Updated on January 8, 2016
GIC Medicare Guideline :When to Enroll in Medicare..
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 and have GIC health coverage; 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, visit Social Security’s website or your local Social Security Office for confirmation of Social Security and Medicare benefit eligibility. If eligible for Part A for free and if you are retired, you must enroll in Medicare Part A and Part B to continue coverage with the GIC. See the Medicare health plan page for State Retirees or Municipal Retirees for your health plan options.
If you are retired, the GIC will send you a Medicare enrollment form before your 65th birthday with instructions. Social Security’s online enrollment system offers convenient access to the Benefit Verification Letter you must provide the GIC with this form.
If you are eligible for Medicare Part A for free but you continue working for the state or a participating municipality after age 65, you and your covered spouse age 65 or over should not enroll in Medicare Part B until you (the insured) retire You can apply for free Part A online; Part A will not interfere with your active employee health insurance coverage.
Most enrollees should not sign up for an individual Medicare Part D plan. Your drugs are already provided by your GIC health plan.
Q) I'm retired, but not age 65. My spouse is turning age 65; what should my spouse do?
A) Your spouse should visit Social Security's website or your local Social Security Office for confirmation of Social Security and Medicare eligibility. If eligible for Part A for free, he/she must enroll in Medicare Part A and Part B to continue coverage with the GIC through a GIC Medicare Supplemental plan. See the under/over age 65 section 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 for Medicare for Part A for free, enroll in Part A and B and contact the GIC at 617-727-2310 Ext 6 to begin the enrollment process.
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 Social Security's website or call 1-800-772-1213. If you are not eligible for Medicare, the GIC will require a copy of your denial letter from the Social Security Administration that you are not eligible and you will remain in a GIC non-Medicare health plan.
Q) What is the cost of Medicare Part B?
A) The premium is set by the Centers for Medicare and Medicaid Services (CMS). Visit their website or contact them at 1-800-633-4227 for the current premium cost.
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 quarterly for the Medicare Part B premium.
Q) I have GIC health insurance coverage. When must I enroll in Medicare Part A and Part B?
A) The answer depends on your employment status with the Commonwealth or participating GIC municipality:
- If retired: When you or your covered spouse turn age 65, apply for Medicare Part A and Part B up to three months before your 65th birthday. You or your spouse turning age 65 will receive a Medicare enrollment package from the GIC approximately three months before your 65th birthday to make your Medicare health plan selection. Be sure to respond to the GIC by the due date noted in the package.
- If retiring, and you or your covered spouse is age 65 or over, the family member(s) age 65 or over should apply for Medicare Part A and Part B up to a month before your retirement. You and/or your spouse age 65 or over will receive a Medicare enrollment package from the GIC approximately four to six weeks after the GIC is notified by your GIC Coordinator of your retirement. Be sure to respond to the GIC by the due date noted in the package.
- If you, the insured, continue working for the state or a participating GIC municipality at age 65 or over, you and your covered spouse should only enroll in free Medicare Part A if eligible. Defer Part B until you, the insured, retire. Refer to the above bullet for additional details.
If you do not enroll in Medicare Part B within the required time or cancel Part B and re-enroll at a later date, you will be required to pay federal government penalties. Also, you may be ineligible for health coverage through the GIC.
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 January - March 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 don't pay Part B.
Q) What documents must I provide to the GIC when I am retired and age 65 or over with the Medicare Option form I receive from the GIC?
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 the Benefit Verification letter printed from Social Security's website, 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:
- Social Security denial letter 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 Health Plan Combination Choices Under and Over 65 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) 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) If you have GIC health coverage, 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. Keep in mind that if your spouse is at least age 62 when you approach age 65, you may be eligible for free Part A due to your spouse's eligibility. Contact Social Security three to four months before you turn age 65 to understand your options and give yourself time to gather your documents.
Q) I am retired and 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, if you may be eligible for Medicare Part A for free in the future (for example, you have a younger spouse) you may want to enroll in Part B to avoid a Medicare penalty later on. Contact Social Security for further information.
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 Supplemental plan through the GIC?
A) You must call Medicare at 1.800.633.4227 to correct coordination of benefits.
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 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) Complete a Retiree/Survivor Form and return to the GIC, write to the GIC, or attend a GIC annual enrollment health fair and the GIC will process your change. If writing, include your name, address, Social Security Number and the requested change. If you are enrolling in Fallon Senior Plan, the plan will send you an application to complete and return. If you are currently in a Medicare Advantage HMO Plan (Fallon Senior or Tufts Medicare Preferred), you must disenroll from the plan by also sending to the GIC a completed Medicare Advantage Plan Dis-enrollment form. If you are writing to the GIC to request the change, you must 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 at 617-727-2310 ext. 6.
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 at 617-727-2310 ext. 1 for your options.
Q) I am an active employee with GIC health coverage who is age 65 or over. Should I enroll in an individual Medicare Part D Plan?
Q) I am a retiree with GIC health coverage. Should I enroll in an individual Medicare Part D plan?
A) No. For most GIC Medicare enrollees, the drug coverage you currently have through your GIC health plan is a better value than the individual Medicare drug plans being offered. Therefore, you should not enroll in a Non-GIC Medicare Part D drug plan. If you are a member of Fallon Senior Plan, Tufts Medicare Preferred and effective January 1, 2016, UniCare State Indemnity Plan/Medicare Extension (OME), your plan automatically includes Medicare Part D coverage and if you enroll in another Medicare Part D drug plan, the Centers for Medicare & Medicaid Services (CMS) will automatically dis-enroll you from your GIC Medicare plan, which means you will no longer have a Medicare plan through the GIC.
If you are a member of Harvard Medicare Enhance, Health New England MedPlus or Tufts Medicare Complement and have limited income and assets, contact the Social Security Administration to find out about subsidized Part D coverage. If you are eligible for subsidized coverage, you may want to enroll in one of the GIC’s Medicare Part D plans (Fallon Senior Plan, Tufts Medicare Preferred and in January UniCare/State Indemnity Plan/Medicare Extension) during Annual Enrollment or when you become Medicare eligible.
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 that is mailed to you and is also on the Health Plans pages.
This information provided by the Group Insurance Commission .