Medicare

The SSA has three Medicare enrollment periods:

1. Initial Enrollment Period - When you're turning 65, you have a seven-month period to sign up for Part A and/or Part B. This Initial Enrollment Period begins three months prior to the month you turn 65, and ends three months after the month you turn 65.

   The date you sign up determines the effective date your Medicare coverage starts.

   If you sign up:	Your Part A and/or Part B effective date is:
   Before the month you turn 65	The first day of your 65th birth month Or The first day of the month prior to your 65th birth month, if your birthday is on the first day of the month
   The month you turn 65	The next month after the month you sign up
   One month after you turn 65	Before December 31, 2022: Two months after the month you sign up Starting January 1, 2023: The next month after the month you sign up
   Two or three months after you turn 65	Before December 31, 2022: Three months after the month you sign up Starting January 1, 2023: The next month after the month you sign up

2. General Enrollment Period - If you're not enrolled in Medicare, you have the opportunity to sign up for Part A and/or Part B during a three-month period each year. The General Enrollment Period begins January 1 and ends March 31. Your coverage begins the month after you sign up.

3. Special Enrollment Period - If you and/or your spouse are currently working and covered by an employer group health plan from that current employer, you may be eligible to sign up for Part A and/or Part B during a Special Enrollment period. The CMS also has special enrollment periods for individuals who meet exceptional conditions created by emergency or disaster, health plan or employer error, formerly incarcerated individuals, termination of Medicaid coverage, and other exceptional conditions evaluated on a case-by-case basis. Contact the SSA for more information.

Before you turn 65, you must meet these requirements to continue your CalPERS health coverage:

1. Apply for Medicare by contacting the Social Security Administration (SSA). If you qualify for Medicare Part A at no cost because either you or your qualified spouse worked for 40 quarters in Social Security/Medicare-covered employment, you must also enroll in Medicare Part B as soon as you're first eligible.

   When you enroll in Medicare Part A and Part B two to three months prior to your 65^th birth month, CalPERS will work with the CMS to obtain your Medicare information and automatically transfer you from a CalPERS Basic (non-Medicare) health plan to a CalPERS Medicare health plan. If CalPERS is unable to obtain your Medicare information from CMS, you'll need to complete and submit the Certification of Medicare Status (PDF) form to CalPERS with copies of supporting documentation for manual processing.

2. If you're ineligible for Medicare Part A at no cost, or if you're deferring enrollment in Medicare Part B due to current working status and covered under an employer group health plan, you must complete the Ineligibility of Medicare Certification (PDF) form.

   Submit the Ineligibility of Medicare Certification form to CalPERS with copies of supporting documentation prior to your 65^th birth month to prevent cancellation of your CalPERS health coverage. You may remain in a Basic (non-Medicare) health plan if you're ineligible for Medicare.

   To view what plans are available to you, log into your myCalPERS account. Transitioning from a Basic (non-Medicare) health plan into a Medicare health plan is an opportunity to change health plans. Not all Basic (non-Medicare) health plans have a corresponding Medicare health plan available. You may request to change health plans when you provide your Medicare eligibility information. If you don't choose a Medicare health plan, CalPERS will automatically enroll you in a Medicare health plan.

For next steps, view the Transitioning to a Medicare Health Plan section below.

If CalPERS is unable to obtain your Medicare information from the CMS and can't automatically enroll you in a CalPERS Medicare health plan, you must certify your Medicare status to continue your CalPERS health coverage.

Complete and submit the Certification of Medicare Status (PDF) form with supporting documentation certifying one of the following choices:

• Enrolled in Medicare Part A and Part B (Submit a copy of your Medicare card or SSA documentation.)
• Ineligible for Medicare either in your own right and/or through the work history of a current, former, or deceased spouse (Submit SSA documentation.)
• Deferring enrollment in Medicare Part B due to your or your spouse’s employment (Submit proof of active group health insurance through current employer.)

If you don't meet these requirements, you'll receive a notice of cancellation of health coverage for yourself and all enrolled dependents the month you turn 65. Your CalPERS health coverage will automatically be canceled the first day of the month after you turn 65.

See Cancellation of CalPERS Health Coverage for information on reinstating your health coverage.

If you're ineligible for Medicare Part A at no cost, you must complete and submit the Ineligibility of Medicare Certification (PDF) form or the Certification of Medicare Status (PDF) form with the reason for your ineligibility:

• Didn't work in employment covered by Social Security/Medicare
• Don't have 40 quarters in Social Security/Medicare-covered employment
• Don't qualify through the work history of a current, former, or deceased spouse

You must include supporting documentation such as a copy of the Social Security statement or letter from the SSA indicating that you're not eligible for Medicare based on your work record and/or the work history of a current, former, or deceased spouse.

You may remain in a CalPERS Basic (non-Medicare) health plan until you later become eligible for Medicare Part A at no cost. If you later become eligible for Medicare Part A at no cost, you'll no longer be eligible to remain in a Basic (non-Medicare) health plan. To continue CalPERS health coverage, enroll in Medicare Part A and Part B, provide documentation of enrollment to CalPERS, and transition to a CalPERS Medicare health plan.

If you're deferring enrollment in Medicare Part B, you must complete and submit the Ineligibility of Medicare Certification (PDF) form or the Certification of Medicare Status (PDF) form indicating the reason for deferral:

• You're still working and have active employer group health coverage.
• Your spouse is still working and you're covered under their active employer group health coverage.

You must provide supporting documentation showing proof of enrollment in an active employer group health plan through the current employer.

Once this information is received, you may remain in a CalPERS Basic (non-Medicare) health plan until retirement or until you lose your active coverage in the employer group health plan. If you later retire or lose your employer group health coverage through active employment, you'll no longer be eligible to remain in a CalPERS Basic (non-Medicare) health plan. To continue CalPERS health coverage, enroll in Medicare Part A and Part B, provide documentation of enrollment to CalPERS, and transition to a CalPERS Medicare health plan. The SSA will allow you to enroll in Medicare Part B without a late-enrollment penalty if you're eligible to enroll during a Special Enrollment period.

If your CalPERS Basic (non-Medicare) health plan coverage is canceled because you didn't provide supporting documentation to meet the requirements to continue your CalPERS health coverage after age 65, you can request reinstatement of your health coverage within 90 days of your cancellation. In your request for reinstatement, you must provide supporting documentation from the SSA.

You may also request re-enrollment through an administrative review process after 90 days of the date the coverage is canceled.

Submit your request for reinstatement of health coverage to:

CalPERS Health Account Management Division
Attention: Medicare Administration
P.O. Box 942715
Sacramento, CA 94229-2715

If your coverage isn't reinstated, you may re-enroll during the annual Open Enrollment period by providing a completed Certification of Medicare Status (PDF) form along with the required documentation.

State and California State University (CSU) retirees and their dependents enrolled in a CalPERS Medicare health plan may be eligible for a reimbursement of all or part of their Medicare Part B premium (some exceptions apply based on Bargaining Unit and first hire date).

Pursuant to the Public Employees’ Medical and Hospital Care Act (PEMHCA) section 22879, the following bargaining units with a first state hired date aren't eligible for Part B premium reimbursement:

If you or your dependents are eligible for Medicare Part B reimbursement, we’ll automatically reimburse the eligible amount of the standard Medicare Part B premium, beginning the date of your enrollment into a CalPERS Medicare Health Plan. Your reimbursement will be listed on your warrant as “Medicare Reimbursement.”

If you receive SSA benefits, the Part B premium will be deducted from your SSA benefits; otherwise, the SSA will bill you quarterly.

Each year, the Centers for Medicare and Medicaid Services (CMS) announces the Medicare Part B premium amount. CalPERS sets the standard Medicare Part B premium reimbursement amount on January 1 based on the amount determined by the CMS. According to the CMS, most Medicare beneficiaries will pay the standard Medicare Part B premium amount.

• If you’re enrolled in a CalPERS Medicare health plan, you must pay for and maintain enrollment in Medicare Part B to remain enrolled in the CalPERS health program.
• If the SSA disenrolls you from Part B for not paying the Part B premium, your enrollment in the CalPERS Medicare health plan will be cancelled.
  • To enroll in Part B, you may have to wait until the SSA’s next enrollment period, which may delay your reinstatement in a CalPERS Medicare health plan. The SSA will determine your Part B effective date.
  • In the meantime, you may not be enrolled in a CalPERS Basic health plan.
• If you’re no longer paying a Part B premium to the SSA, contact us immediately to stop the Part B reimbursement.
• If you receive a Part B reimbursement from CalPERS for coverage periods that you didn’t pay Part B premiums to the SSA, you’ll be required to reimburse us.

When you turn 65, you're eligible to enroll in Medicare Part B. If you don't enroll in Part B when you're first eligible, you may be subject to the federal late enrollment penalty. The late enrollment penalty is added to your monthly Part B premium for as long as you have Part B. You may also be subject to the late enrollment penalty if you voluntarily terminate your enrollment from Part B and enroll in Part B at a later date.

State & CSU

If your Modified Adjusted Gross Income (MAGI) as reported on your IRS tax return is above the set threshold established by the CMS, you’ll pay the standard Medicare Part B premium amount plus an additional Income-Related Monthly Adjustment Amount (IRMAA). If you’re required to pay an IRMAA, you’ll receive a notice from the Social Security Administration (SSA) advising you of your Medicare Part B premium cost for the following calendar year, and how the cost is calculated.

Each fall, we mail letters to members currently receiving an IRMAA adjustment detailing the standard Medicare Part B premium for the following calendar year and provides instruction for requesting additional Medicare Part B reimbursement.

If you or your dependents are paying an increased Part B premium (IRMAA) due to your income level and would like to request additional Medicare Part B reimbursement, submit to us a copy of your entire SSA notice showing the IRMAA determination and increased Part B premium. Processing time for IRMAA documents is up to 60 calendar days.

If you’re no longer paying a Part B premium to the SSA, contact us immediately to stop the Part B reimbursement. If you receive a Part B reimbursement from us for coverage periods that you didn’t pay Part B premiums to the SSA, you’ll be required to reimburse us.

Public Agency

CalPERS doesn't administer reimbursement of Medicare Part B premiums for retirees of contracting public agencies. If you're retired from a contracting public agency, you may contact your former employer to ask if this benefit is provided to you.

Request reimbursement using secure upload

If you or your dependents are paying an increased Part B premium (IRMAA) due to your income level and would like to request additional Medicare Part B reimbursement, submit a copy of your entire SSA notice showing the IRMAA determination and increased Part B premiums to CalPERS.

To ensure secure and timely processing, upload your and/or your dependent’s SSA notice online by logging in to your myCalPERS account at my.calpers.ca.gov and select the Health tab, then the Health Summary option. Scroll down to the Health Deductions section and select the Submit Documents link. If you or your dependents submit documents via mail, please include the attached cover sheet of this letter and mail to the following address:

CalPERS Health Account Management Division
Attn: Medicare Administration
P.O. Box 942715
Sacramento, CA 94229-2715

Without a complete copy of your SSA notice, CalPERS may not be able to process your request and may need to request additional information from you.

If you already submitted your IRMAA letter prior to receiving this letter, it will be processed based on received date. There is no need to resubmit your IRMAA letter to CalPERS.

Processing time for IRMAA documents is up to 60 calendar days from the date of receipt and additional reimbursement will be credited retroactively to January 1 of the year documentation was submitted for. Once processed, you may view the Medicare Part B reimbursement by logging into your myCalPERS account. Your reimbursement will be listed as “Medicare Reimbursement” under Health Deductions in the Health and Health Plan Summary tabs.

If you pay an IRMAA for Part B, you may also pay an IRMAA for Part D. California law doesn't provide for reimbursement of Medicare Part D premiums.

CalPERS requires all family members to have the same health carrier. A combination plan means at least one family member is enrolled in a Medicare health plan and at least one family member is enrolled in a Basic (non-Medicare) health plan through the same health carrier.

Consider your family's needs when determining which Medicare health plan is right for you. If you or your family member become eligible for Medicare and enroll in a CalPERS Medicare health plan, all members of your family will be impacted by the Medicare member's change in health plans.

For example:

• If the Medicare member enrolls in the UHC Group Medicare Advantage (PPO) Plan, the other family members must move to the UHC Basic Plan, SignatureValue Alliance (HMO).
• If the Medicare member enrolls in another available Medicare plan, such as Kaiser Permanente Senior Advantage, the other family members will be enrolled in the Kaiser Permanente Basic Plan.

If your current health carrier doesn't offer a CalPERS-sponsored Medicare health plan, and you don't choose one when transitioning to Medicare, CalPERS will enroll you in a combination plan based on your ZIP code. Refer to the table below:

Search the UHC SignatureValue Alliance HMO Network or call (877) 359-3714 to find out if UHC accepts your or your dependent's current providers. If not, and it's a priority to keep your or your family members' current providers, you may consider enrolling in one of CalPERS PPO Plans (PERS Gold or PERS Platinum). Both the Medicare and Basic plans are PPOs, which will allow all family members to retain their current providers but may result in higher costs.

You can log in to myCalPERS and use the CalPERS Search Health Plans tool to compare the costs and benefits of different plan options.

If you're currently ineligible for Medicare Part A without cost in your own right, you may be or become eligible through a current, former, or deceased spouse's work history. If you're eligible through a spouse, you may apply when your spouse is first eligible to receive Social Security benefits, generally at age 62. Contact the Social Security Administration at (800) 325-0778 or TTY (800) 325-0778 to clarify your Medicare eligibility through a spouse.

CalPERS participates in a Medicare Part D prescription drug plan for members enrolled in a CalPERS Medicare health plan.

The standard Part D premium is paid through your CalPERS health insurance premium. If your income exceeds a federal threshold as determined by the SSA, you may be subject to an additional Income Related Monthly Adjustment Amount (IRMAA) for Part D prescription drug premiums. You'll either receive an invoice for the additional amount, or it'll be deducted from your Social Security benefits. Non-payment of the additional prescription drug premium will result in cancellation of your CalPERS health coverage.

If you enroll in a CalPERS-sponsored Medicare Advantage Plan that includes Part D prescription drug coverage in its benefit package and you are subject to an additional Medicare Part D premium, you must pay the additional Medicare Part D premium, or your health coverage will be canceled. If you re-enroll at a later date, you may incur a federal late enrollment penalty.

If you enroll in a CalPERS-sponsored Medicare Supplement Plan and a Medicare Advantage Plan that doesn't include Medicare Part D prescription drug coverage in its benefit package, you'll also be enrolled in a CalPERS-sponsored Medicare Part D prescription drug plan unless you notify the Medicare Part D prescription drug plan that you wish to opt-out of prescription drug coverage. If you decline coverage, you'll be responsible for all of your prescription drug costs. If you re-enroll at a later date, you may incur a federal late enrollment penalty.

Don't enroll in a non-CalPERS Medicare Part D plan. If you do so, CMS will disenroll you from your CalPERS-sponsored Medicare Advantage Plan or Medicare Part D prescription drug plan resulting in cancellation of your CalPERS health coverage and you'll be responsible for your prescription drug costs.

If you're Medicare eligible and you lose your Part A and/or Part B, you'll be disenrolled from the CalPERS Medicare health plan. Your disenrollment from Part A and/or Part B may result in cancellation of your CalPERS health coverage.

CMS requires members to live in the approved plan service area and list a residential address. Post Offices Boxes are not permitted. If CalPERS is unable to verify your permanent residential address, your enrollment may be subject to cancellation, or you may be administratively enrolled in a Medicare Supplement plan to continue your CalPERS health coverage.

CMS must approve your enrollment in a Medicare Advantage plan and Medicare Part D plan. CalPERS and/or your CalPERS Medicare health plan may contact you to obtain additional information required by CMS to complete your enrollment. If you're contacted for additional information, respond immediately to protect your health coverage.

You may be enrolled in only one Medicare Advantage plan at one time, as well as one Medicare Part D plan at one time. If you're enrolled in a CalPERS Medicare health plan and later enroll in another Medicare health plan, you'll be disenrolled from the previous Medicare health plan.

CMS is requiring Medicare enrollment requests to include race and ethnicity data. This requirement is part of CMS' commitment to address health inequities in the health care system.

CalPERS is fulfilling the requirement to ask for race and ethnicity information by directing members and dependents to submit their race and ethnicity information through their Health Demographic Profile either by logging into their myCalPERS account or by visiting Health Demographic Profile.

Providing race and ethnicity data is at the discretion of members and their dependent(s); CalPERS can't deny coverage if information isn't provided.

You can make changes to your health plan outside of Open Enrollment due to a qualifying event, such as adding a dependent child, registered domestic partner, or new spouse.

For more information about special enrollment opportunities, visit Retiree Plans & Rates or review the Health Program Guide (HBD 120) (PDF).