How Medicare works with RSCCD Retiree Health Benefits
- If Neither You nor Your Spouse are Eligible for Medicare: The District retiree coverage will be your only plan until one of you becomes Medicare eligible
- If You or Your Spouse are Eligible for Medicare: When one of you becomes Medicare eligible and enrolled in Medicare Part A or B, Medicare will be the primary form of coverage for the Medicare-eligible family member. This means Medicare pays benefits first; your coverage through the District will be secondary. District Benefits will continue to be the primary carrier for the other family member until he or she is Medicare eligible.
- To avoid claim processing delays, you are required to tell your health care provider that you primary health care coverage is through Medicare. This means that Medicare pays for your medical care first. Notifying your provider of this change will help ensure that your claims are submitted correctly and processed in a timely manner.
|||Medicare Part A||Medicare Part B|
|What does it Cover?||Inpatient care (hospitalization, Skilled nursing, hospice)||General medical services (physician visits, diagnostic and lab, durable medical equipment), preventative care|
|What does it cost?||Free for those who are age 65 and older or those who are disabled||Monthly premium is subject to change each year, based on income|
|Do I need to enroll?||Yes, it is important that you enroll in these benefits as soon as you are eligible. Remember, it’s a good idea to request your Medicare enrollment package three months before your 65h birthday.||You must actively enroll when you become eligible to avoid a potential cost increase for these benefits. If you’re unsure if this cover-age is right for you, consult a Medicare Representative.|
|How does Medicare co-ordinate with my current benefits?||Medicare part A pays first, then District benefits pays for eligible care not paid by Medicare, up to the amount allowed under the district plan||Medicare Part B pays first, then District benefits pays for eligible care not paid by Medicare, up to the amount allowed under the district plan.|
Medicare details and when to apply
The Districts retiree health benefits coordinate with Medicare to give you comprehensive medical coverage.
Individual situations vary and you need to determine what is best for you. Please confirm your enrollment eligibility with Medicare @ (800) 633-4227.
Part A - Hospitalization
- Hospital insurance that helps cover inpatient care in hospitals, skilled nursing facilities, hospice and home health care.
- Sign up 3 months before the month of your 65th birthday @ www.Medicare.gov.
- Cost: You won’t pay a premium if you paid Medicare taxes while working.
- Those not eligible for free part A can elect to enroll in part A at $422 per month (2018).
Part B - Doctor Visits, hospital outpatient care and home health care
- There is a monthly charge for Part B
- If you don't sign up when you are first eligible, you will be assessed a 10% penalty for each year you did not sign-up.
- If an employee is turning 65 and is still actively working and covered by District group health plan, they may decline Medicare part B without a penalty. This is also true for your spouse if they are covered under your current plan. It's important to note that COBRA and retiree coverage does not count towards this exception.
- Retirees with lifetime benefits do not need Part B, however there could be advantages such as no pre-authorization for certain procedures, reduction or elimination of out of pocket expenses by coordination benefit between Medicare and your District plan.
- If the retiree passes away before their spouse, their spouse may need to purchase Part B and they would be assessed the 10% penalty when they sign-up. This could be a significant cost. The surviving spouse can continue the RSCCD benefits by paying the full premium.
- Once you retire you will have 8 months to enroll in Part B without incurring a penalty. To apply for Part B, go to www.medicare.gov, select "I have employer or union coverage" and download the application for enrollment in Part B
Part C - Medicare Advantage
- This is a supplemental plan that you would enroll in thru a private insurance company. There is a monthly charge in addition to the Part B premium. This plan is not needed if enrolled in District coverage. In General, a Medicare Advantage (Part C) plan supersedes any other medical plan, such as your District Plan.
Part D, Prescription Coverage
- Prescription drug coverage is included in your retirement benefits offered through the District and your coverage is considered to be comparable to or better than the prescription drug coverage that is offered through Medicare Part D. Therefore, you do not need to enroll in Medicare Part D.
- You may defer this coverage as long as you have District provided drug coverage which is considered "Creditable Coverage" to Medicare. Keep a copy of the documentation that advised the coverage is creditable, as it may be needed when you do sign up later.