Medicare and Your GIC Benefits

Medicare Guidelines
Under and Over Health Plan Combinations
Under and Over Age 65 Health Plan Combinations - RMTs and EGRs
Helpful Reminders

Medicare is the federal health insurance program for retirees age 65 and older and certain younger 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. Call or visit your local Social Security office to determine your eligibility.

When you or your spouse is age 65 or over, or if you or your spouse is disabled, visit your local Social Security Administration office to find out if you are eligible for free Medicare Part A coverage.

If you (the insured) continue working after age 65, you and/or your spouse should NOT enroll in Medicare Part B until you (the insured) retire. Due to federal law, different rules apply for same-sex spouses.

When you (the insured) retire:

• If you and/or your spouse is eligible for Part A for free, state law requires that you and/or your spouse must enroll in Medicare Part A and Part B to be covered by the GIC.
• You must join a Medicare plan sponsored by the Group Insurance Commission (GIC) to continue health coverage. These plans provide comprehensive coverage for some services that Medicare does not cover. If you and your spouse are Medicare eligible, you must enroll in the same Medicare Plan.
• You MUST continue to pay your Medicare Part B premium. Failure to pay this premium will result in the loss of your GIC coverage.

Retiree and Spouse Coverage if Under and Over Age 65
If you (the retiree) or your spouse or other covered dependent is younger than age 65, the person or people under age 65 will continue to be covered under a non-Medicare plan until you and/or he/she becomes eligible for Medicare.

If this is the case, you must enroll in one of the pairs of plans listed in "Health Plan Combination Choices" below.

Health Plan combination choices for state retirees, municipal retirees, deferred retirees, and former employees receiving continuation coverage:

Health Plan combination Choices - Retired Municipal Teachers (retired teachers not participating in the municipal health-only program) and Elderly Governmental Retirees (EGRs):

Non Medicare Plan	Medicare Plan
Fallon Community Health Plan Direct Care	Fallon Senior Plan
Fallon Community Health Plan Select Care	Fallon Senior Plan
Health New England	Health New England MedPlus
UniCare State Indemnity Plan/ Basic	UniCare State Indemnity Plan/ Medicare Extension (OME)

Helpful Reminders

• Call or visit your local Social Security office for more information about Medicare benefits.
• HMO Medicare plans required you to live in their service area. See the individual Medicare plan pages for details.
• You may change GIC Medicare plans only during annual enrollment, unless you move out of your plan's service area. Note: if your doctor or hospital drops out of your Medicare HMO, you must stay in the HMO until the next annual enrollment.
• If you want to enroll in a GIC Medicare Plan, write to the Group Insurance Commission - new municipal retirees, use the Municipal Medicare enrollment form.
• Benefits and rates of Fallon Senior Plan and Tufts Health Plan Medicare Preferred are subject to change January 1, 2009.  These plans automatically include Medicare Part D prescription drug benefits.  Contact the plans for additional details.