How Medicare Eligibility Affects District-Provided Medical Coverage

 

While your retiree health care coverage is available after you become eligible for Medicare, you should understand how health care coverage is affected by Medicare.

Medicare is the national health care program for individuals who are age 65 and older (and certain other individuals). There are two parts: Part A, which provides coverage for hospitalization, and Part B, which provides coverage for outpatient care. There is a monthly cost for both Parts A and B; however, Part A coverage is provided at no cost to those who have at least 40 calendar quarters of Medicare-covered employment.

To retain your District-sponsored retiree medical coverage after you or your spouse/domestic partner become eligible for Medicare for any reason, you must enroll and remain enrolled in Medicare Part B (and Part A if applicable). If you do not enroll in Medicare as required, you will lose your District-sponsored medical benefits; once you enroll in Medicare Part B (and Part A if applicable), these benefits will be restored. Lack of Medicare coverage will not affect your dental or vision benefits.

How To Enroll In Medicare

To enroll in Medicare and maintain your District benefits:

  • Contact the nearest Social Security office three months before you (or your eligible dependent) reach age 65.
  • Send a photocopy of your Medicare card—along with your name and Social Security Number—to Benefits Administration.

Attention Kaiser Senior Advantage Participants

You must be enrolled in Medicare Part B to enroll in this plan. You must also complete and sign a Kaiser Senior Advantage Medicare Assignment Form to enroll. Please call the Kaiser number listed in Contact Information to request a form. With Senior Advantage, you will be responsible for paying a small copayment for most outpatient services, and the plan generally pays 100% of hospitalization. For services that are covered by Medicare, Kaiser will file a claim with Medicare on your behalf, and will coordinate benefit payments directly with Medicare.

Attention Participants of Secure Horizons Retiree Plan from PacifiCare

You must be enrolled in Medicare Parts A and B to enroll in this plan. You must also complete and sign a Secure Horizons Medicare Assignment Form to enroll. With Secure Horizons, you will be responsible for paying a small copayment for most outpatient services, and the plan generally pays 100% of hospitalization. There is virtually no paperwork for covered services.

Attention Blue Cross Participants

Once you are enrolled in Medicare Part B, Medicare is the primary coverage and the Blue Cross plan will pay benefits second. This means you must first file a claim with Medicare; then, when Medicare has paid the claim, you can file a claim with Blue Cross.

Both Medicare and Blue Cross will use Medicare’s definition of "eligible charges" when determining benefit payments. After Medicare pays 80% of the eligible charge, Blue Cross will generally pay 20% of the eligible charge. For more detailed information, see your Evidence of Coverage booklet (EOC).