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    Medicare Information

     & Retaining District-Sponsored Medical Coverage
     
     
    CMS Medicare
     

    800-633-4227

     

     Medicare & You 2020 Guide

     
     Soc Sec Administration

    800-772-1213 

                                                                                                         
     
     

    To retain District-sponsored medical coverage for those retirees and/or their dependents turning 65 years of age, one must enroll and remain enrolled in Medicare Parts A and B in addition to enrolling in a Medicare Advantage medical plan. Applying to Medicare 90 days prior to turning 65 years of age is highly recommended.

    Medicare is a national health care program for individuals who are age 65 and older. Essentially, Medicare is comprised of Part A - hospitalization coverage, Part B - outpatient care coverage, and Part D - prescription drug coverage. Please note that all District medical plans include prescription drug coverage.

    Lack of Medicare coverage does not affect dental and vision plans.

     

    ANNOUNCEMENTS

    Medicare Retirees
    Depending on the medical plan you select as a Medicare-eligible retiree, you may have access to free wellness programs such as SilverSneakers® through Anthem Medicare Preferred (PPO) Medical plan and Silver&Fit® through Health Net Seniority Plus and Kaiser Senior Advantage at no cost.  These programs provide gym membership and other fitness offerings that maintain a healthy lifestyle and improve overall well-being.  Additional details can be found in the flyers below:

    Anthem Medicare Preferred (PPO) SilverSneakers® Brochure/Fast Facts
    Health Net Seniority Plus Silver&Fit® Brochure
    Kaiser Senior Advantage Silver&Fit® Brochure

     

     

To continue your medical benefits without interruption, complete the following steps.  Failure to complete all three steps stipulated below will result in the termination of medical benefits effective the first day of the month of your and/or your spouse/domestic partner’s 65th birthday.

Benefits Administration must receive the proper documentation by the end of the month prior to your and/or your spouse/domestic partner’s 65th birthday to continue your medical benefits.

You must notify Benefits Administration in writing if you are switching plans.  Include a written statement with the document(s) you are faxing or mailing.

Step 1
Obtain a Medicare Card from the Centers for Medicare and Medicaid Services (CMS) or your local Social Security Office by enrolling in Medicare Parts A and B.  If not eligible for premium-free Medicare Part A, provide letter of ineligibility from CMS.  Further information can be found under the ”Additional Medicare Part A Information” tab.

Step 2
Obtain and complete an application for a new Medicare Advantage medical plan.  Forward your application to the medical plan per their instructions.

Step 3
FAX or MAIL a copy of your Medicare Card, Part A ineligibility letter, if applicable, and written statement if switching medical plans, to Benefits Administration.  Please write your Employee ID number on each document you are submitting.

Benefits Administration, Attention Retirement Unit
PO Box 513307
Los Angeles, CA 90051-1307
Fax: 213-241-4247

 

It is recommended that you contact Medicare or the Social Security Administration at least three months prior to your and/or your spouse/domestic partner’s 65th birthday.

Medicare accepts applications in the following instances.

1) Three months prior to, during the month of, or within three months after an individual’s 65th birthday.

2) Individuals 65 years of age or older who lose medical coverage under their own active employee medical plan or under their working spouse/domestic partner's medical plan.

3) During the open enrollment period of January through March with coverage taking effect July 1st of the same year.

Note: Retirees and/or their spouse/domestic partners age 75 and older as of January 1, 2010 (born prior to January 1, 1935), were grandfathered-in at their current Medicare Part A and B enrollment levels.

 

 

 Anthem Blue Cross ABC  Kaiser Permanent  Health Net
       EPO Medicare Preferred PPO
Senior Advantage   Seniority Plus


Medicare plans for retirees over 65 may require small copayments for most outpatient services.  These plans will file a claim on your behalf for services that are covered by Medicare and will coordinate payment directly with them.  Individuals who are not eligible for Medicare Part A may be responsible for additional costs.

However, the Anthem Medicare Preferred PPO Medical plan does not have copays, coinsurance, or deductibles.  Once you are enrolled in the Anthem Medicare Preferred PPO Medical plan, Anthem coordinates all of your care.

It is important to ensure your provider of choice is also a Medicare provider because the Medicare Advantage plans and Medicare will not pay for any services rendered by a non-Medicare provider.  Providers and services may vary by plan.  Please contact each plan directly for details.

 

 

If you are currently an Anthem Blue Cross Select HMO member who is turning 65 years of age or an Anthem Blue Cross EPO member and wish to stay with Anthem Blue Cross, you do not need to complete an enrollment application.  All Anthem Blue Cross HMO and EPO members who have Medicare Parts A and B will be automatically enrolled into the Anthem Medicare Preferred (PPO) Medical plan unless you select another plan such as Kaiser Senior Advantage or Health Net Seniority Plus.  Dependents of Anthem Medicare Preferred (PPO) Medical plan members who do not have Medicare Parts A and B will remain/be enrolled in Anthem Blue Cross EPO.  Members who are over the age of 65 with Medicare Part B only or who are under the age of 65 will remain/be enrolled in Anthem Blue Cross EPO, unless a different plan is elected.  

Anthem members/dependents who have a P.O. Box address must attest that they reside within the United States (U.S.) or certain U.S. territories per CMS guidelines.  Medical and prescription drug coverage will be terminated for members/dependents who fail to attest prior to their 65th birthday.

For more information you may contact Anthem Medicare Preferred PPO Medical plan at (833) 277-5221 or Anthem Blue Cross EPO at (800) 700-3739.

Prescription drug coverage for Medicare eligible members enrolled in Anthem Blue Cross EPO and Anthem Medicare Preferred (PPO) Medical plan will be provided by SilverScript® Insurance Company, a CVS Caremark Company.  Eligible members will be automatically enrolled in the SilverScript plan and will receive a new ID card.

Your age 19-25 dependent child(ren), until the end of the 25th birthday month, are eligible for District-sponsored health benefits if they are a full-time student (8 units or more) and verification of student status is provided to Benefits Administration.

 

If you are currently a Kaiser member who is turning 65 years of age and wish to stay with this plan or are switching to Kaiser Senior Advantage (KPSA) from another plan, you must complete a KPSA application and submit it directly to Kaiser.

Contact Kaiser Senior Advantage for more information by calling 877-425-0717 or obtain an application under the "Medicare" section of the Forms and Publications page.

Your age 19-25 dependent child(ren), until the end of the 25th birthday month, are eligible for District-sponsored health benefits if they are a full-time student (8 units or more) and verification of student status is provided to Benefits Administration.

 

You and your spouse/domestic partner must both be eligible for both Medicare Parts A and B to qualify for this plan.  Ineligibility letters from CMS will not be accepted.

If you are currently a Health Net member who is turning 65 years of age and wish to stay with this plan or are switching to Health Net Seniority Plus (HNSP) from another plan, you must complete a HNSP application and submit it to HNSP.

Please note that the Health Net HMO physician group network is not the same as the HNSP network. Certain medical groups, such as UCLA Medical Group and Cedars Sinai Health Associates, are not included in the Seniority Plus network. You may need to select a new provider if you choose to enroll in HNSP and your current doctor does not participate in the HNSP network.

Contact Health Net Seniority Plus for more information by calling 800-596-6565 or obtain an application under the "Medicare" section of the Forms and Publications page.

Your age 19-25 dependent child(ren), until the end of the 25th birthday month, are eligible for District-sponsored health benefits if they are a full-time student (8 units or more) and verification of student status is provided to Benefits Administration.

 

All retirees/spouses/domestic partners eligible for premium-free Medicare Part A must enroll and remain enrolled in Medicare Part A.  If retirees/spouses/domestic partners are not eligible for premium-free Medicare Part A, they do not need to enroll.  Instead, obtain a letter from the CMS stating ineligibility for Medicare Part A.

To be eligible for Part A premium free, the retiree or spouse/domestic partner must have 40 quarters of Medicare-covered employment.

Retirees not eligible for premium-free Part A may be eligible for the CalSTRS Medicare Premium Payment Plan (MPPP).  Contact CalSTRS at 800-228-5453 for eligibility requirements.

If a retiree is ineligible for premium-free Medicare Part A and the MPPP, letters from both CMS and CalSTRS stating ineligibility are required.  Ineligibility for both Part A and MPPP limit medical plan options to Anthem Blue Cross EPO and Kaiser Senior Advantage.

Spouses/domestic partners who are not eligible for premium-free Part A are required to get a letter of ineligibility from CMS.

 

All retirees/spouses/domestic partners must enroll and remain enrolled in Medicare Part B.  Retirees/spouses/domestic partners are responsible for paying all Medicare Part B premiums.  These payments are made directly to CMS.

If you stop paying your Medicare Part B premium at any time for yourself and/or your spouse/domestic partner, your District-sponsored medical benefits will terminate.

 

Higher-income Medicare beneficiaries who are enrolled in a Medicare Advantage Plan are subject to a Medicare Part D - IRMAA premium (income-related monthly adjustment amount) if their gross adjusted income exceeds certain threshold amounts.  The Part D premium charges, if any, will automatically be determined by Medicare.

The invoice for Medicare Part D premium charges will be sent to you by Medicare and will not be paid by the District or your medical plan.  You are required to remit the specified payment to Medicare directly to maintain your District-sponsored coverage.

2020 Medicare Part D Monthly Adjustment Amounts

Do not join a third-party Medicare Part D prescription plan on your own or you will lose your District sponsored medical benefits.

To view related documents, please visit the "Medicare" section of the Forms and Publications page.