Please note: This page was compiled using information from the Social Security Administration and the Commonwealth’s Group Insurance Commission. The MTRS is not responsible for its accuracy. The MTRS does not administer your health insurance or Medicare benefits. While we may deduct your health insurance premiums from your monthly check and forward them to either the GIC or your city or town treasurer, that service and bookkeeping function is our only involvement. For more complete information about Medicare, please go to www.ssa.gov, www.medicare.gov or call 1-800-MEDICARE.

A federally funded health insurance program, Medicare is the largest health insurance program in the world. Each year Medicare assists millions of older Americans and disabled Americans in meeting the costs of health care coverage. Medicare is run by the Health Care Financing Administration (HCFA) of the U.S. Department of Health and Human Services. You apply for Medicare through your local Social Security office.

Medicare pays for many health care expenses, but it does not cover all of them. It is very important to understand what will be covered by Medicare, what will be covered by supplemental insurance and how the two insurance programs interact.

When you’re 64...you should contact your local Social Security office approximately three months before your 65th birthday. At that point, you will be able to determine your eligibility for Medicare coverage. If you will be able to participate in Medicare, you should contact your insurance administrator—not the MTRS—to adjust your existing coverage.

As a retiree of the MTRS, you may or may not be eligible for health care coverage through Medicare, but you should be sure to investigate your eligibility at least three months before your 65th birthday.

Generally, you will be eligible for health care coverage through Medicare (Part A) when you reach the age of 65 and you meet one of the following conditions:

• you will be eligible to receive a Social Security benefit, or
• you are married to someone who will be eligible to receive a Social Security benefit, or
• you are a public employee, hired on or after April 1, 1986 and you paid the 1.45% Medicare tax for the required period (usually 10 years).

If you do not meet the eligibility criteria for Medicare, your health care coverage will remain with your local employer.

Medicare as your primary health care coverage

Once you become eligible to receive health care coverage through Medicare, you may be required to enroll in Medicare. (Whether you are required to switch depends on whether you are covered under the Commonwealth’s Retired Municipal Teachers (RMT) program or under locally provided insurance, and on whether your municipality has accepted the provisions of M.G.L. c. 32B, § 18. Please check with your local benefits coordinator or the Group Insurance Commission to see if you are required to switch to Medicare upon becoming eligible.)

If you enroll in Medicare, you may want to obtain “Medigap” insurance to supplement Medicare’s coverage. If, prior to enrolling in Medicare, you were covered under:

• the local municipality’s program, you should make arrangements with your local insurance coordinator to continue coverage through your group insurance program. The local insurance program will then serve as a supplement to Medicare. You should contact your local benefits coordinator for Medigap options.
• the RMT program, you will be required to enroll in Medicare, if eligible; you should then apply for Medigap coverage through the Group Insurance Commission. For your Medigap options, contact the GIC (www.mass.gov/gic).

Cost and method of payment for Medicare

Coverage for Medicare Part A is free to eligible retirees. There is a charge for Medicare Part B. Once you have established coverage with the Medicare program, the MTRS will withhold the monthly premium for your Medigap coverage.

Starting in 2007, the Medicare Part B premium is based on retirees’ income: In the past, all Medicare-eligible retirees paid the same premium for their Medicare Part B coverage. Starting in 2007, the Medicare Part B premium is higher for retirees whose income exceeds certain limits. The standard Medicare Part B premium in 2007 is $93.50/month. For retirees whose total earnings exceed $80,000 (for a single person) or $160,000 (for a married couple filing jointly), the Part B premiums increase on a sliding scale, up to a maximum of $161.40/month for those retirees whose income exceeds $200,000 (single) or $400,000 (married filing jointly).

For more information and the new scale of premiums by annual income, please see Medicare’s web page on Part B monthly premiums.

For more information

For additional information on Medicare, please contact your local Social Security office or call the Social Security Administration at 800-772-1213.