Retirees and/or Spouses Over 65
Retirees and/or spouses over the age of 65 are required to enroll in Medicare Parts A & B in order to remain on the district's insurance plans. Once you are enrolled in Medicare, you will be transitioned into one of two plans: Anthem Medicare Advantage Plan or Kaiser Senior Advantage Plan.
Anthem National Passive PPO Medicare Advantage Plan with Part D
With the RetireeFirst Anthem National Passive PPO Medicare Advantage plan a member will be able to seek covered services from any Medicare provider (96% of the health providers nationally) in the US. That provider will then bill Anthem directly for 100% of the costs vs. having to bill Medicare first and then Anthem secondary. Anthem then works with Medicare to obtain the applicable reimbursements. The processing of the Medicare reimbursements by Anthem is why retirees are asked to “assign" their applicable parts of Medicare. Under a Medicare supplement plan, provider must bill Medicare first and then the plan second. However, the difference is an administrative issue that is not a responsibility of the retiree but rather the provider. This plan utilizes Anthem as the carrier which ensured minimal to zero disruption for all retirees currently on the Anthem HMO and PPO plans.
FAQ's
Is this an HMO Plan or PPO Plan?
The Anthem National Passive PPO Plan is not an HMO and you will not have a primary care physician. It is a PPO plan which will allow you to see the provider of your choice. They do not need to be part of the Anthem Blue Cross network. The only requirement is that the provider be a part of the Medicare network (96% of the health providers nationally) to receive full coverage (Passive PPO).
Is RetireeFirst the Carrier?
No. The administration, approval, and billing of all medical services is done by Anthem Blue Cross as the carrier for the plan. RetireeFirst provides support services to retirees and the District but does not make medical coverage decisions.
What happens if I want to leave the plan?
Since it is an employer sponsored group Medicare insurance plan, any participating retiree would be allowed a special open enrollment upon termination. During the special open enrollment, they could select whether to move to an individual Medicare advantage plan or Medigap plan. It is important to note that this flexibility is due to the fact that this is a group Medicare insurance plan and not an individual Medicare Advantage policy.
This plan may be offered to retirees over 65 with Medicare Parts A & B (see www.medicare.gov for information on Medicare) and retirees under age 65 with Medicare for the disabled. In order to be eligible, the member must be retired and enrolled in both Medicare Part A and Medicare Part B.
Is there dependent coverage?
No. This plan is an individual enrollment. If a spouse/domestic partner is currently enrolled as a retiree health dependent and qualifies for Medicare Parts A & B a they must complete a separate enrollment form for their own coverage.
How does a member enroll?
An enrollment form must be completed and submitted to the District with a copy of the member's Medicare card. RetireeFirst will assist with this enrollment process.
Does the member need to enroll in Medicare Part D?
No. The prescription plan is already included with this plan.
RetireeFirst 714.646.3618 or Toll-Free at 833.265.8654
Anthem 2022 Formulary.pdf
Rancho Santiago CCD_2022_PPO 0PH_$0 Ded_F01242022_CA_EOC (3).pdf
Rancho Santiago Community College District Anthem MAPD Plan Summary Updated.pdf
4.11.2022_BoardMeeting_RF.Anthem.Keenan FINALv4.pdf
Kaiser Senior Advantage Plan
Kaiser Senior Advantage Plan Requirements (retirees and/or dependents 65+):
- If you or your dependent are over 65 and you want Kaiser, you will be required to enroll in the Kaiser Senior Advantage Plan.
- Retirees and/or dependents in this plan must be enrolled in Medicare A & B and you must assign your Medicare benefits to Kaiser.
- If your home zip code is outside of the Kaiser Senior Advantage service area, you will not be eligible to enroll.
Frequently Asked Questions
Q. If I'm a retiree over 65 and enroll in Kaiser's Senior Medicare Advantage Plan but my spouse is
under 65, does he/she stay on the regular Kaiser Plan?
A. Yes, but on their 65th birthday they would be moved to the Senior Advantage Plan. Your spouse must also
be enrolled in Medicare Part A & B and assign the benefits to the Kaiser Senior Advantage Plan.
Q. If I am a retiree under 65, but my spouse is over 65, can we both be enrolled in Kaiser?
A. Yes. You would enroll in the regular Kaiser plan and your spouse would need to enroll in the Kaiser Senior
Advantage Plan. He/She must be enrolled in Medicare Part A & B and they must assign their Medicare benefit
to Kaiser. Otherwise, Kaiser coverage terminates for you and your dependent and you will need to enroll in
Anthem Blue Cross HMO or PPO Medical Plans. When you turn 65 you may either elect the Kaiser
Permanente Senior Advantage plan or elect to enroll in Anthem HMO or PPO plan.
Q. If I or my dependent become eligible for Medicare on our 65th birthday and enroll only in Medicare
Part A and not in Part B, can we keep our Kaiser coverage?
A. No, you would need to contact the district's Employee Benefit Office to terminate Kaiser HMO medical and
enroll in Anthem Blue Cross HMO or PPO medical plan.
Q. If I enroll in Kaiser and move from California to another state, am I able to switch to Anthem Blue
Cross PPO?
A. Yes. Contact the district's Employee Benefit Office prior to relocation for assistance.
If you need additional information, please visit RSCCD's website at www.rsccd.edu/Departments/Benefits
For more information about Kaiser Permanente, please visit www.kp.org
