Medicare and SEBB benefits while employed

What are the parts of Medicare?

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. 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.
• Skilled nursing facilities care.
• Hospice services.

As a school employee, you will be automatically enrolled in Medicare Part A, if you are age 65 or older and receive Social Security benefits.

Medicare Part A has no monthly premium if you or your spouse worked and paid Medicare taxes for at least 10 years. 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 school employee, you may choose to delay enrollment until you retire or leave employment. However, if you plan to retire within three months of turning age 65, you should apply for Part B when you turn age 65.

Federal rules may not allow state-registered domestic partners to delay enrolling in Part B without a penalty. If your partner will soon turn age 65, contact the Social Security Administration.

There is a premium for Medicare Part B that you pay directly to Medicare. Contact Medicare with questions about premiums and how to pay them.

Medicare Part C – Medicare Advantage

Medicare Part C, also known as Medicare Advantage plans, generally includes Parts A, B, and D. All Medicare Advantage plans include additional benefits. These plans manage all the paperwork for claims with Medicare. There is a premium for most Medicare Advantage plans.

As a school employee, you may not waive SEBB medical to enroll in a Medicare Advantage plan.

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 school employee, you should know:

• You do not need Medicare Part D with SEBB medical plans. SEBB medical plans meet or exceed Medicare's minimum standard of coverage (also known as "creditable prescription drug coverage").
• The SEBB Program does not offer stand-alone Medicare Part D plans.
• You cannot be enrolled in both a Medicare Part D plan and a SEBB medical plan.

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

Medicare supplement plans do not offer prescription drug coverage. This means a Medicare Part D plan will also need to be purchased on the open market.

As a school employee, you may not waive SEBB medical to enroll in a Medicare Supplement Plan.

What if I enroll in Medicare?

Do I need to provide proof of Medicare enrollment?

No. You do not need to provide proof of Medicare enrollment if you are still working.

You will need to provide proof when you retire if you enroll in PEBB retiree insurance coverage.

Do I need to enroll in Part D?

You do not need Medicare Part D with SEBB medical plans. SEBB medical plans include prescription drug coverage that is as good as or better than Medicare Part D. If you or your dependent enrolls in a stand-alone Part D plan, your SEBB medical plan may not coordinate prescription drug benefits with that plan.

What happens to my medical plans?

Can I keep my SEBB medical plan when I turn age 65?

Yes, unless you have UMP High Deductible. In most cases, employees and dependents becoming eligible for Medicare can choose to keep SEBB medical as primary coverage, with Medicare coverage as secondary, if they enroll in Medicare Parts A and B.

I have UMP High Deductible. What should I do?

Enrolling in Medicare creates a special open enrollment that allows you to change medical plans. If you are enrolled in UMP High Deductible with a health savings account (HSA), you should consider a plan change when you, the employee, enroll in Medicare. Employees cannot contribute to an HSA while enrolled in Medicare. If you do, you will face tax consequences.

If you are eligible for premium-free Medicare Part A but don't enroll when first eligible, your Part A will be enrolled retroactively six months before the month you apply for Medicare, but no earlier than the month you turn age 65. If you keep UMP High Deductible past your Initial Enrollment for Medicare, plan carefully when to stop contributing to the HSA to avoid a tax penalty.

If your dependent enrolls in Medicare, however, you can still contribute to an HSA. Contact HealthEquity, Inc. UMP members call 1-844-351-6853 (TRS: 711) for more information about how Medicare enrollment affects your HSA.

How do I waive SEBB medical or remove a Medicare-eligible dependent?

You can waive SEBB medical if you are enrolled in other employer-based group medical, a TRICARE plan, or Original Medicare coverage. You must enroll in SEBB dental, vision, life, accidental death and dismemberment, and long-term disability insurance, if offered. You cannot waive enrollment in SEBB medical if you are enrolled in PEBB retiree insurance coverage.

You may choose to remove a dependent who enrolls in Medicare Part A and Part B as a special open enrollment event.

Can I waive SEBB medical and stay enrolled in PEBB retiree insurance coverage?

No. You cannot waive enrollment in SEBB medical to stay enrolled in PEBB retiree insurance coverage. Your PEBB retiree insurance coverage will be automatically deferred. You will be exempt from the deferral form requirement.

What happens when I retire?

If you retire and are eligible for PEBB retiree insurance coverage, you and your covered dependents must enroll and stay enrolled in Medicare Part A and Part B, if eligible, to enroll in or keep a PEBB retiree health plan. Medicare will become primary coverage, and PEBB medical becomes secondary coverage.

Learn how Medicare works with retiree benefits.

Are there more 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