Medicare Eligibility and Coverage Scenarios
Updated June, 2018
GIC Medicare Guidelines - When to Enroll in Medicare.
Medicare is a federal health insurance program for retirees age 65 or older and people with disabilities. 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.
When to enroll in Medicare Part A and Part B if you have GIC health coverage
This depends on your employment status with the state or a participating GIC municipality:
- 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.
- 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 (premium free) and Part B up to a month before your retirement. You and/or your spouse age 65 or over will receive a Medicare enrollment form from the GIC approximately two to three 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 retired, when you or your covered spouse turns age 65, apply for Medicare Part A (premium free) and Part B up to three months before your 65th birthday. You or your spouse turning age 65 will receive a Medicare enrollment form 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.
If you do not enroll in, cancel, or do not pay Medicare Part B within the required time, or cancel Part B and re-enroll at a later date, you will be ineligible for health coverage through the GIC. Also, you may be subject to pay federal government penalties.
If you are retired, but not age 65 and your spouse is turning age 65
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 the Benefit Decision Guide, or the Medicare Plan enrollment form for Medicare plan options.
How to find out whether or not you are eligible for Medicare Part A and Part B benefits if you are retired and under age 65 and your spouse or you are disabled
If you or your spouse is disabled and receiving Social Security disability benefits, contact Social Security about Medicare-eligibility. If eligible, contact the GIC at 617.727.2310 to request a Medicare Plan enrollment form.
If you have been a state employee and have never contributed to Social Security
You may still be eligible for Medicare benefits through your spouse. When you turn age 65, visit Social Security’s website or call Social Security to apply to see if you are eligible.
Medicare Part B cost
The premium is set by the Centers for Medicare and Medicaid Services (CMS). Contact Medicare (1.800.633.4227) for your premium cost.
How to pay for Medicare Part B
The federal government will usually deduct the Medicare Part B premium from your monthly Social Security, or will bill you quarterly for the Medicare Part B premium.
When your GIC Medicare Plan goes into effect
The GIC determines the Medicare Plan effective date based on receipt of completed forms. The effective date of a GIC Medicare Advantage Plan (Tufts Medicare Preferred) is determined by the Centers for Medicare and Medicaid (CMS). Once you are enrolled, you will receive an ID card from your Medicare health plan.
What happens to your spouse's coverage if you enroll in a GIC Medicare supplemental plan
Your spouse will continue to be covered under in a GIC non-Medicare plan if he/she is under age 65 until he or she becomes eligible for Medicare. See the Benefit Decision Guide for under and over age 65 health insurance products. If your spouse is over age 65, he/she must enroll in the same Medicare supplemental plan that you have joined.
What you need to do at age 65 if your spouse or yourself was not eligible for Medicare Part A for free, but now, you and your spouse have subsequently become eligible for Medicare Part A for free
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 Medicare’s rules allow you to buy Part B at age 65, even if you are not eligible for free Medicare Part A. 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. Under Medicare’s rules, failure to apply for Part B when you become eligible may mean a penalty for late enrollment. Contact Social Security for details.
You may want to purchase Medicare Part B if you are retired and are not eligible for Medicare Part A for free, but are eligible for Medicare Part B. The GIC does not require you to enroll in Medicare Part B if you are not eligible for premium free Medicare Part A. However, if you may be eligible for Medicare Part A 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 details.
What to do if you are retired with GIC health insurance but are working elsewhere
Because you have health insurance through the GIC as a retiree, you will must apply for Medicare.
Which ID card you should present to a doctor’s office or hospital if you are an active state employee age 65 or over and have a Medicare card with Part A only
When receiving services at a hospital or doctor, present your GIC health plan card (not your Medicare card) to ensure that your GIC health 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 if he/she asks for your Medicare card.
What to do when Medicare says they are not your primary carrier yet you are retired, age 65 or over and have a Medicare supplemental plan through the GIC
You must call Medicare at 1.800.633.4227 to correct the coordination of benefits.
When to change GIC Medicare plans
You may only change your GIC Medicare plan during the GIC’s spring annual enrollment period or if you are enrolled in Tufts Medicare.
How to change Medicare plans if you move out of Tufts Medicare service area
Complete and return to the GIC a GIC Retiree/Survivor Enrollment/Change Form. Changes can also be made at a GIC health fair.
If you are currently in a Medicare Advantage HMO plan—Tufts Medicare Preferred—, you must dis-enroll from the plan by also sending to the GIC a completed Medicare Advantage/EGWP Plan dis-enrollment form. The plan will notify you and the GIC of the effective date of the dis-enrollment.
How to calculate your monthly premium rates
Using the rate section of our website, add the following:
1. For an insured and spouse on Medicare
- Find the premium for the Medicare plan in which you are enrolling and multiply the rate by 2 for your monthly rate.
2. For insured 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.
If you are insured with GIC health coverage and age 65 or over, you should not enroll in Medicare Part D
For most GIC Medicare enrollees, the drug coverage you currently have through your GIC health plan is a better value than a basic Medicare Part D drug plan.
- All GIC Medicare plans automatically include Medicare Part D coverage through CVS SilverScript. Do not enroll in a non-GIC Medicare Part D plan. If you enroll in another Medicare Part D drug plan, the Centers for Medicare & Medicaid Services will automatically dis-enroll you from your GIC health plan, which means you will lose your GIC health, behavioral health, and prescription drug benefits.
- If you have extremely limited income and assets, you may be eligible for prescription drug subsidies through the Extra Help program. Contact Medicare at 1-800-MEDICARE (1-800-633-4227) or Social Security (1-800-772-1213) for more information.
- If your adjusted gross income, as reported on your federal tax return, exceeds a certain amount, Social Security will impose a monthly additional fee called IRMAA (Income-Related Monthly Adjustment Amount). Visit Medicare's website for more information. Social Security will notify you if IRMAA applies to you.
How to avoid paying a late enrollment penalty for Medicare Part D
The Medicare Part D Late Enrollment Penalty (LEP) is the amount that Medicare requires a person to pay if he/she:
• Did not enroll in a Medicare prescription drug plan when first eligible for Medicare; or
• Did not have creditable prescription drug coverage – coverage at least as good as Medicare’s standard plan; or
• Had a break in coverage of more than 63 consecutive days.
Note that if you decide to enroll in a non-GIC Medicare Part D plan that cancels your GIC coverage, you may be responsible for the Medicare Part D late enrollment penalty if you later wish to re-enroll in GIC Part D coverage.
The GIC’s retiree prescription drug coverage meets or exceeds the Medicare Part D coverage standard and is therefore considered creditable coverage. See your health plan handbook on your plan’s or the GIC’s website for a Creditable Coverage notice.
What to do if you are a surviving spouse of a Commonwealth or participating municipality employee/retiree enrolled in a GIC health plan and are turning age 65
When you are age 65, visit your local Social Security Administration Office to see if you are eligible for Medicare Part A for free. If you are eligible, you must enroll in Medicare Part B and enroll in a Medicare Plan sponsored by the GIC. The GIC will contact you about your options.