Getting Started With Medicare

Click here to view CMS Handbook, Medicare & You 2018

1. When does Medicare start?

  • It depends. Even if you have coverage through the District, you still may need to make some important Medicare enrollment decisions and it is important to understand how your current coverage works with Medicare before making any decisions.
  • If you (or your spouse) are currently working, and you’re covered by an employer or union group health plan based on that employment, Medicare guidelines state you can sign up later during a Special Enrollment Period without a late enrollment penalty.
  • When you are first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. But if you are working for the District and have medical coverage, you also have an 8-month Special Enrollment Period to sign up for Part A and/or Part B that starts the month after the employment ends or the group health plan insurance based on current employment ends, whichever happens first. Usually, you don’t pay a late enrollment penalty if you sign up during a Special Enrollment Period.
  • It is also important to note that COBRA and retiree health plans aren’t considered coverage based on current employment. You’re not eligible for a Special Enrollment Period when that coverage ends. So if you are eligible for Medicare when you retire, or become eligible at any time during the period you are enrolled in COBRA, you should enroll in and pay for Part B. Failure to do so may subject you to a late enrollment penalty.
  • Medicare Open Enrollment (October 15–December 7) is the time when all people with Medicare are encouraged to review their current health and prescription drug coverage. This includes any changes in costs, coverage, and benefits that will take effect next year. If you want to change your coverage for next year, this is the time to do it. If you’re satisfied that your current coverage will continue to meet your needs for next year, you don’t need to do anything.

2. What will I pay for Medicare?

  • Part A (Hospital Insurance): You usually don’t pay a monthly premium for Medicare Part A (Hospital Insurance) coverage if you or your spouse paid Medicare taxes while working. This is sometimes called “premium-free Part A.”
  • Part B (Medical Insurance): You pay a premium each month for Part B. If you get Social Security, your Part B premium will be automatically deducted from your benefit payment. If you don’t get these benefit payments, you’ll get a bill. Most people will pay the standard premium amount. However, if your modified adjusted gross income as reported on your IRS tax return from 2 years ago is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). IRMAA is an extra charge added to your premium.
  • The standard Part B premium amount is $121.80 (or higher depending on your income).
  • Part D (Medicare Prescription Drug Coverage): The Part D monthly premium varies by plan (higher-income consumers may pay more). Private insurers, in addition to employers and unions, offer Medicare Part D plans. For help finding a Part D drug plan, check out the Medicare Plan Finder.

The charts below show your estimated prescription drug plan monthly premium based on your income as reported on your IRS tax return from 2 years ago and last year. If your income is above a certain limit, you’ll pay an income-related monthly adjustment amount in addition to your plan premium.

If your filing status and yearly income in 2014 was
File individual tax return File joint tax return File married & separate tax return You pay (in 2016)
$85,000 or less $170,000 or less $85,000 or less your plan premium
above $85,000 up to $107,000 above $170,000 up to $214,000 not applicable $12.70 + your plan premium
above $107,000 up to $160,000 above $214,000 up to $320,000 not applicable $32.80 + your plan premium
above $160,000 up to $214,000 above $320,000 up to $428,000 above $85,000 up to $129,000 $52.80 + your plan premium
above $214,000 above $428,000 above $129,000 $72.90 + your plan premium
  • Late enrollment penalty: You may owe a late enrollment penalty if you go without a Medicare Prescription Drug Plan (Part D), or without a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, or without creditable prescription drug coverage for any continuous period of 63 days or more after your Initial Enrollment Period is over.
  • Creditable Prescription drug coverage is prescription drug coverage from a current or former employer or union, which is expected to pay, on average, at least as much as Medicare’s required prescription drug coverage. The H&W Retiree Plan for retirees under age 65 is considered creditable coverage. The H&W Plan for retirees age 65 or older, or Medicare eligible, is a Medicare Part D drug plan.

3. Do I need to enroll in a medical plan if I am enrolled in Medicare?

Yes. You will have the choice of enrolling in a Medicare Supplement Plan (https://www.medicare.gov/supplement-other-insurance/medigap/whats-medigap.html) or a Medicare Advantage Plan (https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/medicare-advantage-plans.html). Compare Medigap plans side-by-side https://www.medicare.gov/supplement-other-insurance/compare-medigap/compare-medigap.html.

We encourage you to check out the Health Options Program (www.hopbenefits.com), which operates for the sole benefit of participants of the Pennsylvania Public School Employees’ Retirement System (PSERS), their dependents and survivors.