Updated on November 5, 2013
GIC Medicare Guideline : View and print the attached for an overview of when to apply for Medicare Parts A and B.
Turning Age 65 Q&A : Retirees who are turning age 65 and enrollees who are newly receiving a pension will receive this brochure by mail a month before they turn age 65 or after their first pension check, respectively.
Q) What is Medicare?
A) Medicare is a federal health insurance program for retirees age 65 or older and certain disabled people. Medicare Part A covers inpatient hospital care, some skilled nursing facility care and hospice care. Medicare Part B covers physician care, diagnostic x-rays and lab tests and durable medical equipment. Medicare Part D is a federal prescription drug program.
Q) I'm turning age 65; what do I need to do? Should I enroll in Medicare Part A and/or Part B if I am eligible?
A) If you are age 65 or over, call or visit your local Social Security Office for confirmation of Social Security and Medicare benefit eligibility. If eligible and if you are retired, you must enroll in Medicare Part A and Part B to continue coverage with the GIC. See the Retiree/Survivor Benefit Decision Guide for your health plan options.
If you are eligible but you continue working for the state or a participating municipality after age 65, do NOT enroll in Medicare Part B until you (the insured) retire.
The spouse covered of an active employee who is 65 or over should NOT sign up for Medicare Part B until the insured retires. Due to federal law, different rules apply for same sex spouses. See below for details.
Most enrollees should not sign up for Medicare Part D.
Q) I'm retired, but not age 65. My spouse is turning age 65; what should my spouse do?
A) Your spouse should call or visit your local Social Security Office for confirmation of Social Security and Medicare eligibility. If eligible, he/she must enroll in Medicare Part A and Part B to continue coverage with the GIC. See the under/over age 65 section of the Benefit Decision Guide for your health plan combination options.
Q) If I am retired and under age 65 and my spouse or I am disabled, how do I find out whether or not I am eligible for Medicare Part A and Part B benefits?
A) If you or your spouse is disabled, contact Social Security about Medicare eligibility. If eligible, contact the GIC for your health plan options.
Q) How to I find out whether I am eligible for Medicare Part A and/or Part B benefits?
A) When you or your spouse is age 65 or over, visit your local Social Security Administration office to find out if you are eligible for Medicare Part A for free. If you or your spouse is disabled, contact Social Security about Medicare eligibility. If eligible, contact the GIC for your health plan options.
Q) I have been a state employee for my entire career and have never contributed to Social Security. Why do I need to know about Medicare?
A) You may still be eligible for Medicare benefits. For example, if you are married, you may be eligible for Medicare through your spouse. When you turn age 65, visit your local Social Security office for eligibility information. If you are not eligible for Medicare, the GIC will require proof from the Social Security Administration that you are not eligible and you will remain in a GIC non-Medicare health plan.
Q) How do I pay for Medicare Part B?
A) In most cases, the federal government will deduct the Medicare Part B premium from your monthly Social Security check. If you or your spouse are not eligible for a Social Security check, the federal government will bill you for the Medicare Part B premium.
Q) When must I enroll in Medicare Part A and B?
A) When you or your spouse turns 65, and if you (the insured) are retired, you must enroll in Medicare Part A and Part B. If you (the insured) continue working for the state or a participating municipality after age 65, you and/or your spouse must enroll in Medicare Part A. (Different rules apply to same sex spouses; see below for details.) When you retire, you and/or your spouse must enroll in Medicare Part B and join a Medicare plan sponsored by the GIC.
If you do not enroll in Medicare Part B within the required time, you will be required to pay federal government penalties. Also, you will be ineligible for health coverage through the GIC if you do not enroll in Part B within the required time.
Q) Should I choose only Medicare for health care coverage?
A) "Medicare only" coverage is not recommended as it has coverage limitations. To ensure comprehensive coverage, Medicare retirees should enroll in a Medicare health plan sponsored by the GIC as a supplement to their Medicare coverage.
Q) I am in a GIC Medicare plan. What are the consequences if I cancel or do not pay Medicare Part B?
A) If you cancel or do not pay Medicare Part B, the GIC is required to terminate your GIC health coverage. This would mean that you would only have Medicare Part A coverage for inpatient hospital care. You would no longer have coverage for:
- Physician office visits
- Prescription drugs
- Outpatient mental health/substance abuse care
- Outpatient surgery
- X-rays and diagnostic tests
- Hearing aids
If you wanted to later reinstate your Medicare Part B coverage, you would be subject to federal late enrollment penalties and would have to wait for Medicare’s enrollment period followed by the GIC’s annual enrollment period to get back into a GIC health plan. So, consider the consequences before you cancel or not pay Part B.
Q) What documents must I provide to the GIC when I am retired and age 65 or over?
A) If you and/or your spouse are on Medicare, we will need the following documentation:
- Photocopy of your Medicare Card (include a copy of spouse's card if applicable)
- Photocopy of your latest 1099 or a letter from Social Security stating how your monthly Part B premium is paid (e.g., you are being directly billed by Social Security or it is being deducted from your Social Security check). Include this same documentation for your spouse, if applicable.
If you and/or your spouse are over age 65 and not eligible for Medicare we will need the following documentation:
Letter from Social Security stating that you or your spouse is not eligible for Medicare Part A for free.
Q) When will my GIC Medicare Plan go into effect?
A) The GIC determines the Medicare Plan effective date based on receipt of completed forms and Medicare documentation. Once you are enrolled, your GIC Medicare health plan will send you an ID card.
Q) If I enroll in a GIC Medicare supplemental plan, what happens to my spouse's coverage?
A) Your spouse will continue to be covered under your existing non-Medicare plan if he/she is under age 65 until he or she becomes eligible for Medicare. You and your spouse must join the same health plan. See the Retiree/Survivor Benefit Decision Guide for under and over age 65 health plan combination options. If your spouse is over age 65, he/she must enroll in the same Medicare supplemental plan that you have joined.
Q) I have a same sex spouse who has coverage through the GIC. My same sex spouse is turning age 65. What does he/she need to do?
A) Regardless of whether you (the insured) are retired, to avoid any federal government late enrollment penalties, your same sex spouse should enroll in Medicare Part A and Part B if he or she is eligible for Medicare Part A for free. Your same sex spouse will continue to be covered under your non-Medicare health plan until you (the insured) retire.
Keep in mind that the same sex spouse is subject to federal imputed income taxes. See the imputed income table for more information.
Q) At age 65 my spouse or I were not eligible for Medicare Part A for free. I or my spouse have subsequently become eligible for Medicare Part A. What do we need to do?
A) You or your spouse must notify the GIC in writing when you become eligible for Medicare Part A. The GIC will notify you of your coverage options. Failure to do this may result in loss of GIC coverage.
Q) I am retired with GIC health insurance, but am working elsewhere. Do I need to enroll in Medicare Part A and Part B if I am age 65 or over and eligible?
A) Yes. Because you have health insurance through the GIC as a retiree, you will be enrolling a GIC supplemental Medicare plan to continue coverage. See above for required documentation.
Q) I am an ACTIVE state employee age 65 or over; which health plan card should I present at a doctor's office or hospital?
A) When visiting a hospital or doctor, present your GIC health plan card ( not your Medicare card) to ensure that your GIC plan is charged for the visit. If you are still working and are age 65 or over, your GIC health plan is your primary health insurance provider; Medicare (if you have it) is secondary. You may need to explain this to your provider is he/she asks for your Medicare card.
Q) What do I do when Medicare says they are not my primary carrier yet I am retired, age 65 or over and have a Medicare Supplement plan through the GIC?
A) You must either call Medicare at 1-800-633-4227 or visit your nearest Social Security office and request that Medicare correct their records to indicate that your are retired from the Commonwealth or a participating municipality and have coverage through the GIC as a retiree. Medicare receives information from various sources, such as the Internal Revenue Service, and retirees with part-time jobs can encounter this problem.
Q) How do I find out about Medicare Plan options?
A) When you retire at age 65 or over or if you are retired and turn age 65, the GIC will contact you about your health plan options. The GIC's Retiree/Survivor Benefit Decision Guide provides an overview of your Medicare health plan choices.
Q) When can I change GIC Medicare Plans?
A) You may change your GIC Medicare Plan during annual enrollment or if you move out of a GIC HMO Medicare Plan's service area.
Q ) How do I change Medicare plans during annual enrollment or if I move out of my HMO Medicare Plan's service area?
A) Write to the GIC or attend a GIC annual enrollment health fair and the GIC will process your change. If you are enrolling in a Medicare HMO plan, the plan will send you an application to complete and return. If you are currently in a Medicare Advantage HMO Plan, you must also dis-enroll from your Plan by notifying the current carrier in writing. The plan will notify you and the GIC of the effective date of the dis-enrollment.
Q) How do I calculate my monthly premium rates?
A) Using the rate section, add the following:
For an insured and spouse on Medicare - Find the premium for the Medicare plan in which you are enrolling and double it for your monthly rate.
For a Retiree and Spouse Coverage if Under and Over Age 65
- Find the premium for the Medicare Plan in which the Medicare retiree or spouse will be enrolling
- Find the individual coverage premium for the Non-Medicare Plan in which the Non-Medicare retiree or spouse will be enrolling.
- Add the two premiums together; this is what you will pay monthly.
For other coverage combinations, contact the GIC.
Q) I am enrolled in a GIC Non-Medicare Plan and have become Medicare eligible because I have End Stage Renal Disease. What should I do?
A) Contact the GIC’s Public Information Unit for your options.
Q) I am not eligible for Medicare Part A for free, but am eligible for Medicare Part B. Should I purchase Medicare Part B?
A) The GIC does not require you to enroll in Medicare Part B if you are not eligible for Medicare Part A for free. However, you may still wish to do so. Contact Social Security for further information including the possibility of penalties for late enrollment.
Q) I am an active employee who is age 65 or over. Should I enroll in Medicare Part D?
Q) I am a retiree. Should I enroll in Medicare Part D?
A) For most GIC Medicare enrollees, the drug coverage you currently have through your GIC health plan is a better value than the Medicare drug plans being offered. Therefore, you should not enroll in a Medicare drug plan. (If you are a member of one of the GIC's Medicare Advantage plans - Fallon Senior Plan or Tufts Medicare Preferred - your plan automatically includes Medicare Part D coverage and you may not join an additional Part D plan.)
If you have limited income and assets, the Social Security Administration offers help paying for Medicare prescription drug coverage and this may be the one case where signing up for a Medicare Part D plan may work for you. Contact the Social Security Administration for details.
Q) How do I avoid paying a penalty for late enrollment in Medicare Part D?
A) If you should later enroll in a Medicare drug plan because of changed circumstances, show the GIC's Creditable Coverage Notice to the Social Security Administration to avoid paying a penalty. This notice is in your health plan handbook.
This information provided by the Group Insurance Commission.