When you turn age 65—whether you’re still working or not—you become eligible to enroll in Medicare, the federal program to provide older adults and those with disabilities or permanent kidney failure with secure access to medical care.
If you’re still working when you turn age 65 (or become Medicare-eligible), you can wait to enroll in Medicare and stay covered in your UC medical plan for non-Medicare members. However, most employees enroll in Medicare Part A (which covers hospitalization) since there is typically no cost. Medicare Part A will be secondary to your UC active employee medical plan.
There are specific rules for the timing of when you must enroll in Medicare Part B, which has a monthly premium. Generally, you can delay enrolling in Part B if you are still working and have coverage through your employer. However, the rules are complex and there are penalties associated with not following them carefully (lifetime higher premiums for Part B.) You can find more information on medicare.gov. You might also want to discuss your personal situation with Medicare directly at (800)-MEDICARE.
UC Retiree Coverage Coordinates With Medicare
Generally, each UC non-Medicare medical plan has a corresponding Medicare option offered to eligible retirees after they enroll in Medicare. However, the Medicare version of the non-Medicare plans often have different costs, benefits, doctors, service areas and behavioral health providers.
Once you enroll in Medicare and complete a UC Medicare form, you’re automatically enrolled in the UC retiree Medicare plan that corresponds to your current medical plan. If you’d prefer a different Medicare plan, you can make that change during the next Open Enrollment period.
Under UC retiree coverage, if some family members are eligible for and enrolled in Medicare and others are not, you’re considered a split-Medicare family.
Tip: During the Open Enrollment period before you enroll in Medicare or retire with Medicare, take a look at the Medicare version of your current plan so that you understand your plan’s corresponding Medicare plan. Open enrollment is the time to make changes, if you want to transition to a different plan when you enroll in Medicare.
When You Must Enroll in Medicare
- If you are retired when you turn age 65, or retiring after age 65, you must enroll in Medicare. If you are eligible for premium-free Part A and you don’t enroll in Part A and B when first eligible or at retirement, you could lose your UC-sponsored medical coverage and be charged penalties by RASC and lifelong penalties by Medicare. Ninety (90) days before you turn 65, or when you are retiring, RASC will send you the Medicare forms you'll need to fill out, along with the date UC needs you to enroll in Medicare and return the forms.
- If you’re receiving Social Security benefits. You’ll be automatically enrolled in Medicare Parts A and B when eligible, and are required by SSA to accept Part A. If you are still covered by UC active employee coverage, you can contact Social Security to opt out of Part B. When you later transition to UC retiree coverage, you will be able to enroll in Part B during a Medicare Special Enrollment Period.
Medicare Part A (hospital and facility coverage) is usually offered at no premium cost. There is a monthly premium for Part B (doctor and outpatient services) and Part D (prescription drugs) based on your income. Medicare premiums are in addition to any premium you pay UC for your UC medical coverage.
What Happens to Your UC Coverage When You Enroll in Medicare
Once you enroll in Medicare, you can still stay enrolled in UC medical benefits. However, as a UC retiree, you’ll need to transition to a UC plan for Medicare members. (Note: If you're enrolled in the UC Health Savings Plan as an active employee and want to continue receiving Health Savings Account contributions from UC—and making your own—you should not enroll in Medicare. The IRS does not allow Medicare participants to receive or make contributions to a Health Savings Account.)
Under UC retiree coverage, Medicare (not the UC medical plan) becomes your primary insurance, meaning Medicare will pay for Medicare-covered expenses first. Your UC plan then covers many of the remaining costs. This could be either a percentage of the eligible expenses left over after Medicare pays its share, or expenses that Medicare doesn’t cover and the UC plan does, such as services outside the U.S., hearing aids, and some behavioral health care with non-Medicare providers.
To get the highest level of benefits, make sure your doctors and other providers accept Medicare for services covered by Medicare. For services covered by the UC plan but not Medicare, such as hearing aids and some behavioral health, it is best to use providers that are in the UC plan network.
Learn more about the UC Medicare-coordinated medical plans.