Medicare is a health insurance program administered by the U.S.
government for people age 65 or older, under age 65 with certain
disabilities, and any age with End-Stage Renal Disease (permanent
kidney failure requiring dialysis or a kidney transplant).
Qualified Medicare-eligible ACERA members, dependents, and
survivors can select a medical plan through ACERA that works in
conjunction with the federal Medicare system.
When you or your dependents become eligible for Medicare (usually
at age 65), in order to keep or enroll in group health coverage
through ACERA, you are required to enroll in and be covered by
Medicare Parts A and B and maintain that coverage. After you are
enrolled in Medicare, you may enroll in an ACERA Medicare Plan,
which is a medical insurance plan offered by ACERA that works in
conjunction with your federal Medicare coverage.
The Medicare enrollment requirement allows ACERA to offer health
coverage to retirees on a group basis and results in you paying
significantly lower monthly premiums.
Everyone 65 and older is eligible to enroll in Medicare. If you
paid into Medicare during your career and earned enough credit,
Medicare Part A will be available at no cost. If you did not pay
into Medicare, don’t worry–you can still enroll in Medicare, but
there will be a cost for you to be enrolled in Medicare Part A.
For retired members who will be eligible at age 65, ACERA encourages you to begin the process for enrolling in Medicare at least 90 days prior to your 65th birthday. Begin by contacting the Social Security Administration at 1-800-772-1213 to verify your eligibility for Medicare. Medicare will typically automatically enroll you in Medicare Parts A and B within this time period, and send you a letter notifying you of your approval for Medicare and the date Medicare will go into effect.
Within this time period, ACERA will send you an invitation to attend a Medicare Transition Seminar. During the seminar, we will impart very important information about Medicare, provide assistance completing enrollment forms for ACERA’s medical plans, and provide publications that help you understand it more clearly. If you do not receive an invitation, please register for the next seminar.
If you do not wish to attend the seminar or are unable to attend, ACERA will mail you the enrollment packet containing enrollment forms, important information, and instructions. You can also obtain more information on Medicare by reviewing the Medicare & You Handbook, which is a very user-friendly source of information, covering all aspects of Medicare.
If you are retired when you turn 65, Medicare usually goes into effect on the first day of the month of your birthday—unless your birthday is on the first, then the effective date will be first day of the month before. If you retire after you are Medicare eligible, Medicare usually goes into effect on the first day of the month after you stop working (but it could be later).
Once you have received your letter from Medicare stating your effective date, you are enrolled in Medicare. You can then submit the enrollment form for one of ACERA’s Medicare medical plans. It’s a good idea to submit those forms as soon as you receive your letter so you can begin paying lower premiums.
When Medicare has processed your enrollment, they will send you a Medicare card in the mail containing your name and claim number. ACERA does not recommend carrying the card around with you, as your claim number is often your Social Security number—so keep it in a secure place.
If you and/or your dependents are eligible for Medicare prior to age 65 (for example, due to disability), contact the Social Security Administration to discuss your eligibility and Medicare enrollment options.
If you are near or over age 65 and are currently employed but plan to retire soon, you are probably not on our mailing list for the seminar invitations. However, the Medicare Transition Seminar will be beneficial to you as you will soon begin the Medicare enrollment process. ACERA recommends that you register for the next seminar.
Do I have to wait for ACERA’s Open Enrollment in November to enroll in Medicare?
No. Turning age 65 is a qualifying event allowing you to transition from a pre-Medicare medical plan in to one of ACERA’s Medicare plans. You should begin the process 90 days before your 65th birthday.
Do I need to contact Social Security to get medicare, or will they enroll me automatically?
Usually, the Social Security Administration knows when your 65th birthday is approaching and will automatically enroll you in Medicare Parts A and B, and notify you. However, ACERA encourages you to contact Social Security at least 90 days prior to your birthday to ensure everything is in order.
What Forms Do I Complete To Enroll In the Kaiser Permanente Senior Advantage Plan?
ACERA offers Medicare plans to individuals who are eligible for Medicare (generally, those over age 65). These ACERA plans work in conjunction with your Medicare coverage provided to you by the U.S. government. The plans may change from year to year:
An individual plan through the Via Benefits Medicare exchange
To enroll in an ACERA-sponsored Medicare plan, you must first sign up for and maintain enrollment in Medicare Parts A and B.
As you choose the plan that best meets your health care and budget needs, it’s important to understand how each plan works, the benefits provided, and the costs you may incur under each plan (monthly premiums and out-of-pocket expenses at the point of care).
Generally, you must live in a plan’s specific service area to enroll.
Before selecting a medical plan, call the plan’s customer service number or visit its website to verify that your residence is within its service area, and to verify access to providers, including doctors, specialists, and hospitals, that participate in each plan’s network. Each plan’s contact information is located on the back of ACERA’s annual Enrollment Guide.
When you become eligible for and enroll in Medicare, Medicare coverage is provided as follows:
Medicare Part A provides hospital insurance.
It helps pay for Medicare approved hospital stays, care in skilled nursing facilities, hospice care, and hospital care from qualified Medicare providers.
You typically do not pay a premium for Part A coverage if you paid Medicare taxes while you were working. If you did not pay into Medicare, don’t worry–you can still enroll in Medicare Part A, but there will be a cost for participation.
If you are already receiving Social Security benefits, enrollment in Medicare Part A is automatic.
Medicare Part B provides medical insurance.
It helps pay for Medicare approved doctor services, outpatient care, certain preventive care services, diagnostic tests, and some other services and supplies that Medicare Part A does not cover.
You pay a monthly premium for Part B coverage. For example, for most Medicare-eligible individuals, the lowest monthly premium in 2010 was $96.40, although some will pay more, depending on their income and date of enrollment into Medicare.
Enrolling in Medicare Part B at the right time is critical.
When you turn age 65, you have an initial 7 month period to enroll in Part B:
You may enroll in Part B up to 3 months before the month of your 65th birthday.
You may enroll in your birthday month.
You may enroll up to 3 months after your birthday month.
If you miss this initial 7 month period you may still enroll in Part B during the general enrollment period from January through March of each year.
Coverage becomes effective July 1 of that year.
You will be assessed a lifetime penalty of 10% for each year you were eligible for Part B but did not enroll.
Exception: If you or your spouse are still working, you may delay enrollment in Part B until retirement, without incurring the 10% penalty.
Medicare Part C is a federal program that allows you to receive your Part A and B Medicare benefits through a Medicare Advantage or other Medicare-approved insurance plans.
These are health plans (such as HMOs) approved by Medicare and run by private insurance companies. Currently, ACERA sponsors two Medicare Advantage plans and a Medicare Supplement Insurance Plan.
Medicare Part D helps to cover your prescription drug costs.
When you become eligible for Medicare Part A, you also have the opportunity to enroll in a Medicare Part D prescription drug plan. Medicare prescription drug plans are run by insurance companies and other private companies approved by Medicare.
If you enroll in an ACERA-sponsored medical plan, your Medicare Part D prescription drug benefits are covered through that plan; you do not need to enroll in a stand-alone Medicare Part D plan! If you do enroll in a separate Medicare Part D plan, ACERA will be forced to cancel your entire medical coverage, because you cannot be enrolled in two plans at once.
Eligible members, non-member payees, and dependents who are enrolled in Medicare Parts A and B, can elect to participate in an ACERA-sponsored medical plan, also known as an ACERA Medicare Plan.
Depending on the plan you elect, the ACERA Medicare Plan provides or supplements your Medicare Parts A and B coverage and Medicare Part D prescription drug coverage. Participation in an ACERA Medicare Plan generally enhances the coverage provided through Medicare. You pay a monthly premium to ACERA in addition to the Medicare Part B premium you pay to the federal government for this coverage.
To maintain coverage under an ACERA Medicare Plan, you MUST maintain enrollment in Medicare Parts A and B.
Current plan details are described in the ACERA Enrollment and Health Plan Brochure. The plans offered are subject to change from year-toyear. Currently, ACERA provides Medicare-eligible individuals the opportunity to elect two different types of plans:
Medicare Advantage Plan
When you enroll in an ACERA-sponsored Medicare Advantage Plan, you agree to allow the plan’s carrier (a private insurance company) to provide your Medicare Parts A and B benefits and your prescription drug coverage. In doing so, you authorize Medicare to pay your benefits directly to the insurance company.
These plans are similar to an HMO, where you choose from a list of plan physicians. These plans are typically only available in California service areas.
Supplemental Medicare Insurance Plan
As an alternative to electing a Medicare Advantage plan, many Medicare-eligible individuals opt to enroll in an ACERA-sponsored Supplemental Medicare Insurance plan. Also known as a “Medigap” plan, these plans are private health insurance designed to work alongside Medicare by paying some of the health care costs not covered through Medicare.
These plans are similar to a PPO, where you may select any physician that accepts Medicare. These plans can be used all across the U.S. Doctors you visit under this plan may ask to see your Medicare card so they can submit claims.
When I go into a Medicare plan can I keep my doctor?
Check with your doctor to see if she/he accepts the Medicare medical plan you wish to enroll in. Eligibility for enrollment in a medical plan is determined by zip code. The service area for a Medicare medical plan may have different zip codes than a pre-Medicare plan from the same provider. Contact ACERA or the medical provider for verification before you enroll in a plan.
ACERA reimburses members for the lowest monthly rate that Medicare charges retirees for being enrolled in Medicare Part B, which is $164.90 for 2023 (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.
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
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.
If you are enrolled in the Kaiser Permanente Senior Advantage Medicare Plan, you cannot use Monthly Medical Allowance to get reimbursed for the IRMAA.
However, if you are enrolled in an individual plan through Via Benefits, you can use Monthly Medical Allowance to get reimbursed for the IRMAA.
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?
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.
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.
If you continue to work after age 65 when you become Medicare eligible, you have the option of enrolling in Medicare. Medicare A is offered at no cost to you, but remember that you will have to pay a monthly premium for Medicare Part B, in addition to any premiums you may be paying to be covered under your employer’s health plan. The same consideration should be made for Part D.
If you choose not to enroll in Medicare Part B, as long as you are actively employed you will not incur the late sign-up penalty explained on the How Medicare Works page.
Individuals who are permitted to delay enrollment have their own special enrollment periods. A special enrollment period begins when current employment ends or when coverage under the plan ends. The special enrollment period ends eight months later. Individuals who fail to enroll in this period are considered to have delayed enrollment and could become subject to the penalty.
If my spouse wants coverage under an ACERA medical plan, does it have to be the same plan as mine?
A spouse cannot be enrolled with a different medical provider than a member. If he/she is Medicare eligible, he/ she can only be covered under your plan. If your spouse is not yet eligible for Medicare, he/she can be covered by a pre-Medicare plan from the same provider.