Medicare Insurance
What you need to know
Medicare
General Medicare information:
Part A is hospitalization coverage free to most eligible Medicare beneficiaries.
Part B is medical coverage that requires a monthly premium (taken from your Social Security check or paid by personal check).
Part C (Medicare Advantage Plan) is a type of Medicare health plan that contracts with Medicare to provide you with all your Part A and Part B benefits and often includes prescription drug coverage. You must be enrolled in Medicare Part B and you may also be required to send a monthly premium to the insurance company.
Part D is prescription drug coverage that may require a monthly premium (taken from your Social Security check or paid by personal check).
Medicare Supplement (Medigap) Plans sold by private companies can help pay some of the health care costs Medicare doesn't cover, like co-payments, coinsurance, and deductibles. Some Medigap policies also offer coverage for services that Medicare doesn't cover.
You may purchase Part B, Part C, Part D or Medigap plans on the private market. If you choose to do so, you should cancel your state group health insurance plan. Remember, once you cancel, you cannot enroll at a later time.
You are eligible for Medicare (either at retirement or after retiring) and keeping a State Group Insurance health plan:
Coordinating medical coverage: When Medicare Part A or Part B pays, your State Group Insurance health plan pays secondary. When Medicare does not pay, your state group health insurance pays primary for covered benefits and services (just like when you were an employee). Florida Blue administers the nationwide PPO secondary plan; Aetna, AvMed, and UnitedHealthcare administer the HMO secondary plans in their respective service areas.
If you fail to enroll in Medicare Part B: You will have significant out‐of‐pocket expenses for Part B eligible services because you will be required to pay the portion (approximately 80 percent) that Medicare would have paid. If you choose to continue your state group health insurance coverage once you’re eligible for Medicare, elect your Medicare Part B coverage. Although Medicare does not require you to purchase Part B, it is in your financial interest to do so. This coverage provision also applies to Medicare-eligible dependents on your plan.
Creditable Coverage for Medicare Part D: For prescription drug coverage, your state group health insurance pays primary for most prescription drugs. Covered medications, copays and the network remain the same as when you were an employee. If you are enrolled in the state group secondary health insurance, do not enroll in a separate Medicare Part D plan. The state’s prescription drug coverage is as good as or better than Medicare Part D and is currently approved by Medicare as creditable coverage.
Medicare (Retiree) Advantage Plan: Capital Health Plan offers this plan to state retirees in their respective HMO service areas. To become a member, you must be enrolled in Medicare Parts A and B, complete the HMO’s application and receive approval before your retiree health coverage becomes effective. Medicare Advantage Plans do not allow retroactive enrollment and claims can only be paid if you are approved for the plan. Medical and prescription drug coverage are included.
Medicare Advantage and Prescription Drug (MA-PD) Plans: Capital Health Plan and Humana offer an MA-PD HMO plan and UnitedHealthcare offers an MA-PD PPO to state retirees and their dependents. To become a member (you and your dependents) must be enrolled in Medicare Parts A and B and you must send a copy of your Medicare card to the People First Service Center. If your Medicare enrollment cannot be verified before the effective date of your MA-PD plan, you will be moved into the State Group Insurance PPO health plan with Florida Blue. Medicare Advantage Plans do not allow retroactive enrollment and claims can only be paid if you are approved for the plan. Medical and prescription drug coverage are included. For more information visit the Medicare Advantage and Prescription Drug page.
Enrolling in Medicare: Once you are eligible for Medicare Part A and Part B due to age (65) or disability and no longer working, you should contact the Social Security Administration (SSA) about your Medicare benefits. Enrollment in Medicare is time sensitive and you may be subject to substantial financial penalties if you fail to meet federal deadlines. Contact your local SSA office three months before your 65th birthday: call 800‐MEDICARE (800‐633‐4227), or visit www.Medicare.gov for more information. TTY users call 877-486‐2048.
Enrolling in state group Medicare secondary coverage or a Medicare advantage plan: the state offers three Medicare coverage tiers when you or a dependent is Medicare eligible:
Medicare I: a single policy for you
Medicare II: a family policy for you and your eligible dependents and at least one is eligible for Medicare. (If enrolling in an MA-PD plan all members covered under your family policy must be enrolled in Medicare.)
Medicare III: a family policy for you and one dependent and you are both Medicare eligible
You do not meet Medicare eligibility requirements: If you have not worked enough quarters to be eligible for Medicare at age 65, call the Social Security Administration and request an ineligibility letter. Please send a copy of that letter immediately to People First to ensure your health insurance coverage continues without interruption. Mail or fax copies of Medicare documentation with your People First ID number to: People First Service Center
PO Box 6830
Tallahassee, FL 32314
You Should Know
Once you or your dependents become eligible for Medicare, the state pays secondary, even if you do not enroll in Medicare. To avoid high out-of-pocket claims costs (about 80 percent), you should enroll in Medicare Parts A and B as soon as you are eligible and no longer employed by the state.
