Medicare Enrollment Requirements for UC Health Plan Members
- Enrollment Requirements
- Why is enrollment necessary?
- I’m still working, do I have to enroll in Medicare Part B?
- What is the enrollment process?
- What happens to my UC medical plan coverage when I enroll in Medicare Parts A and B?
- What happens to my enrolled family members who are not enrolled in Medicare?
- Do I need to enroll in Medicare Part D?
- Resources
Enrollment Requirements*
UC requires retirees and their enrolled family members who become eligible for Medicare Part A (hospital insurance) free of cost, to enroll in Medicare Part B (medical insurance) and transfer to UC sponsored medical coverage for Medicare enrollees. The current premium for Medicare Part B is $88.50 per month in 2006, . (Link to www.medicare.gov website for detailed definition of Medicare Parts A and B).
If a retiree does not enroll in Part B, he/she and all enrolled family members will be de-enrolled from UC sponsored medical coverage. Any family member eligible for premium -free Part A is also required to enroll in Part B or be de-enrolled from UC medical coverage.
There are some exceptions to the requirements. If you and/or your family member(s) are past age 65 and you are still working at UCSF (never retired from UC) and are covered by a UC sponsored health plan for employees, you and/or your family member(s) may delay enrollment in Medicare Part B without penalty from UC or Medicare. When you retiree you must follow the enrollment requirements above. Adult dependent relatives who are eligible for Medicare Part A cannot continue their UC-sponsored medical coverage after age 65.
Why is enrollment necessary?
UC requires enrollment in Medicare Part B if you or your eligible family members become eligible for Medicare Part A, free of cost, to keep costs down. Of the total medical costs to UC and annuitants, Medicare can pay 80% of doctor and hospital bills. With Medicare assuming some of the costs of health care, UC benefit/budget planners retain leverage to negotiate high-value coverage for UC retirees.
I’m still working, do I have to enroll in Medicare Part B?
If you and/or your family member(s) are past age 65 and you are still working at UCSF (never retired from UC) and are covered by a UC sponsored health plan for employees, you and/or your family member(s) may delay enrollment in Medicare Part B without penalty from UC or Medicare. When you retiree you and your family members must follow the enrollment requirements above.
What is the enrollment process?
If you are already receiving Social Security benefits when you reach age 65, you will be enrolled automatically in both parts A and B of Medicare. If so, a Medicare card will be sent to you about 2 months before your 65th birthday and the Medicare premium will automatically be taken from your monthly Social Security benefit.
Also, about 2 months prior to your 65th birthday UC will send you a Medicare Factsheet and ask you to complete a UC Medicare Declaration form to verify your Medicare status. If you have questions about eligibility and enrollment for Medicare, please contact the social security office at 1-800-772-1213.
If you are past age 65 when you retire and you or your family members have delayed enrollment in Medicare Part B, you or your family members must contact the social security office to enroll in Medicare. In addition, to the Medicare enrollment form, the social security office will require you to complete and submit an employment verification form. You must also take the initiative to complete and submit to UC, a UC Medicare Declaration form.
If the above two senarios do not represent your status at age 65, please review the Medicare Enrollment Chart for additional examples.
What happens to my UC medical plan coverage when I enroll in Medicare Parts A and B?
In most cases, when you become eligible and enroll in Medicare, you will remain in your UC medical plan. If you are enrolled in an HMO (Kaiser, Health Net, PacifiCare, Western Health Advantage) you are further required to assign Medicare benefits to the HMO. This means that Medicare and your HMO will work together to pay for services and you will not be able to use Medicare separately from you HMO. If you are enrolled in an HMO plan whose Medicare service area does not include your current residence, you will need to change plans. In this case you will have a window of opportunity to choose another UC-sponsored medical plan. If you are enrolled in Blue Cross Plus, PPO, or Core, Medicare will become primary and your health plan will become the secondary payor for most health services. Each of these plans has a unique coordination with Medicare. For detailed information regarding how Medicare will coordinate with your medical plan, review the Medicare Factsheet or contact your plan.
What happens to my enrolled family members who are not enrolled in Medicare?
Your family members will remain in the same plan and will keep their basic plan coverage. If you have to choose a new medical plan because you do not live within your current HMO’s service area, your enrolled family members will also be transferred to basic coverage under your new plan.
Do I need to enroll in Medicare Part D?
No. In most cases your UC Medicare coordinated medical plan will enroll you in Medicare Part D, though enrollment will not change the plan’s three tier prescription drug co-pay design and you will not be required to pay an additional premium for Medicare Part D. Also, UC medical plans meet the qualification of ‘Creditable Coverage’ because they include prescription drug benefits that are equal or better than the standard Medicare Part D plan. For for information please review the Medicare Factsheet.
Resources
Retiring from UC
Medicare Factsheet for California Employees and Retirees
California Health Advocates - Includes access to the Health Insurance Counseling and Advocacy Program (HICAP). This program provides free individual counseling on Medicare-related issues.
Medicare Savings Programs - State programs for folks covered by Medicare Part A, that have limited income/resources to pay for Medicare Part B.
*(Policies apply to members who retire after July 1, 1991)