Health Plans

Overview

ACERA retired members, dependents, and survivors have the opportunity to enroll in medical, dental, and vision plan coverage. Additionally, members may be eligible for subsidies to offset the costs of these plans.

Overview

Getting & Managing Health Coverage

ACERA offers a range of health plan options to ACERA retirees, dependents, and survivors who are receiving a monthly retirement benefit from ACERA.

Overview

Medicare and ACERA

Medicare is health insurance for people 65 or older. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease). 

Some people get Medicare automatically, others have to actively sign up. Follow these steps to enroll in Medicare:

Step 1: Determine if You Are Eligible to Enroll in Medicare

Who is eligible for Medicare?

People under age 65 who are disabled

If you’re getting Social Security disability benefits, you’ll get Medicare automatically after getting disability benefits for 24 months, or at age 65, whichever is sooner. If you have ALS (also called Lou Gehrig’s disease) you’ll get Medicare automatically as soon as you start getting disability benefits. 

People age 65 and older

At age 65, you can enroll in Medicare. But you may want to wait if you’re still working when you turn 65.

 

Step 2: Understand What Medicare Is and How it Works

What are the parts of Medicare?

Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.

Part B (Medical Insurance): Helps cover:

  • Services from doctors and other health care providers
  • Outpatient care
  • Home health care
  • Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
  • Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)

Part C (Medicare Advantage): Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D. In most cases, you’ll need to use doctors who are in the plan’s network. Plans may have lower out-of-pocket costs than Original Medicare. Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.

Part D (Drug coverage): Helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.

Also, Supplemental Insurance (Medigap): Extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. Policies are standardized, and in most states named by letters, like Plan G or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it.

When do I sign up for Medicare?

People Under Age 65 Who Are Disabled

If you’re getting Social Security disability benefits, you’ll get Medicare automatically after getting disability benefits for 24 months, or at age 65, whichever is sooner. If you have ALS (also called Lou Gehrig’s disease) you’ll get Medicare automatically as soon as you start getting disability benefits. 

retired People 65 and Older (and not covered under working spouse’s insurance)

Most people who are retired (and not covered under a working spouse’s insurance) sign up for both Part A (Hospital Insurance) and Part B (Medical Insurance) when they’re first eligible (usually when they turn 65). When you turn 65, you have a 7-month enrollment:

7-Month Medicare Enrollment Period
3 months before 65th birthday month 65th birthday month 3 months after 65th birthday month
Coverage effective 1st day of birthday month Coverage effective 1st day of month after birthday month Coverage effective 1st day of the month after enrollment

Enrollment Period if You Miss the Initial 7-Month Period: January – March of each year. Coverage becomes effective the 1st day of the month after you sign up.

Medicare Part B Late Enrollment Penalty: If you are not still working and you do not enroll in Medicare during this period and sign up later, you will have to pay a lifetime 10% penalty for each 12-month period you did not enroll in Medicare Part B after you were eligible.

Learn more about other special situations (special enrollment periods).

People 65 and Older Still Working or retired and covered under working spouse’s insurance

If you (or your spouse) are still working at a job that has 20 or more employees and have health insurance from that job, you can wait until you (or your spouse) stop working (or lose your health insurance, if that happens first) to sign up for Part B (Medical Insurance), and you won’t pay a late enrollment penalty.

If you don’t have to pay a premium for Part A (Hospital Insurance), you can choose to sign up when you turn 65 (or anytime later). Your job-based insurance pays first, and Medicare pays second.

Learn more about other situations.

What does Medicare cost?

See Current Medicare Costs

Part A (Hospital Insurance)

$0 for most people because they paid Medicare taxes long enough while working—generally at least 10 years. You get “Premium-Free Part A” if you:

  • Qualify to get (or are already getting) retirement or disability benefits from Social Security (or the Railroad Retirement Board).
  • Get Medicare earlier than age 65.

If you’re not sure, you can log into (or create) your secure my Social Security account to find out if you paid Medicare taxes long enough. 

Part B (Medical Insurance)

You’ll pay a monthly premium to Medicare for Part B. The amount can change each year. Some people pay higher premiums because they have higher incomes.

Usually, the Part B premium is deducted from your monthly benefits from Social Security. If you don’t get Social Security benefits or if your monthly benefit is too low, you’ll get a bill from Medicare to pay your Part B premium.

Part C (Medicare Advantage Plan)

Varies by plan. If you choose a Medicare Advantage Plan like the Kaiser Permanente Senior Advantage Plan, you’ll usually pay an additional premium to the insurance carrier on top of the premiums you pay directly to Medicare.

Part D (Drug Coverage)

Varies by plan. You pay the premium directly to the insurance carrier.

What is the difference between Original Medicare and Medicare Advantage (Part C)?

There are 2 main ways to get your Medicare coverage:

1. Original Medicare 2. Medicare Advantage Plan (Part C)
  • You pay for services as you get them. When you get a covered service, Medicare pays part of the cost and you pay your share.
  • You can see any doctor or hospital that takes Medicare, anywhere in the U.S.
  • You join a Medicare-approved plan from a private company (like the Kaiser Permanente Senior Advantage Plan) that offers an alternative to Original Medicare for your health and drug coverage.
  • In many cases, you can only use doctors who are in the plan’s network.
  • You must enroll in both Part A and Part B to join a Medicare Advantage Plan.

Includes:

  • Part A (Hospital Insurance)
  • Part B (Medical Insurance)

Includes:

  • Part A (Hospital Insurance)
  • Part B (Medical Insurance)

You can add:

  • Medicare drug coverage (Part D)
  • Supplemental coverage (Medigap) to help pay your share of costs: Medicare Supplement Insurance (Medigap), coverage from a former employer or union, or Medicaid.
  • Learn more about adding coverage.

Most plans include:

  • Medicare drug coverage (Part D)
  • Some extra benefits (that Original Medicare doesn’t cover, like certain vision, hearing, and dental services)

More comparisons at Medicare.gov

 

Step 3: Preview Your Coverage Options

You can stick with Original Medicare, but you will probably want to consider seeking a higher level of coverage by either adding a Part D Plan and a Medigap Supplemental Plan to Original Medicare, or selecting a Medicare Advantage Plan. ACERA has plan options for both.

Your ACERA plan options depend on where you live in the U.S.

Where You Live Your ACERA Plan Options

In the Kaiser Permanente Senior Advantage Plan (CA) service area (based on zip code):

  • Bay Area
  • Southern California
  • Sacramento
  • Fresno
  • Santa Cruz
  • Kaiser Permanente Senior Advantage Plan (group Medicare Advantage plan)
  • Individual Medicare Advantage plan through Via Benefits
  • Individual Medigap plan through Via Benefits
     

In the Kaiser Permanente service areas (based on zip code) outside of California including:

  • Washington
  • Oregon
  • Hawaii
  • Georgia
  • Washington D.C. ares
  • Kaiser Permanente individual plan
  • Individual Medicare Advantage plan through Via Benefits
  • Individual Medigap plan through Via Benefits
Anywhere in the U.S. not in a Kaiser Permanente Service area
  • Individual Medicare Advantage plan through Via Benefits
  • Individual Medigap plan through Via Benefits

Kaiser Permanente Senior Advantage Plan

The Kaiser Permanente Senior Advantage Plan is a group Medicare Advantage Plan option for ACERA retirees living in metro California in the service areas above. You’ll pay a monthly premium to Kaiser Permanente that ACERA will deduct from your retirement check and send to Kaiser. Premiums are listed below. 

Benefits
2024 Kaiser Permanente Senior Advantage Plan Monthly Premiums
Plan Self Premium

Self + 1

2 w/ Medicare

Self + 1

1 w/ Medicare

Family

2 w/ Medicare

Family

1 w/ Medicare

Kaiser Permanente HMO $354.31 $708.62 $1392.07 $1570.00 $2253.45

 

Via Benefits Individual Medigap and Medicare Advantage Options

ACERA contracts with Via Benefits, a private health insurance exchange, to provide you access to 1000+ healthcare plans across 80+ insurance carriers. You’ll typically pay a monthly premium for these plan in addition to what you pay to Medicare, but not always.

  • You must enroll in both Medicare Parts A & B
  • Prescription drug coverage
    • If you enroll in a Medicare Advantage plan, prescription drug coverage wil come with the plan, so you don’t need to enroll in a separate plan. 
    • If you enroll in a Medigap plan, you’ll need to enroll in a separate Part D plan for prescription coverage. Via Benefits will help you choose a Part D plan.
  • Plans are nationwide in the U.S. There are no plans outside of the U.S., but most plans will provide emergency coverage while you travel.
  • Enrollment is done via phone 1-(888) 427-8730 or online.
  • A licensed benefits advisor will go over plans available in your area
    • You tell them how much coverage you’re looking for, how much you want to pay, what doctors you want to visit, and/or what prescriptions you need.
  • If you’re eligible for the Monthly Medical Allowance, reimbursement is available for retiree’s out of pocket medical expenses e.g., Medical & prescription drug plan premiums, prescription co-pays and deductibles and medical necessary costs
  • Auto-pay and direct deposit are available
  • Online health reimbursement account tracking and status updates

Explore Via Benefits Plan Options

 

Step 4: Sign up for Medicare Parts A & B when you’re ready

When do I sign up for Medicare?

People Under Age 65 Who Are Disabled

If you’re getting Social Security disability benefits, you’ll get Medicare automatically after getting disability benefits for 24 months, or at age 65, whichever is sooner. If you have ALS (also called Lou Gehrig’s disease) you’ll get Medicare automatically as soon as you start getting disability benefits. 

retired People 65 and Older (and not covered under working spouse’s insurance)

Most people who are retired (and not covered under a working spouse’s insurance) sign up for both Part A (Hospital Insurance) and Part B (Medical Insurance) when they’re first eligible (usually when they turn 65). When you turn 65, you have a 7-month enrollment:

7-Month Medicare Enrollment Period
3 months before 65th birthday month 65th birthday month 3 months after 65th birthday month
Coverage effective 1st day of birthday month Coverage effective 1st day of month after birthday month Coverage effective 1st day of the month after enrollment

Enrollment Period if You Miss the Initial 7-Month Period: January – March of each year. Coverage becomes effective the 1st day of the month after you sign up.

Medicare Part B Late Enrollment Penalty: If you are not still working and you do not enroll in Medicare during this period and sign up later, you will have to pay a lifetime 10% penalty for each 12-month period you did not enroll in Medicare Part B after you were eligible.

Learn more about other special situations (special enrollment periods).

People 65 and Older Still Working or retired and covered under working spouse’s insurance

If you (or your spouse) are still working at a job that has 20 or more employees and have health insurance from that job, you can wait until you (or your spouse) stop working (or lose your health insurance, if that happens first) to sign up for Part B (Medical Insurance), and you won’t pay a late enrollment penalty.

If you don’t have to pay a premium for Part A (Hospital Insurance), you can choose to sign up when you turn 65 (or anytime later). Your job-based insurance pays first, and Medicare pays second.

Learn more about other situations.

How do I sign up for Medicare?

Follow the instructions at Medicare.gov by answering the questions where it says “Answer a few questions to find out.”

sign up for MedicarE Now

 

When will my Medicare coverage start?

Enrollment Time Coverage Effective
3 months before 65th birthday month 1st day of birthday month
65th birthday month 1st day of month after birthday month
3 months after 65th birthday month 1st day of the month after enrollment
Between January 1-March 31 each year (after initial enrollment period) 1st day of the month after you sign up
Special situations See the chart at Medicare.gov

 

 

Step 5: Enroll in Your ACERA Medicare Plan

How do I enroll in the Kaiser Permanente Senior Advantage Plan?

After you enroll in Medicare, complete the appropriate forms below. Avoid paper, ink, scanning, and hassle with DocuSign E-Forms. PDF forms require Adobe Acrobat Reader (free). 

Form DocuSign E-Form Manual PDF Form Notes

Medical Plan Enrollment Form

DocuSign PDF Mandatory. If you’d like to enroll in the ACERA Kaiser Permanente Senior Advantage Plan
Kaiser Permanente Senior Advantage Enrollment Form DocuSign PDF Mandatory. If you’re enrolling in the Kaiser Permanente Senior Advantage Plan, you must fill this out in addition to the Medical Plan Enrollment Form.
Medicare Part B Reimbursement Plan (MBRP) Application Form DocuSign PDF

Recommended. With 10+ years of ACERA service credit or a service-connected disability retirement, get reimbursed for the federal cost of Medicare Part B. More info on the MBRP page.

Before you start, have a scan or photo of your Medicare card available showing your Medicare Part B effective date to upload with the form.

Affidavit of Dependent Eligibility DocuSign PDF Optional. Mandatory if you are electing coverage for your children (or other non-spouse dependents) age 19 through 25 or children age 26 and older if incapable of supporting themselves due to a mental or physical disability incurred prior to age 26
Affidavit of Domestic Partnership   PDF Optional. Mandatory if you are electing healthcare coverage for a domestic partner. Since this requires notarization, you can’t submit it through DocuSign. Follow the instructions below to submit your form.

How do I enroll in a Via Benefits Individual Plan?

Sign Up For Via Benefits Online

Or call 1-888-427-8730

Helpful Hints To Make Your Via Benefits Experience Efficient
  • Before you call Via Benefits for your enrollment appointment, have a list of all of your prescription medications in front of you so the Benefit Advisor you speak with can help you choose a Medicare Part D plan and inform you about the copay required for each medication.
  • When you call Via Benefits for your enrollment appointment, to help you choose between Via Benefits plans, ask these questions and any others you have:
    • What’s the monthly premium cost for the plan?
    • What extras does the plan cover above the standard?
    • What does the Via Benefits Benefit Advisor recommend?
  • You are not obligated to choose a plan during the first call. In fact, once the Benefit Advisor narrows down the plan choices for you, you may ask them to mail you documentation on a small group of plans. You may want to ask your doctor some questions about these plans:
    • Does my doctor accept the plan?
    • What does my doctor recommend?
  • After you sign up for a plan, you will receive a packet about your plan in the mail. Look over the plan documents within the 30-day grace period after your enrollment date to make sure the plan has the benefits you believe you signed up for. If the plan is different than you believe you signed up for, you may call Via Benefits again during the grace period to enroll in the correct plan.

When will my ACERA Medicare plan coverage start?

[Info coming soon]

 

Step 6: Use Your Medicare Plan

What’s my Medicare card?

What’s my Medicare card?

How do I get services?

How to get Medicare services

What are some tips for using Medicare?

5 tips for using Medicare

What helpful tools are available?

Helpful tools