Medicare and turning age 65

What are the different 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. You will 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.
• Inpatient care in skilled nursing facilities.
• Hospice services.

As a PEBB retiree, you are required to enroll in Part A.

For most, there is no premium for Medicare Part A. 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 PEBB retiree, you are required to enroll in Part B.

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 PEBB retiree, you can enroll in a PEBB Medicare Advantage plan. The PEBB Program offers several Medicare Advantage with Part D plans. You also have the option of purchasing a Medicare Advantage plan from a private insurance company. If you choose to purchase a private plan, you may lose your right to enroll in PEBB retiree insurance coverage.

Learn more about these plans under What are my medical plan options?

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 PEBB retiree you should know:

• PEBB medical plans, except Plan G, meet or exceed Medicare's minimum standard of coverage (also known as "creditable prescription drug coverage).
• The PEBB Program does not offer standalone Medicare Part D plans.
• If you enroll in a standalone Medicare Part D plan, your only PEBB medical plan option is Premera Blue Cross Medicare Supplement Plan G.
• If you are enrolled in a PEBB plan with Part D and enroll in another Medicare plan, you will lose your PEBB Part D.

There is a premium for Medicare Part D. The Part D premium is included in the premium for PEBB plans that include Part D.

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.

Medicare supplement plans do not offer prescription drug coverage. If you don’t have creditable drug coverage, you will also need to purchase a Medicare Part D plan on the open market, since the PEBB Program does not offer a stand-alone Part D plan.

Each Medicare supplement plan is identified by a letter A through N. All plans offer the same basic benefits, and some offer extra benefits. The PEBB Program only offers Premera Blue Cross Medicare Supplement Plan G. Plan G only pays when Medicare pays for services billed under Medicare Part A and Part B. You also have the option of purchasing a Medicare supplement plan from a private insurance company. If you choose to purchase a private plan, you may lose your right to enroll in PEBB retiree insurance coverage.

As a PEBB retiree, you can enroll in Medicare Supplement Plan G. There is no prescription drug coverage with this plan. If you choose Plan G, you may have to enroll in Medicare Part D to get your prescriptions, unless you have other creditable drug coverage, like VA.

Contact Medicare with questions.

What must I do when I am eligible for Medicare?

Do I have to enroll in Medicare?

Yes. As a retiree, you and your covered dependent are required to enroll in both Medicare Part A and Part B as soon as eligible to stay enrolled in a PEBB retiree health plan.

We encourage applying for Medicare three months before turning age 65. Doing so will make sure you enroll (or meet the requirements to stay enrolled) in PEBB retiree insurance coverage within our timelines.

To enroll in Medicare, call the Social Security Administration at 1-800-772-1213, TTY: 1-800-325-0778 or visit their website.

Do I need to provide proof of Medicare enrollment?

Yes. Once you or your dependent enrolls in Medicare Part A and Part B, you must send us proof of the enrollment. We must receive your proof no later than 30 days before you or your dependent turn age 65 (or if delayed, no later than 60 days after turning age 65). If you are enrolling in PEBB retiree insurance coverage for the first time, submit proof in Benefits 24/7 or with your Retiree Election Form (form A).

Which documents act as proof of enrollment?

Send us a copy of the Medicare:

• Card or benefit verification letter showing the effective date of Medicare Part A and Part B.
  Note: If you or your dependent are determined not eligible for Medicare Part A or Part B, send a copy of the denial letter from the Social Security Administration.

Write your name and last four digits of your Social Security number on the copy.

How to submit proof

You can:

• Upload your documents in Benefits 24/7.
• Send us a secure message through HCA Support, a secure website that allows you to log into your own account to communicate with us. You will need to set up a SecureAccess Washington (SAW) account to use this option.  
• Fax to: 360-725-0771
• Mail to:
  Health Care Authority
  PEBB Program
  PO Box 42684
  Olympia, WA 98504-2684

What happens after I submit proof of Medicare enrollment?

We will reduce your premium to the lower Medicare rate, if applicable. We will also notify your medical plan of your Medicare coverage. If you are paying premium surcharges, they will stop when you (the subscriber) enroll in Medicare Part A and Part B.

What are my medical plan options?

Compare the PEBB Medicare plan benefits. In many cases, you and your dependents can stay enrolled in your current medical plan. If you choose to change medical plans, here are your options and instructions on how to enroll.

Kaiser Permanente NW Senior Advantage with Part D (MAPD)

If available in your county of residence. See plans available by county.

Learn more about Kaiser Permanente NW Senior Advantage with Part D. 

How do I enroll?

Use Benefits 24/7 or a form to enroll. 

If you are enrolled in PEBB retiree insurance coverage submit:

• Retiree Change Form (form E).

If you are not enrolled in PEBB retiree insurance coverage submit:

• Retiree Election Form (Form A).

How long do I have to enroll?

You have seven months to enroll in a Medicare Advantage plan.

This seven-month period:

• Starts three months before you or your dependent first enroll in Medicare Part A and Part B.
• Ends three months after the month of Medicare eligibility, or before you or your dependent's last day of the Medicare Part B initial enrollment period.

We must receive the forms no later than the last day of the month before the month you or your dependent enrolls in the Medicare Advantage plan. Non-Medicare members will be enrolled in Kaiser Permanente NW Classic.

When does coverage start?

The enrollment will be effective on the first of the month after we receive Form E.

Kaiser Permanente WA Medicare Advantage with Part D (MAPD)

If available in your county of residence. See plans available by county.

Learn more about Kaiser Permanente WA Medicare Advantage with Part D. 

How do I enroll?

Use Benefits 24/7 or a form to enroll. 

If you are enrolled in PEBB retiree insurance coverage submit:

• Retiree Change Form (form E).

If you are not enrolled in PEBB retiree insurance coverage submit:

• Retiree Election Form (Form A).

How long do I have to enroll?

You have seven months to enroll in a Medicare Advantage plan.

This seven-month period:

• Starts three months before you or your dependent first enroll in Medicare Part A and Part B.
• Ends three months after the month of Medicare eligibility, or before you or your dependent's last day of the Medicare Part B initial enrollment period.

We must receive the forms no later than the last day of the month before the month you or your dependent enrolls in the Medicare Advantage plan. You must also select Kaiser Permanente WA Classic, SoundChoice, or Value for any non-Medicare members enrolled.

When does coverage start?

The enrollment will be effective on the first of the month after we receive Form E.

Premera Blue Cross Medicare Supplement Plan G

Plan G does not include prescription drug coverage, so you may want to enroll in a stand-alone Medicare Part D prescription drug plan to avoid being penalized in the future.

Learn more about Premera Blue Cross Medicare Supplement Plan G. 

How do I enroll?

Use Benefits 24/7 or a form to enroll.

If you are enrolled in PEBB retiree insurance coverage submit:

• Retiree Change Form (form E).
• Group Medicare Supplement Enrollment Application (form B).

If you are not enrolled in PEBB retiree insurance coverage submit:

• Retiree Election Form (Form A).
• Group Medicare Supplement Enrollment Application (form B).

How long do I have to enroll?

You have up to six months after the Medicare Part B enrollment date to enroll. Non-Medicare members will be enrolled in Uniform Medical Plan (UMP) Classic.

When does coverage start?

The enrollment will be effective the first of the month after the date of the event or the date we receive the required forms, whichever is later.

Uniform Medical Plan (UMP) Classic Medicare with Part D (PDP)

Learn more about UMP Classic Medicare with Part D (PDP).

How do I enroll?

Use Benefits 24/7 or a form to enroll.

If you are enrolled in PEBB retiree insurance coverage submit:

• Retiree Change Form (form E).

If you are not enrolled in PEBB retiree insurance coverage submit:

• Retiree Election Form (Form A).

How long do I have to enroll?

You have seven months to enroll in UMP Classic Medicare with Part D (PDP).

This seven-month period:

• Starts three months before you or your dependent first enroll in Medicare Part A and Part B.
• Ends three months after the month of Medicare eligibility, or before you or your dependent's last day of the Medicare Part B initial enrollment period.

When does coverage start?

The enrollment will be effective the first of the month after the date of the event or the date we receive Form E, whichever is later.

UnitedHealthcare PEBB Balance or UnitedHealthcare PEBB Complete

Medicare Advantage Prescription Drug (MAPD) plans include Medicare Part D prescription drug coverage.

Learn more about UnitedHealthcare PEBB Balance and PEBB Complete.

How do I enroll?

Use Benefits 24/7 or a form to enroll.

If you are enrolled in PEBB retiree insurance coverage submit:

• Retiree Change Form (form E).

If you are not enrolled in PEBB retiree insurance coverage submit:

• Retiree Election Form (Form A).

How long do I have to enroll?

You have seven months to enroll in a Medicare Advantage plan.

This seven-month period:

• Starts three months before you or your dependent first enroll in Medicare Part A and Part B.
• Ends three months after the month of Medicare eligibility, or before you or your dependent's last day of the Medicare Part B initial enrollment period.

We must receive the forms no later than the last day of the month before the month you or your dependent enrolls in the Medicare Advantage plan.

When does coverage start?

The enrollment will be effective on the first of the month after we receive Form E. Non-Medicare members will be enrolled in UMP Classic.

Do I need to enroll in Part D?

You do not need to enroll in Medicare Part D prescription drug coverage. Most PEBB medical plans include prescription drug coverage that is as good as or better than Medicare Part D.

If you enroll in Premera Blue Cross Medicare Supplement Plan G you will need to sign up for a standalone Part D plan because Plan G does not include drug coverage. Doing so will help you avoid a Part D late enrollment penalty.

If you want to enroll in any other PEBB medical plan, you must disenroll from your other Part D plan.

FAQs

What if I'm enrolled in a CDHP, UMP Select, or a UMP Plus plan?

If the person enrolling in Medicare is:

• You (the retiree):
  • Choose a new medical plan. Your annual deductible and out-of-pocket maximum may restart with your new plan.
• Your dependent and you want to keep them enrolled:
  • Choose a new medical plan. Your annual deductible and out-of-pocket maximum may restart with your new plan.
• Your dependent and you want to keep your current plan:
  • Remove your dependent by submitting the Retiree Change Form (form E) before they enroll in Medicare Part A and Part B. They will not qualify for PEBB Continuation Coverage.

Can my dependents and I enroll in different plans?

Generally, you and your dependents must enroll in the same medical plan. However, there are some exceptions, as listed in the table below.

If the person enrolled in Medicare enrolls in:	The non-Medicare members on your account:
Kaiser Permanente NW Senior Advantage with Part D	Will be enrolled in Kaiser Permanente NW Classic.
Kaiser Permanente WA Medicare Advantage with Part D	Will choose to enroll in Kaiser Permanente WA Classic, SoundChoice, or Value.
Premera Blue Cross Medicare Supplement Plan G UMP Classic Medicare with Part D (PDP) UnitedHealthcare PEBB Balance UnitedHealthcare PEBB Complete	Will be enrolled in UMP Classic.

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 plan's 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 Benefits while traveling.

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