When you reach age 65, you may be eligible for Medicare through your work history, or the work history of a spouse (current, former, or deceased). You may also become eligible at an earlier age if you qualify for Social Security disability benefits. To enroll or get more information about Medicare, visit www.medicare.gov, or call 1.800.633.4227.
Retired Tier I and Tier II members may be eligible for SDCERA’s Medicare Part B Reimbursement. Visit the Health Allowance/Health Insurance Reimbursement Page for more information.
General Medicare Information
Part A covers many major medical expenses, including the costs of hospitalization. Usually, you will not be charged when you enroll in Part A because you or a spouse (current, former, or deceased) paid Medicare taxes while working.
Part B covers physician office visits and most outpatient hospital services. You will pay a monthly premium for Part B. If you do not sign up for Part B when you are first eligible, you will have to pay a late enrollment penalty for as long as you have Part B.
Part D covers prescription drug benefits. If you enroll in an SDCERA-sponsored medical plan, you will receive your prescription drug benefits through the SDCERA-sponsored plan. If you enroll in a separate Medicare prescription drug plan, your current SDCERA-sponsored medical and prescription drug coverage will end for you and all covered dependents. You will not be eligible to re-enroll until the next Open Enrollment period.
SDCERA-sponsored Medicare Health Plan Types
When you are enrolled in Medicare Part A and Part B, you may still have medical expenses that are not covered; therefore, you may enroll in an additional insurance plan. SDCERA offers three types of medical plans that coordinate with Medicare for members covered by Medicare Part A and Part B:
Medicare Supplement plans allow you to keep your Medicare benefits and use any physician or facility that accepts Medicare. Medicare will pay its share of the Medicare-approved amounts for covered health care costs, and then your Medicare supplement plan pays its share. You are responsible for paying for services that are determined to be ineligible Medicare services or expenses. Certain procedures under Medicare supplement plans require preauthorization. The supplement plan SDCERA currently offers is United Healthcare Senior Supplement. This plan also offers prescription drug coverage. If you choose to enroll in this plan, you will not need to enroll in any other Medicare Part D plan.
Medicare HMO plans coordinate coverage with Medicare, and provide health care through an HMO network. In this type of plan, Medicare is primary and the HMO network is secondary. In a Medicare HMO plan, you receive services through the plan’s network of facilities and physicians and your care is coordinated by your primary medical group or primary care physician, which you select from a list provided by the plan. You may go outside the HMO network using your Medicare card to receive services from a contracted Medicare provider; however, the HMO will not cover these services and you would be responsible for all charges that Medicare does not cover. The Medicare HMO plan SDCERA currently offers is Health Net Medicare HMO. This type of plan offers prescription drug coverage. If you choose to enroll in this plan, you will not need to enroll in any other Medicare Part D plan.
Medicare Advantage plans require that your Medicare be assigned to a health plan. It is also referred to as a Medicare Assignment plan. If you enroll in this type of plan, you may not enroll in an individual or group plan offered by another carrier, and you must receive all services through the plan’s network of facilities and physicians at all times, except for emergencies or urgent care out of the plan’s service area. Your care is coordinated by your primary medical group or primary care physician, which you select from a list provided by the plan. The Medicare Advantage plans SDCERA currently offers are Health Net Seniority Plus, Kaiser Senior Advantage, and United Healthcare Group Medicare Advantage. Each of these plans offer prescription drug coverage. If you choose to enroll in any of these plans, you will not need to enroll in any other Medicare Part D plans.
Prescription Drug Coverage
SDCERA-sponsored Medical plans include a prescription drug benefit. If you enroll in a separate Medicare prescription drug plan, your current SDCERA-sponsored medical and prescription drug coverage will end for you and all covered dependents. You will not be eligible to re-enroll in the plan until the next Open Enrollment, unless you experience a qualifying life event.
Assistance with Medicare Prescription Drug Plan Costs
If you have limited income and resources, you may qualify for the Extra Help program from Medicare. The program is designed to help pay Medicare prescription drug program costs, like premiums, deductibles, and coinsurance. To see if you are eligible, or to enroll, visit www.socialsecurity.gov/extrahelp or contact Social Security at 800.772.1213.
If you have questions, please contact the SDCERA Health Plans Service Center at 866.751.0256 from 5:30 a.m. to 6:00 p.m. Pacific Time, M-F.