What happens to my school district insurance when I turn 65?

Advisories:

• Review the collective bargaining agreement in effect at the time you reach age 65.

• If there is no contract language granting you the opportunity to continue district insurance, the district may discontinue your coverage.

Rev 12.05.12

Can my dependents continue school district insurance after I turn age 65?

Advisories:

• Review the collective bargaining agreement in effect at the time you reach age 65.

• If there is no contract language granting you the opportunity to continue district insurance for dependents they are entitled to continue district insurance under COBRA until they enroll in Medicare themselves not to exceed 36 months.

Rev 12.05.12

What happens to my school district insurance if my spouse turns 65 before I do?

Advisories:

• Review the collective bargaining agreement in effect at the time your spouse reaches age 65.

•  If there is no contract language granting you the opportunity to continue district insurance for dependents they are entitled to continue district insurance under COBRA until they enroll in Medicare themselves not to exceed 36 months.

Rev 12.05.12

What do I need to know about signing up for Medicare?

Advisories:

• There is automatic enrollment in Part A (hospital insurance) at age 65.

• Part B (medical insurance) is automatic enrollment at the time you become eligible if you are receiving a Social Security check. . However, because you must pay a premium for Part B coverage, you have the option of turning it down.   Those that do not enroll when first eligible may be subject to a penalty for each 12 month period when they could have enrolled but did not.

• The initial enrollment period is 3 months before and after turning age 65 (or earlier if receiving social security disability). If someone does not enroll at age 65 because of coverage from an employer as an employee or a dependent, they can enroll without penalty until 8 months following the loss of that coverage.  

This special enrollment period only applies when coverage is due to the individual or spouse’s active employment.

Rev 12.05.12

What are Medicare supplement programs and what choices do I have? (*2009 amounts - will be updated as soon as possible)

Advisories:

• Medicare does not cover all medical expenses. Many retirees find it advantageous to also have Medicare Supplemental Insurance (Medigap). 

Medicare Part A (hospital insurance) does not pay

• A $1,068* deductible for each benefit period
• $267* for each day you are hospitalized after 60 days and up to 90 days. This is called the daily coinsurance.
• $534* for each day you are hospitalized after 90 days and up to 150 days. This is called the daily coinsurance.
• Any costs for a hospitalization of more than 150 days.
• The first three pints of blood, unless replaced
• Any expenses during foreign travel.

Medicare Part A (skilled nursing facility) does not pay

• $133.50* per day for each day you are in a skilled nursing facility more than 20 days up to 100 days for any one benefit period.  This is called the daily coinsurance.
• Any costs after a stay of more than 100 days.

Medicare Part A (Home Health Care) does not pay

• 20% of the approved cost of durable medical equipment or approved non-skilled care, and any costs for non-medical personal care services.

Medicare Part B (doctors, clinics, laboratories, etc.) does not pay

• $135* yearly deductible
• 20% of the Medicare-approved amount
• 15% above the Medicare-approved amount if the provider does not accept Medicare rates
• 20% of the total charges for outpatient hospital services
• Preventive or routine examinations and testing
• Prescription medication
• Dental care
• Routine eye and hearing exams or glasses or hearing aids        
  

 

• There are many Medigap plans approved by the Pennsylvania Insurance Commission for sale in Pennsylvania.  (See:  www.medicare.gov)

• The approved plans offer a wide assortment of choices and features.  You should consider your needs when choosing a plan.

• PSERS premium assistance program provides up to $100/month for school retirees enrolled in the PSERS Health Option Program Medigap Plan.

Rev 12.05.12

Why are Medigap plans identified by different letters (Plan A, Plan B, etc)?

Advisory:

• The federal government regulates Medicare supplemental insurance policies (“medigap”) and has designated 12 standardized plans.  Each of these plans is identified by a specific letter (“A” through “L”) to make comparison of plans easier.

Rev 12.05.12

What happens if I don’t enroll in Medicare immediately?

Advisories:

•  If you or your spouse are currently employed and are receiving medical insurance --- No Problem.

• There is automatic enrollment in Part A (hospital insurance) at age 65.

• Part B (medical insurance) is automatic enrollment at the time you become eligible if you are receiving a Social Security check.  Those that do not enroll when first eligible may be subject to a penalty for each 12 month period when they could have enrolled but did not.

• The initial enrollment period is 3 months before and after turning age 65 (or earlier if receiving social security disability). If someone does not enroll at age 65 because of coverage from an employer as an employee or a dependent, they can enroll without penalty until 8 months following the loss of that coverage.  This special enrollment period only applies when coverage is due to the individual or spouse’s current or active employment.

 

Rev 12.05.12

What is Part D/prescription coverage and what do I need to know?

Advisories:

• Medicare’s prescription drug coverage will be offered through Part D.

• There will be many drug plans offered but they must meet Medicare’s requirements. (Part D will have a premium cost.)

• The monthly premium is not impacted by an individual’s health condition or how many prescription drugs that individual may need.  However, the premium may be increased based on your total income.

• Individuals who are eligible for Medicare prescription drug as of January must enroll by May of that year.  Exception: If you are currently employed and are receiving full benefits with a prescription program equal or better than Medicare Part D.

Rev 12.05.12