A member’s Base Retirement Benefit is established at the time of retirement. The amount of the Base Benefit is determined by the retirement plan benefit formula, the member’s age at the time of retirement, the amount of service credit accrued at the time of retirement and the average monthly salary for the highest consecutive pay periods as prescribed by the member’s plan, usually either one year or three years. The Base Retirement Benefit does not change over the life of the retired member. It is possible however, for the gross monthly retirement benefit to change if for example, cost-of-living adjustments are granted and applied.
I am (or my covered dependent is) going to be turning 65 soon and eligible for Medicare but I have Employer-sponsored Health Insurance; what do I need to know and what do I do?
Retirees who become eligible for Medicare have some choices to make regarding their County, Court or Firefighter (“Employer-sponsored”) health insurance coverage. (Note to retired firefighters on Union plans- only the retiree’s Medicare enrollment causes rate changes.) Choosing whether or not to enroll or being ineligible for Medicare, may have an effect on your County insurance premiums. You should also consult the “Important Facts You Need to Know” and other information in your most recent “Guide to County/Court Health Plans and Open Enrollment” book for additional information about Medicare and your Employer-sponsored insurance:
Guide to County Health Plans and Open Enrollment
Guide to Court Health Plans and Open Enrollment
There are many Medicare insurance offerings. Medicare offers parts A (Hospital coverage) and B (Medical coverage). If you enroll in Parts A and B, you can generally enroll in a private Part D (Prescription drug) plan. A Medicare alternative to having original Medicare (Parts A and B) is to enroll in a private or group Part C (Advantage) plan, which provides your original Medicare (Parts A and B) plus your prescription (Part D) coverage and other insurance benefits. You can also enroll in a private Medigap or Supplemental plan (such as Parts F, G, K, L, M and N).
Where can I get help understanding Medicare and determining what plan(s) best suit my needs and budget?
There are many resources for help with understanding Medicare and finding plans. Medicare’s website can be very helpful. There are also agencies, such as HICAP (Health Insurance Counseling and Advocacy Program) who counsel seniors about Medicare and explain the various plans, as well as the County’s Health Advocacy group, CareCounsel available to retirees.
While you are not required to enroll in Medicare, you need to be aware that if you do not enroll when you are first eligible (within Medicare’s 7-month Initial Enrollment Period) you may pay a higher premium that includes a penalty for late enrollment if you enroll later during Medicare’s General Enrollment Periods or Special Enrollment Periods. Medicare does have an annual open enrollment period.
As an SBCERS retiree, you may continue to use the Employer-sponsored health insurance while you are enrolled in Medicare. You will be eligible for a coordination of benefit and a decrease in the premium for your Employer-sponsored Medical insurance, but only if you enroll in both parts A and B of Medicare, and you report the Medicare to SBCERS. You will also be eligible to change to a different Employer-sponsored medical plan (such as a Medicare Advantage type of plan).
What happens when I choose to keep the Employer-sponsored medical insurance and want the coordination of benefit?
You are responsible for the timely completion and submission of a Subscriber Change Request form for SBCERS. You will need to report the changes to your medical providers. Medicare will now be your primary insurance, and your Employer-sponsored medical plan will be secondary. Providers will bill Medicare and in turn, Medicare will coordinate with your Employer-sponsored plan for secondary payment after Medicare pays claims.
You should be aware that your Employer-sponsored medical insurance plan offers two prescription drug plan (PDP) options from which you may choose as a Medicare-enrolled retiree, provided you are notifying SBCERS the specified deadline , usually at least 60-90 days before your initial Medicare A and B effective date. There is no separate premium to pay to Medicare for Part D or for the Employer-sponsored Medicare PDP. In fact, your Medicare PDP premium might be less than the non-Medicare prescription plan. Coverage in either of these plans is considered by Medicare to be “creditable”. Creditable means that the benefits are as good as or better than Medicare standards. Having creditable coverage also means that, should you drop your Employer-sponsored Medical (and the included prescription coverage) at some point in the future and join a private Medicare D plan, you should not be penalized for a “late enrollment”.
Medicare does not allow a Medicare enrollee (aka “beneficiary”) to be enrolled in more than one Medicare Part D (prescription drug) plan at a time. If you do enroll in a second prescription plan, you may be dropped from the first plan which could jeopardize your medical insurance participation.
Yes. You will receive the insurance subsidy as long as you are enrolled in Employer-sponsored insurance and your former employer is still providing the benefit to retirees.
You may cancel your Employer-sponsored medical insurance any month. The cancellation will be effective the 1st of the month following SBCERS’ receipt of your change form as long as it is received by the 15th of a month. You must be aware that you will not be eligible to continue dental or vision insurance if you are participating in either when you cancel your medical. You are responsible for the timely completion and submission of an insurance change forms to SBCERS to cancel each insurance plan.
Note that SBCERS Retirees* are permitted to re-enroll (or enroll) in the future during Open Enrollment. You may participate in all insurance offerings in the future if you drop or decline all insurance plans. If however, you drop or decline dental insurance while you are participating in a Medical insurance plan, you are not permitted to enroll in dental insurance in the future. *Retirees who participate in the Firefighters’ Union insurance may not re-enroll in the Union insurance after dropping or declining it, however they may enroll in the County-sponsored plans under the mid-year or Open Enrollment rules.
No. The subsidy can only be applied to premiums for Employer-sponsored insurance. However, upon processing your cancellation request, SBCERS will automatically enroll you in the alternate Health benefit program, the “Health Reimbursement Arrangement” (HRA) if it is still offered by the Employer Plan Sponsor at the time of your cancellation. Review your Open Enrollment Guide for additional information about your HRA benefit.
If you cancel your Employer-sponsored insurance, you should consider shopping for a Medicare D plan, a private Medicare Supplemental plan to compliment your Medicare, or a private Medicare Advantage Plan as well as private dental and/or vision insurance if you need them. Contact the HICAP (Health Insurance Counseling and Advocacy Program) office (800-434-0222) or your State Department of Insurance to obtain free assistance in finding appropriate plans.
The Medicare Claim Number is also known as a Medicare Number or Health Insurance Claim Number (HICN). The primary function of the HICN is to identify you (the beneficiary) and your claims. It helps in the processing of Medicare claims. The number is between seven and 11 digits long and may be different than the beneficiary’s Social Security number. There are two parts to the number. One part, the claim account number, reflects the policy number of the person who has earned the Medicare benefits — typically either yourself or your spouse. The other part, the beneficiary identification code, identifies your current relationship to the wage earner. This number is typically two digits–one letter and one number. For example, the A in the claim number above denotes that the claim account number belongs to the primary wage earner, a B suffix denotes an aged wife, first claimant and a D suffix denotes an aged widow, first claimant.