark company.

 

You and your spouse/domestic partner who are over 65 must be eligible and enrolled in Medicare Parts A and B to enroll in this plan. You must complete and submit a Health Net Seniority Plus group enrollment form. This form is found on the Form/Publications page. You will be enrolled in Health Net Seniority Plus once the form is received and approved by Health Net and Medicare.

Health Net Seniority Plus is a Medicare Advantage HMO Plan. When you become a member, you agree to receive all your routine medical services from a Health Net Seniority Plus Participating Physician Group. Please be aware that the Health Net HMO physician group network that is available to active employees and early (pre-Medicare) retirees is not the same as the Health Net Seniority Plus network. Certain medical groups, such as UCLA Medical Group and Cedars Sinai Health Associates, are not included in the Health Net Seniority Plus network. You may need to select a new provider if you choose to enroll in Health Net Seniority Plus and your current doctor does not participate in the Health Net Seniority Plus network.

 

You must be enrolled in Medicare Parts A and B or Medicare Part B only. You must notify the District and submit proof of enrollment in Medicare in the month(s) prior to your 65th birthday. Once your verification of Medicare enrollment is received by the District, you will be enrolled in the Kaiser Senior Advantage plan. All Kaiser HMO plan members who have Medicare will be enrolled in the Kaiser Permanente Senior Advantage plan unless they select another plan.

Both Medicare Parts A and B are required for Kaiser Permanente Senior Advantage regional areas of Hawaii and the Northwest (OR and WA).

Medicare Part B is required at the minimum for CA residents. Medical Part A is required unless you are not eligible for Medicare Part A without a cost. If this is the case a letter from the Centers for Medicare and Medicaid Services (CMS), stating you are ineligible to enroll in a premium-free Medicare Part A, must be provided to the District.

CMS requires Medicare participants to confirm they reside in the service area by providing a physical address if they have a P.O. Box address on file with the District. You must submit a P.O. Box Address form to enroll in a Kaiser Senior Advantage plan, otherwise your medical and prescription coverage will terminate. Medicare participants with a P.O. Box address will be sent a P.O. Box Address form. 

  • With these Medicare Advantage plans, you will be responsible for paying a small copayment or no copay for most outpatient services, and the plan generally pays 100% of hospitalization.  Individuals who are not eligible for Medicare Part A may be responsible for additional costs. For services that are covered by Medicare, certain plans will file a claim with Medicare on your behalf and will coordinate benefit payments directly with Medicare.

  • Medicare Part A, Part B, & Part D
    Medicare Part A - inpatient hospital coverage

    All retirees/spouses/domestic partners eligible for premium-free Medicare Part A must enroll and remain enrolled in Medicare Part A.  If retirees/spouses/domestic partners are not eligible for premium-free Medicare Part A, they do not need to enroll.  Instead, obtain a letter from the CMS stating ineligibility for Medicare Part A.

    To be eligible for Part A premium free, the retiree or spouse/domestic partner must have 40 quarters of Medicare-covered employment.

    Retirees not eligible for premium-free Part A may be eligible for the CalSTRS Medicare Premium Payment Plan (MPPP).  Contact CalSTRS at 800-228-5453 for eligibility requirements.

    If a retiree is ineligible for premium-free Medicare Part A and the MPPP, letters from both CMS and CalSTRS stating ineligibility are required.  Ineligibility for both Part A and MPPP limit medical plan options to Anthem Blue Cross EPO and Kaiser Senior Advantage.

    Spouses/domestic partners who are not eligible for premium-free Part A are required to get a letter of ineligibility from CMS.

     

    Medicare Part B - outpatient care coverage

    All retirees/spouses/domestic partners must enroll and remain enrolled in Medicare Part B.  Retirees/spouses/domestic partners are responsible for paying all Medicare Part B premiums.  These payments are made directly to CMS.

    If you stop paying your Medicare Part B premium at any time for yourself and/or your spouse/domestic partner, your District-sponsored medical benefits will terminate.

     

    Medicare Part D - prescription drug coverage 

    Higher-income Medicare beneficiaries who are enrolled in a Medicare Advantage Plan are subject to a Medicare Part D - IRMAA premium (income-related monthly adjustment amount) if their gross adjusted income exceeds certain threshold amounts.  The Part D premium charges, if any, will automatically be determined by Medicare.

    The invoice for Medicare Part D premium charges will be sent to you by Medicare and will not be paid by the District or your medical plan.  You are required to remit the specified payment to Medicare directly to maintain your District-sponsored coverage.

    Medicare Part D Premiums by Income

    Do not join a third-party Medicare Part D prescription plan on your own or you will lose your District sponsored medical benefits.

    The District provides prescription drug coverage, also known as Medicare Part D, through Kaiser Senior Advantage and Health Net Seniority Plus. For Anthem Blue Cross Select HMO, Anthem Blue Cross EPO, and Anthem Medicare Preferred (PPO), prescription drug coverage will be provided by CVS/SilverScript, a Caremark company.