Medicare Coverage Guide

If you or your spouse will be 65 or older when you retire, Medicare will play an important role in your health insurance coverage. The Social Security Administration is responsible for determining eligibility and enrolling individuals in Medicare Parts A & B. Medicare Part A is hospital insurance and Medicare Part B is medical insurance. Premium and coverage information is also available from your local Social Security office. Enrollment requirements are as follows:

Medicare Part A

  • At age 65, if you qualify for premium-free Medicare Part A coverage, you are required to enroll in Part A. This can be initiated by contacting your local Social Security office once you are within 3 months of your 65th birthday and arranging a telephone interview or by making an appointment at your local office for an office visit.
  • You will need to submit your most recent W2 form and a birth certificate, or some other proof of date of birth. All supporting documents you submit are returned to you.

Medicare Part B

Once you are 65 and retired, enrollment in Medicare Part B is required for retirees and covered spouses age 65.

  • If you retire at 65 or later, but do not enroll in Part B at the earliest opportunity you will  pay higher Medicare premiums for this coverage than you would have otherwise.
  • Exception: If you are retiring after reaching 65, or are covering a spouse who is 65 or older at the time of your retirement, there is only a conditional penalty for late enrollment. This penalty may be avoided as long as you provide Social Security with verification that you were covered by the PEBP group plan during the period between reaching 65 and retiring. Social Security will provide you with a form to verify your group health coverage; you should bring this form to the Benefits Office for completion. This form should be completed and submitted no later than 30 days after retirement in order to avoid this penalty.

Medicare Part C

Pharmacy benefits for PEBP members eligible for Medicare continue under the same prescription benefits as an active employee. PEBP retirees should not purchase a plan under the Medicare prescription drug program (often referred to as Medicare Part D).

If you have additional questions on Medicare, contact the Medicare hotline at 1-800-633-4227.