Who Can Enroll in Healthcare Plans?
You
ACERA retirees and anyone who receives an ACERA monthly allowance can enroll in a plan, as long as the live in the plan’s service area. See below.
For the medical plans, members who are under age 65 and not yet eligible for Medicare can enroll in a non-Medicare medical plan. Members who are age 65 an older must enroll in Medicare Part B through the federal government and select an ACERA Medicare Plan to enroll in medical coverage through ACERA.
Your Dependents
If you are enrolled in an ACERA-sponsored health plan, you can choose to cover your eligible dependents. Your eligible dependents include:
- Your legal spouse or domestic partner (more info below)
- Your or your domestic partner’s children under age 26 (more info below)
- Your or your domestic partner’s child(ren) over age 26 who are incapable of supporting themselves due to a mental or physical handicap incurred prior to age 26 (must provide proof of child’s incapacity prior to age 26)
Children Under Age 26
Your or your domestic partner’s children under age 26 (married or unmarried), include your:
- Biological children
- Adopted children, from the date of placement
- Stepchildren
- Dependents under a legal guardianship/conservatorship
- Dependents for whom plan coverage has been court-ordered through a Qualified Medical Child Support Order (QMCSO) or through a National Medical Child Support Notice (NMCSN)
Domestic Partners
Domestic partners of ACERA retirees are eligible to be enrolled in ACERA healthcare plans including medical, dental, and vision. Prior to enrollment, the retiree must complete and have on file with us an Affidavit of Domestic Partnership.
Definition of a Domestic Partnership for ACERA Healthcare Enrollment
A “domestic partnership” can exist between two persons, one of whom is a retired member of ACERA, regardless of their gender. Each of the two persons is considered the “domestic partner” of the other if they both complete, sign, date, and file with ACERA an Affidavit of Domestic Partnership where they attest to the following:
- The two parties reside together and share the common necessities of life;
- The two parties are not married to anyone; eighteen years or older; not related by blood closer than would bar marriage in the State of California; mentally competent to consent to contract;
- The two parties declare that they are each other’s sole domestic partner and they are responsible for their common welfare;
- The two parties agree to notify ACERA if there is a change of circumstances attested to in the Affidavit;
- The two parties affirm, under penalty of perjury, that the assertions in the Affidavit are true to the best of their knowledge.
Terminating a Domestic Partnership With ACERA
A member of a Domestic Partnership may end the relationship as it concerns eligibility for enrollment in ACERA healthcare plans by filing a with ACERA, affirming under penalty of perjury that:
- The partnership is terminated, and
- A copy of the termination statement has been mailed to the other partner.
Filing a New Statement of Domestic Partnership After Terminating One
No person who has filed an Affidavit of Domestic Partnership may file another such Affidavit until six (6) months after a Termination of Domestic Partnership Form of the previous partnership has been on file with ACERA.
Plan Service Areas: Your Eligibility Is Based on Where You Live
Enrollment in an ACERA healthcare plan requires you to live in the plan service area. The general plan services areas are listed in the table below. However, before selecting a plan, be sure to contact the plan provider to confirm whether your zip code is within the plan service area.
ACERA Group Plan Service Areas
Healthcare Plan |
Service Area |
---|---|
|
Metro areas of California including:
|
|
US nationwide |
Individual Plan Service Areas
Service areas for individual plans differ for every plan. Enrollment in these plans is directly with the individual carrier. Refer to the Retiree Enrollment Guide for enrollment instructions.
Healthcare Plan | Service Areas Depend on Each Individual Plan |
---|---|
|
See further eligibility information below. |
|
US nationwide |
|
Kaiser Permanente sites outside California |
Are You Eligible to Enroll in a Via Benefits Non-Medicare Plan?
You can participate if you meet all three criteria:
- You’re an ACERA retiree, spouse, or surviving beneficiary receiving a monthly retirement allowance
- You’re not eligible for Medicare (generally this means you’re under age 65)
- You live outside of California or in parts of non-metro California outside the service areas for our group medical plans. More specifically, you do not live in one of the zip codes in this PDF list:
Your Retirement Allowance Must Be Greater Than the Plan Premium to Enroll in Group Plans
The monthly retirement allowance you receive from ACERA must be large enough to cover the premium costs for the group plan benefits you wish to elect or you cannot newly enroll in our group plans. This includes your dependents; if your allowance is only sufficient for you to enroll yourself and not your dependents, you cannot enroll your dependents.
Can I Enroll in a Via Benefits Individual Medical Plan if My Pension Allowance is Less Than the Plan Premium?
Yes. The amount of your pension allowance will not impact the ability to obtain coverage. You will pay premiums directly to the carrier and if you are eligible for a Monthly Medical Allowance subsidy, you will be reimbursed through a Health Reimbursement Account.
What Happens if I’m Already Enrolled in a Group Plan, and the Premium Increases to Be More Than My Pension Allowance?
You may continue coverage. However, at the time your premium exceeds your income, you are required to submit payment for the entire premium cost each month to ACERA. Contact us for more information.
Healthcare Plan Options
ACERA offers a range of healthcare plan options to ACERA retirees, dependents, and survivors who are receiving a monthly pension benefit from ACERA. Members can enroll family members in coverage. Members who qualify can receive subsidies to offset health plan costs (though not for family members). The plans available, their coverage levels and costs, are subject to change from year-to-year. A summary list of plans and costs is below. Find the full plan details in the Retiree Enrollment Guide.
Medical Plans
2025 Non-Medicare Plans and Costs
Available to members who are under age 65 and not yet eligible for Medicare. If you are 65 an older, you must enroll in Medicare Part B and select a Medicare Plan in the next section to enroll in medical coverage through ACERA.
Plan | Self Premium | Self + 1 | Family | Co-pays |
---|---|---|---|---|
Kaiser Permanente HMO | $1,097.88 | $2,195.76 | $3,107.04 | $15 |
UnitedHealthcare SignatureValue HMO | $1,594.36 | $3,189.80 | $4,514.06 | $15 |
UnitedHealthcare SignatureValue Advantage HMO | $1,042.48 | $2,085.04 | $2,950.20 | $15 |
Via Benefits individual plan if you live outside group plan service areas | Varies | Varies | Varies | Varies |
2025 Medicare Plans and Costs
Available to members who are eligible for Medicare (generally those over age 65 or with certain qualifying medical conditions). If you are age 65 or older, you must enroll in Medicare Part B and select one of these plans to enroll in medical coverage through ACERA. Learn more about Medicare and ACERA’s medical plans on our Medicare page.
Plan | Self Premium |
Self + 1 2 w/ Medicare |
Self + 1 1 w/ Medicare |
Family 2 w/ Medicare |
Family 1 w/ Medicare |
---|---|---|---|---|---|
Kaiser Permanente Senior Advantage Plan | $375.22 | $750.44 | $1,473.10 | $1,661.72 | $2,384.38 |
Via Benefits individual plan if you live outside group plan service areas | Varies | Varies | Varies | Varies | Varies |
To enroll in an ACERA-sponsored Medicare plan, you must first sign up for and maintain enrollment in Medicare Part B. Members who qualify can receive a Medicare Part B Reimbursement to offset the cost of being enrolled in Medicare Part B. See the Medicare and ACERA page for more information on how ACERA plans work with Medicare.
Dental and Vision Plans
ACERA’s dental and vision plans provide participants with access to coverage through a nationwide network of providers. Monthly premiums are subsidized and enrollment is mandatory for retirees who have:
- 10+ years of ACERA service credit
- Service-connected disability
- Non-service-connected disability retirement prior to 2/1/2014
Retired members with less than 10 years of ACERA service credit and other payees may enroll in a voluntary plan which offers the same coverage, but no subsidy is available.
Reciprocal Service Doesn’t Count Toward the Service Credit Requirement for the Dental and Vision Subsidy
When planning your retirement, it’s important to understand that reciprocal service credit does not count toward the service credit required to be eligible for the dental and vision subsidies or any of the healthcare benefits. Reciprocal service credit is service credit you earned working for another public agency in California before or after your active membership with ACERA, and where you’ve linked the retirement systems together by establishing reciprocity. Service credit you earned in another retirement system could possibly be used to establish healthcare benefits with that system; contact that other retirement system to learn about what healthcare benefits they offer.
2025 Dental Plans and Costs
- DeltaCare USA HMO Plan Summary
- Delta Dental PPO Plan Summary
- Delta Dental Dual Coverage Flyer
- How to Get a Pre-Estimate for the Cost of a Dental Procedure
10+ Years ACERA Service Credit or 2 & 3 Above
Mandatory Enrollment
Plan | Self Premium / Subsidy | Self + 1 | Family |
---|---|---|---|
Delta Dental PPO (Nationwide) |
$51.05 Subsidy |
$99.02 |
$174.43 |
DeltaCare USA (CA Only) |
$22.18 Subsidy |
$36.64 | $54.13 |
Less Than 10 Years ACERA Service Credit
Voluntary Enrollment
Plan | Self Premium | Self + 1 | Family |
---|---|---|---|
Delta Dental PPO (Nationwide) |
$74.60 |
$121.82 |
$195.94 |
DeltaCare USA (CA Only) | $31.05 | $45.51 | $63.00 |
2025 Vision Plans and Costs
10+ Years ACERA Service Credit or 2 & 3 Above
Enrollment is mandatory for the VSP Standard plan at minimum. Members can buy up into the VSP Premium plan, but the subsidy will remain at $4.63, so premium plan enrollees pay the difference between their premium and the subsidy.
Plan | Self Premium | Self + 1 | Family |
---|---|---|---|
VSP Standard |
$4.63 Subsidy |
$6.73 |
$12.08 |
VSP Premium |
$16.63 |
$24.15 |
$43.36 |
Less Than 10 Years ACERA Service Credit
Voluntary Enrollment
Plan | Self Premium | Self + 1 | Family |
---|---|---|---|
VSP Standard |
$6.69 |
$9.70 |
$17.42 |
VSP Premium |
$18.43 |
$26.77 |
$48.07 |
When Can You Enroll in or Change Health Plans?
Times when you can enroll in or make changes to your medical, dental, and vision coverage elections fall into 3 categories:
1. Enrolling at Retirement
At retirement, you may choose to continue your medical plan coverage through an ACERA-sponsored plan. You can cover yourself and your eligible dependents, if they were covered under a medical plan prior to your retirement date. You must make this election within 30 days of your retirement date. If you decline coverage, you cannot enroll in an ACERA-Sponsored plan until open enrollment. Enrollment forms for medical, dental, and vision coverage are included in your retirement application package.
A retirement specialist will review your options with you prior to retirement during your ready-to-retire counseling session. If you’re not going to attend a counseling session, you can call ACERA and ask for the healthcare unit for help with enrollment.
2. Enrolling During Open Enrollment
Open Enrollment is your annual opportunity to consider your benefit needs and options and to make changes, if needed. You can change plans and add or drop coverage for you and/or your eligible dependents.
Open Enrollment Periods and Plan Years
Healthcare Plans | Open Enrollment Period | Plan Year |
---|---|---|
|
Nov 1 – Nov 30 | The following Feb 1 – Jan 31 |
|
Nov 1 – Dec 15 | The following Jan 1 – Dec 31 |
|
Oct 15 – Dec 7 | The following Jan 1 – Dec 31 |
3. Enrolling or Making Plan Changes Outside of Open Enrollment
In general, you cannot change your benefit elections or add dependent coverage outside of ACERA’s annual open enrollment period, unless you experience a status change event or special enrollment event.
Status Change Events (Qualifying Events)
- Marriage or divorce, or commencement or termination of a domestic partnership (Affidavit of Domestic Partnership required)
- Birth or adoption of a child
- Death of a dependent
- Loss of a child’s eligibility for dependent coverage (e.g., child marries or reaches the maximum age for coverage)
- Need to cover a child due to a Qualified Medical Child Support Order (QMCSO)
- Change in retiree/spouse/dependent’s employment status, work schedule, or residence that affects their eligibility for benefits (e.g., moving your residence outside of your medical plan’s service area)
- Entitlement or loss of entitlement to Medicare or Medi‑Cal/Medicaid or SCHIP coverage (you have 60 days to make a change with this one)
- Certain changes in the cost of coverage, composition of coverage or curtailment of coverage of the retiree or spouse’s plan
- Changes consistent with special enrollment rights and FMLA leaves
You need to notify ACERA in writing within 30 days of a status change event. ACERA will determine if your change request is permitted. If so, changes become effective on the first day of the month following the event date.
Cancelling Coverage
You may cancel medical plan coverage at any time during the year, for any reason. Plan coverage is cancelled automatically if you or your enrolled dependents no longer meet the plan’s enrollment eligibility criteria. If coverage is cancelled, you will be allowed to continue coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA). If you cancel your medical plan coverage, you cannot re-enroll yourself or your eligible dependents in an ACERA-sponsored plan until the next open enrollment period.
Requesting Cancellation of Coverage
You need to request your coverage cancellation in writing to ACERA. Your written request should specify which plan you want to cancel and for whom you are cancelling coverage (i.e., yourself and/or your dependents). Typically, the effective date of cancellation is on the first of the month following ACERA’s receipt of your written cancellation request. However, if ACERA receives the request after its monthly payroll close date, cancellation will be effective the second month following your written notification. There is no retroactive cancellation of coverage.
How Do You Pay for Your Health Plan?
The monthly cost of being enrolled in a healthcare plan is called a “premium.” Premiums for medical, dental, and vision coverage are based on the plan and coverage level you select.
Paying Group Plan Costs
Your monthly premiums (yours and any dependents you enroll) will be deducted from your monthly retirement allowance. If you’re eligible for the Monthly Medical Allowance and dental and vision subsidies, you’ll see your subsidies added in same pension check. When you seek services or purchase prescription drugs, you will be responsible for paying copays out of pocket.
Paying Individual Plan Costs
You will make payments directly to your insurance carrier. To set up an automatic monthly payment for the plan directly to the insurance carrier from your bank account, simply call Via Benefits at 1-888-427-8730 even if you’re in a non-California Kaiser Permanente medical plan. If you are eligible for ACERA’s Monthly Medical Allowance, ACERA will fund a tax-free Health Reimbursement Account up to the amount you are eligible for. You can also set up an automatic reimbursement to your bank account.
More Info
For more information on receiving reimbursements, read the Making Your Via Benefits Reimbursements Easier Flyer.
Medical Subsidies: Monthly Medical Allowance (MMA)
The Monthly Medical Allowance (MMA) helps eligible retirees offset their monthly medical costs for enrollment in ACERA-sponsored medical plans (costs for outside plans are not covered). The MMA is a non-vested (non-guaranteed) benefit subject to available funds. Benefit levels are determined annually by the Board of Retirement.
Reciprocal Service Doesn’t Count Toward the Service Credit Requirement for the Monthly Medical Allowance
When planning your retirement, it’s important to understand that reciprocal service credit does not count toward the service credit required to be eligible for the Monthly Medical Allowance or any of the healthcare benefits. Reciprocal service credit is service credit you earned working for another public agency in California before or after your active membership with ACERA, and where you’ve linked the retirement systems together by establishing reciprocity. Service credit you earned in another retirement system could possibly be used to establish healthcare benefits with that system; contact that other retirement system to learn about what healthcare benefits they offer.
Who is Eligible?
- ACERA retirees with 10+ years ACERA service credit (receive MMA based on years of service credit)
- Service-connected disability retirees (receive full MMA)
Who is Not Eligible?
- Retirees with less than 10 years of ACERA service (except service-connected disability retirees)
- Spouses and dependents
- Non-member payees (i.e., survivors, former spouses)
ACERA retirees are responsible for 100% of the costs to cover these individuals.
Group Plans MMA
For Plans
- Kaiser Permanente HMO in California
- Kaiser Permanente Senior Advantage in California (Medicare)
- UnitedHealthcare SignatureValue HMO
- UnitedHealthcare SignatureValue Advantage HMO
MMA Will Cover
- Monthly premiums
Years of ACERA Service | Portion of MMA | 2025 MMA Amount |
---|---|---|
< 10 years | No MMA | $0 |
10+ years | 1/2 | $331.19 |
15+ years | 3/4 | $496.78 |
20+ years or service-connected disability retirement |
Full | $662.37 |
More Info
The maximum MMA amount is limited to your self-only medical premium or the highest allowable benefit under the MMA, whichever is lower. Plan premium costs exceeding the MMA contribution are deducted from your monthly retirement allowance. Premiums for your dependents are also deducted from your monthly retirement allowance.
MMA Does Not Cover
- Medicare Part B Income-Related Monthly Adjustment Amounts (IRMAA) charged by Medicare to members with higher incomes who are enrolled in the Kaiser Permanente Senior Advantage Medicare Plan. ACERA only reimburses for the cost of the IRMAA for members enrolled in individual Medicare plans through Via Benefits. However, ACERA does reimburse for the base premium for Medicare Part B is a separate benefit, the Medicare Part B Reimbursement Plan.
Individual Plans Non-Medicare MMA
For Plans
- Via Benefits Individual Non-Medicare Plans
- Kaiser Permanente Non-Medicare Plans Outside California
MMA Will Cover
- Monthly premiums
- Copays
- Deductibles
- Other out-of-pocket medical expenses listed in IRS Publication 502
Years of ACERA Service | Portion of MMA | 2025 MMA Amount |
---|---|---|
< 10 years | No MMA | $0 |
10+ years | 1/2 | $331.19 |
15+ years | 3/4 | $496.78 |
20+ years or service-connected disability retirement |
Full | $662.37 |
More Info
Your MMA can be used to pay your self-only monthly medical plan premiums as well as medical or prescription copays and deductibles (our plan excludes other IRS Code Section 213(d) reimbursement expenses). You will need to submit those claims to Via Benefits for reimbursement (including Kaiser members). ACERA will fund a tax-free Health Reimbursement Account (HRA) up to the amount you are eligible for, and Via Benefits will reimburse you for expenses out of your HRA. You set up an automatic reimbursement to your bank account.
For more information on receiving reimbursements, read the Making Your Via Benefits Reimbursements Easier Flyer.
Unused MMA amounts at the year’s end do not carry over into the new plan year, and do go back into ACERA’s reserve funds.
An Alternative to the MMA for Via Benefits Plans: A Federal Subsidy
When you call Via Benefits to explore enrolling in a non-Medicare eligible plan, your Benefit Advisor can help you choose between utilizing ACERA’s MMA to offset your medical plan costs (if you’re eligible), or selecting a public healthIndividual Plans Non-Medicare MMAcare plan and utilizing the federal government’s healthcare subsidy (tax credit) to offset the costs of your plan. The level of subsidy you could be eligible for is based on your level of income. You can’t receive both an MMA from ACERA and a federal subsidy
Individual Plans Medicare MMA
For Plans
- Via Benefits Medicare Plans
- Kaiser Permanente Senior Advantage Medicare plans outside California
MMA Will Cover
- Monthly premiums
- Copays
- Deductibles
- Other out-of-pocket medical expenses listed in IRS Publication 502
- Medicare Part B Income-Related Monthly Adjustment Amount (IRMAA) (more info below)
Years of ACERA Service | Portion of MMA | 2025 MMA Amount |
---|---|---|
< 10 years | No MMA | $0 |
10-14 years | 1/2 | $253.72 |
15-19 years | 3/4 | $380.57 |
20+ years or service-connected disability retirement |
Full | $507.43 |
More Info
The MMA Will Also Cover the Medicare Part B Income-Related Monthly Adjustment Amount (IRMAA)
If you have a higher income, you’ll pay an additional premium amount for Medicare Part B and Medicare prescription drug coverage. Medicare calls the additional amount the Income-Related Monthly Adjustment Amount or IRMAA. If you are enrolled in an individual Medicare plan through Via Benefits, you can use the Monthly Medical Allowance to get reimbursed for the IRMAA. Simply log in to your account at Via Benefits and submit a reimbursement claim to Via Benefits for the additional amount IRMAA amount that is above the $174.70 base amount for 2024.
Other Info
Monthly premiums for individual Medicare plans are lower than group plan premiums, so the MMA amounts are accordingly lower.
Your MMA can be used to pay your self-only monthly medical plan premiums as well as medical or prescription copays and deductibles (our plan excludes other IRS Code Section 213(d) reimbursement expenses). You will need to submit those claims to Via Benefits for reimbursement (including Kaiser members). ACERA will fund a tax-free Health Reimbursement Account (HRA) up to the amount you are eligible for, and Via Benefits will reimburse you for expenses out of your HRA. You set up an automatic reimbursement to your bank account.
For more information on receiving reimbursements, read the Making Your Via Benefits Medicare Reimbursements Easier flyer.
Unused MMA amounts at the year’s end do not carry over into the new plan year, and do go back into ACERA’s reserve funds.
How to Enroll in Healthcare Plans
Enrollment instructions start on page 4 of our Retiree Enrollment Guide.
Enrollment Forms
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 | Optional. If you’d like to enroll in an ACERA group medical plan | ||
Kaiser Permanente Senior Advantage Enrollment Form | DocuSign | Optional. If you’re Medicare-eligible and are enrolling in the Kaiser Permanente Senior Advantage Plan, you must fill this out in addition to the Medical Enrollment Form. | ||
Dental Plan Enrollment Form |
DocuSign |
Optional: Less than 10 years ACERA service credit Mandatory: 10+ years ACERA service credit, but there is no cost for member’s monthly premium |
||
Vision Plan Enrollment Form |
DocuSign |
Optional: Less than 10 years ACERA service credit Mandatory: 10+ years ACERA service credit, but there is no cost for member’s monthly premium |
||
Medicare Part B Reimbursement Plan (MBRP) Application Form | DocuSign |
Optional. 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 | 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 | 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. |
Cancelling Coverage
You may cancel medical plan coverage at any time during the year, for any reason. If you cancel your medical plan coverage, you cannot re-enroll yourself or your eligible dependents in an ACERA-sponsored plan until the next open enrollment period.
Requesting Cancellation of Coverage
You need to request your coverage cancellation in writing to ACERA. Your written request should specify which plan you want to cancel and for whom you are cancelling coverage (i.e., yourself and/or your dependents). Typically, the effective date of cancellation is on the first of the month following ACERA’s receipt of your written cancellation request. However, if ACERA receives the request after its monthly payroll close date, cancellation will be effective the second month following your written notification. There is no retroactive cancellation of coverage.
Plan coverage is cancelled automatically if you or your enrolled dependents no longer meet the plan’s enrollment eligibility criteria. If coverage is cancelled, you will be allowed to continue coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA).
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.
Age Differences in Your Family
Medicare is not offered as a family or dependent benefit. This means that all people who have Medicare must qualify on an individual basis. For example, a person under age 65 does not automatically receive Medicare because their spouse is 65 or older and enrolled in the Medicare program. If you or your spouse are not yet eligible for one of ACERA’s Medicare plans, you are still eligible to enroll in one of ACERA non-Medicare health plans.
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). You have a 7-month enrollment period associated with your 65th birthday:
7-Month Medicare Enrollment Period | ||
---|---|---|
3 Months Before 65th Birthday | 65th Birthday Month | 3 Months After 65th Birthday Month |
Coverage Effective 1st Day of 65th Birthday Month | Coverage Effective 1st Day of Month After 65th Birthday Month | Coverage Effective 1st Day of Month After Enrollment Month |
Required Enrollment Timing for Kaiser Permanente Senior Advantage Plan: ACERA requires signing up 2 or 3 months before your 65th birthday month to ensure your Kaiser Permanente Senior Advantage Plan enrollment is effective on the 1st day of your 65th birthday month.
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?
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.
- The additional higher premium due to having a higher income is called the Income-Related Monthly Adjustment Amount (IRMAA). If you sign up for an individual Via Benefits Medicare Medical Plan through ACERA, and you’re eligible for the Monthly Medical Allowance subsidy to offset the cost of the plan, you can you can use the Monthly Medical Allowance to get reimbursed for the IRMAA. Simply log in to your account at Via Benefits and submit a reimbursement claim to Via Benefits for the additional amount IRMAA amount that is above the $174.70 base amount for 2024.
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 B Reimbursement Available: Qualifying ACERA members can get reimbursed for the standard Medicare Part B premium through the Medicare Part B Reimbursement Plan (MBRP), which provides the reimbursement as an additional amount in the member’s monthly retirement allowance upon proof of Part B enrollment.
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) |
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Includes:
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Includes:
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You can add:
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Most plans include:
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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.
If you’re 65 or older, you must choose a Medicare plan for medical coverage through ACERA: If you’re age 65 or older and want to enroll in medical coverage through ACERA, ACERA mandates that you enroll in Medicare Part B through the federal government and choose among our Medicare plan options. You can not enroll in or maintain enrollment in a non-Medicare plan if you are age 65 or older. If you are enrolled in a non-Medicare plan and don’t enroll in a Medicare plan upon reaching aged 65, your medical coverage through ACERA will be cancelled.
Your ACERA plan options depend on where you live in the U.S.
Where You Live | Your ACERA Plan Options |
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In the Kaiser Permanente Senior Advantage Plan (CA) service area (based on zip code):
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In the Kaiser Permanente service areas (based on zip code) outside of California including:
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Anywhere in the U.S. not in a Kaiser Permanente Service area |
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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
- $10.00 co-pays for office visits, allergy treatments, hearing and vision exams, and immunizations
- Silver&Fit free gym membership program
- Much more
2025 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 |
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Kaiser Permanente HMO | $375.22 | $750.44 | $1,473.10 | $1,661.72 | $2,384.38 |
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). You have a 7-month enrollment period associated with your 65th birthday:
7-Month Medicare Enrollment Period | ||
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3 Months Before 65th Birthday | 65th Birthday Month | 3 Months After 65th Birthday Month |
Coverage Effective 1st Day of 65th Birthday Month | Coverage Effective 1st Day of Month After 65th Birthday Month | Coverage Effective 1st Day of Month After Enrollment Month |
Required Enrollment Timing for Kaiser Permanente Senior Advantage Plan: ACERA requires signing up 2 or 3 months before your 65th birthday month to ensure your Kaiser Permanente Senior Advantage Plan enrollment is effective on the 1st day of your 65th birthday month.
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.”
When will my Medicare coverage start?
Enrollment Time | Coverage Effective |
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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 | |
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Medical Plan Enrollment Form |
DocuSign | Mandatory. If you’d like to enroll in the ACERA Kaiser Permanente Senior Advantage Plan | ||
Kaiser Permanente Senior Advantage Enrollment Form | DocuSign | 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 |
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. |
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Affidavit of Dependent Eligibility | DocuSign | 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 | 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?
How do I get services?
What are some tips for using Medicare?
What helpful tools are available?
Medicare Part B Reimbursement Plan (MBRP)
ACERA reimburses members for the lowest monthly rate that Medicare charges retirees for being enrolled in Medicare Part B, which is $185.00 for 2025 (Medicare Part B Lowest Standard Premium). Medicare deducts payment for Medicare Part B from your Social Security Check. The Medicare Part B Reimbursement Plan (MBRP) is for qualified retired members only, and is provided as an additional allowance in the member’s retirement allowance payment.
The Medicare Part B Reimbursement Plan is a non-vested benefit that is reviewed by the Board of Retirement annually. This benefit is NOT available for dependents, survivors, former spouses, and beneficiaries.
How it Works
Once you enroll in Medicare Part B, Medicare will begin charging you for Medicare Part B. If you’ve already started collecting Social Security, the monthly Medicare Part B premium will be deducted from your Social Security check. If you haven’t started collecting Social Security, Medicare will bill you quarterly for the monthly premium for Medicare Part B.
If you qualify for the Medicare Part B Reimbursement Plan, you simply submit the application below one time, and ACERA will begin reimbursing you in your monthly ACERA retirement check at the lowest monthly rate listed above.
To Qualify for the MBRP, a Retiree Must:
- Have at least 10 years of ACERA service credit (reciprocal service does not count) OR a Board-approved Service-Connected Disability Retirement;
- Provide proof of enrollment in Medicare Part B and remain enrolled; and
- Enroll in the MBRP by completing the MBRP Application Form below along with a copy of your Medicare card.
Take Note
- MBRP benefits begin the month following ACERA’s receipt of your Form.
- ACERA does not pay the benefit retroactively.
- You must remain enrolled in Part B in order to continue receiving your MBRP from ACERA. You do not to enroll in an ACERA-sponsored medical plan to receive the MBRP, but you do need to be enrolled in Medicare Part B.
Your Medicare Part B Cost May Be Higher if You Have a Higher Income (IRMAA)
If you have a higher income, you’ll pay an additional premium amount for Medicare Part B and Medicare prescription drug coverage. Medicare calls the additional amount the Income-Related Monthly Adjustment Amount or IRMAA. ACERA does not provided a higher MBRP reimbursement for the IRMAA, which is the amount above the Lowest Standard Premium.
However, if you are enrolled in an individual plan through Via Benefits, you can use the Monthly Medical Allowance to get reimbursed for the IRMAA. Simply log in to your account at Via Benefits and submit a reimbursement claim to Via Benefits for the additional amount IRMAA amount that is above the $185.00 base amount for 2025.
If you are enrolled in the Kaiser Permanente Senior Advantage Medicare Plan, you cannot use Monthly Medical Allowance to get reimbursed for the IRMAA.
MBRP Application
Before you start your application, please have a scan or photo of your Medicare card available showing your Medicare Part B effective date to upload with the form.
Use the DocuSign e-form to avoid paper, ink, scanning, and hassle.
Does ACERA Pay Medicare Directly for Your Cost for Medicare Part B?
No.
As stated above, Medicare charges you for the cost of Medicare Part B, known as the monthly premium. You pay Medicare directly. If you enroll in the Medicare Part B Reimbursement Plan, ACERA will reimburse you for the lowest standard Medicare Part B premium.
Open Enrollment for 2025 Plan Year
Open Enrollment is retirees’ annual opportunity to consider their benefit needs and options and to make changes, if needed. You can change plans and add or drop coverage for you and/or your eligible dependents.
How to Enroll During Open Enrollment
Enrollment instructions start on page 4 of our Retiree Enrollment Guide.
For our group plan enrollment forms, ACERA accepts faxes of completed enrollment forms faxed to 510-268-9574. We also accept scanned copies of completed enrollment forms emailed to info@acera.org. Enrollment forms submitted by DocuSign, email, or fax must be time stamped by 11:59 pm PST on November 30, 2024. Mailed enrollment forms must be postmarked by November 30, 2024. Enrollment forms are below.
If you’re enrolling in an individual plan through Via Benefits, you must conclude your enrollment with Via Benefits by the dates specified in the chart below. You must contact Via Benefits by phone or through the Via Benefits website. Instructions for enrollment through Via Benefits can be found in the Retiree Enrollment Guide linked below.
Open Enrollment Periods and Plan Years
Healthcare Plans | Open Enrollment Period | Plan Year |
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Nov 1 – Nov 30 | The following Feb 1 – Jan 31 |
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Nov 1 – Dec 15 | The following Jan 1 – Dec 31 |
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Oct 15 – Dec 7 | The following Jan 1 – Dec 31 |
Open Enrollment 2025 Packet
All retirees and payees receive a paper packet in the mail in mid-October. Here’s the electronic packet:
Making Your Via Benefits Reimbursements Easier flyer
Getting Your Affairs In Order Flyer
Hybrid Retiree Health Fair Website
Kaiser Permanente One Pass Flyer
Delta Dental PPO Plan Description Flyer
Medicare Part D Creditable Coverage Notice (mailed separately to some enrollees)
Healthcare Plan Summary Flyers
- DeltaCare USA HMO Plan Summary
- Delta Dental PPO Plan Summary
- Delta Dental Dual Coverage Flyer
- VSP Vision Plans Summary
Group Plan Enrollment Forms
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 | |
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Medical Plan Enrollment Form |
DocuSign | Optional. If you’d like to enroll in an ACERA group medical plan | ||
Kaiser Permanente Senior Advantage Enrollment Form | DocuSign |
Optional. If you’re Medicare-eligible and are enrolling in the Kaiser Permanente Senior Advantage Plan, you must fill this out in addition to the Medical Enrollment Form. IMPORTANT IF USING DOCUSIGN: Upon receipt, ACERA will submit this form to Kaiser on your behalf. Kaiser will call you to confirm your electronic signature on this form. YOU MUST ANSWER THIS CALL. If you do not answer Kaiser’s call, you will have 7 days to return Kaiser’s Medicare Team’s call to confirm your requested enrollment. Kaiser’s Medicare Team can be reached at 877-251-1532. TAKE NOTE: If you delay in responding to Kaiser’s Medicare Team, your effective date of insurance on ACERA’s Kaiser Senior Advantage Group Plan may be impacted. |
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Dental Plan Enrollment Form |
DocuSign |
Optional: Less than 10 years ACERA service credit Mandatory: 10+ years ACERA service credit, but there is no cost for member’s monthly premium |
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Vision Plan Enrollment Form |
DocuSign |
Optional: Less than 10 years ACERA service credit Mandatory: 10+ years ACERA service credit, but there is no cost for member’s monthly premium |
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Medicare Part B Reimbursement Plan (MBRP) Application Form | DocuSign |
Optional. 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. |
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Affidavit of Dependent Eligibility | DocuSign | 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 | 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. |
Health Plan Contact Information
Insurance Carrier Contact Information
1-800-464-4000 |
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1-800-464-4000 |
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for Kaiser Permanente Senior Advantage members
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1-877-427-4788 (TTY/TDD 711) |
Call your local Kaiser |
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1-800-624-8822 |
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1-800-624-8822 |
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1-844-353-0770 |
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1-888-427-8730 |
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1-800-422-4234 |
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1-888-335-8227 |
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1-800-877-7195 |
Other Contact Information
Medicare | 1-800-633-4227 |
Social Security Administration | 1-800-772-1213 |
ACRE | 510-350-0649 |
REAC | Email contact form |
PERS – Long Term Care | 1-800-982-1775 |
Deferred Compensation | 1-855-969-4572 |