Medicare

Medicare

Medicare is a federal health insurance program administered by the Social Security Administration (SSA) and the Centers for Medicare and Medicaid Services (CMS) for people who are:

  • age 65 or older,
  • certified as medically disabled by the SSA or
  • of any age with end-stage renal disease (ESRD).
Medicare is made up of four parts:
  • Part A covers inpatient hospital stays, skilled nursing facilities, hospice care, and home health care.
  • Part B covers medical services like doctor visits and outpatient care. Part B also covers some preventive services including screenings, vaccines, diagnostic testing and some durable medical equipment like wheelchairs and walkers.
  • Part C, also known as Medicare Advantage Plans, combines Parts A and B (sometimes Part D coverage), and is managed by private insurance companies approved by Medicare. ERS offers Medicare Advantage Plans.
  • Part D covers outpatient prescription drugs and may help lower your prescription drug costs and help protect against higher costs in the future. ERS offers a Part D prescription drug plan.

You need to enroll in Medicare Parts A and B when you are retired and age 65 or older, or if you’re retired and certified medically disabled by the Social Security Administration (SSA) and become eligible for Medicare.

If you are currently working for a state agency or higher education institution that participates in the Texas Employees Group Benefits Program (GBP), you can delay your Part B enrollment. Your state health insurance remains primary to Medicare. Most active employees enroll in Medicare Part A because for most it is free. This will give you secondary hospitalization coverage to your state health insurance. If you decide to delay Part B, remember to contact the SSA no more than 90 days before you stop working to start the enrollment process. You will want your Part B to be effective the first of the month following your retirement date or last day of state employment.

Once you are retired and eligible for Medicare, you will want to enroll in Medicare Parts A and B. In most cases, if you are already receiving SSA benefits, you will be automatically enrolled in Medicare Parts A and B. The coverage will be effective the first day of the month you turn 65. The SSA will send you information in the mail. If you are not yet receiving SSA benefits, you will not be automatically enrolled. You will need to contact the SSA during your initial enrollment period and enroll in Medicare Parts A and B. You can enroll up to 90 days before your 65th birthday or after you have been certified disabled by the SSA for 24 month.

Visit www.ssa.gov or call the Social Security Administration toll-free at (800) 772-1213, or TTY users call (877) 325-0778.

Yes. You need to enroll in both if you are retired, Medicare eligible and no longer work for a state agency or higher education institution that participates in the Texas Employees Group Benefits Program (GBP).

Part A covers hospitalization and is free for most people.

Part B covers medical costs other than hospitalization, such as doctors' visits or lab work, and has a monthly premium. You are responsible for your Medicare premiums. If you do not enroll in Part B, you will pay most or all of your health care out-of-pocket costs for Part B services. The SSA may add a lifetime penalty to your monthly premium if you are retired and do not enroll in Part B when first eligible.

Most people will pay the standard Part B premium amount. However, if your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). If you are subject to IRMAA, you may pay a higher premium amount for Part B. Medicare uses the modified adjusted gross income reported on your IRS tax return from two years ago (the most recent tax return information provided to Social Security by the IRS). For more information on the Part B rates, please see the Medicare Part B rates website.

No. ERS provides Part D prescription drug coverage for Medicare-eligible retirees, dependents, and survivors through the HealthSelect Medicare Rx Plan, currently administered by UnitedHealthcare®. This plan is as good as or better than most private Medicare Part D plans. You must be enrolled in Medicare Parts A and/or B in order to be eligible for Medicare Part D.

You will need to contact ERS and provide your Medicare information to begin the enrollment process into HealthSelect Medicare Rx (prescription drug coverage). The same process applies if you are retired and have Medicare eligible dependents.  

Most people will pay nothing for Part D. However, if your modified adjusted gross income is above a certain amount, you may pay an Income Related Monthly Adjustment Amount (IRMAA). If you’re subject to IRMAA, you may have a premium for Part D. Medicare uses the modified adjusted gross income reported on your IRS tax return from two years ago (the most recent tax return information provided to Social Security by the IRS). For more information, please see the Medicare Part D rates website

Detailed information on the premiums for Medicare Part B (other medical) and Part D (prescription drug) is available in the Medicare & You handbook on the Medicare website. There is usually no cost for Part A (hospital).

In addition to Medicare costs, there is a premium for the additional health coverage provided through the GBP. For eligible retirees and family members, the state currently pays at least part of the premium contribution for additional GBP health coverage. Find the premiums for additional GBP health coverage. Find out if you are eligible for the state’s premium contribution.

With all GBP health plans, you must continue paying Medicare Part B premiums and, if applicable, Part D premiums to the federal government—whether or not the state pays any portion of your additional GBP health coverage.

Once you are retired Medicare eligible and no longer working for a state agency or higher education institution that participates in the GBP, your retiree state health insurance becomes secondary to Medicare. It pays your claims as if you have Medicare Parts A and B, whether or not you enroll.

If you do not sign up for Medicare Parts A and/or B when you are retired and first eligible, you will pay most or all of your health care out-of-pocket costs for Part A and B services (80%). This means you will pay the 80% of your health care costs that original Medicare would have covered before your GBP retiree health insurance will pay out towards your medical services

The SSA may add a lifetime penalty to your monthly premium if you are retired and do not enroll in Part B when you are first eligible. If you are currently working for a state agency or higher education institution that participates in the GBP, you can delay your Part B enrollment. Once you stop working and contact the SSA to enroll in Part B, they will provide a form to verify your employment information. Once the SSA verifies your employment, you will not be assessed the penalty.
Remember: Once you receive your Medicare ID card, contact ERS toll-free at (877) 275-4377 and say “Medicare number” when prompted, to provide your Medicare information.

Retirees, dependents, and survivors enrolled in Medicare will be enrolled in the HealthSelect Medicare AdvantageSM Plan, a preferred provider organization (MA PPO), administered by Humana, once they have provided their Medicare information to ERS. This plan:

  • lowers your monthly insurance premiums for dependents, survivors and retirees subject to tiered insurance,
  • can be used at any doctor's office that accepts Medicare and
  • offers extra benefits.

A Medicare Advantage plan is a Medicare Part C plan, which is a different way of providing Medicare benefits. Insurance companies, approved by Medicare, work with and receive payments from Medicare to manage health care costs.

Medicare Advantage plans combine Medicare Parts A and B, and may provide extra benefits not provided by Medicare. Participants of these plans are still covered by Medicare and must continue enrollment in Parts A and B and continue to pay Part B premiums, but original Medicare is replaced with a Medicare Advantage plan, such as HealthSelect Medicare Advantage MA PPO (part of the GBP). This plan eliminates Medicare paperwork for you by having your claims filed for you, as long as your doctor accepts Medicare.

Medicare Advantage plans allow the state to continue providing quality health insurance coverage for retirees at lower costs. This plan achieves the state's budgetary goal of lowering costs while helping you save and budget your health care costs.

Yes. If you’re retired, enrolled in Medicare Parts A and B and have provided your Medicare information to ERS, you are eligible for HealthSelect MA PPO.

Your dependents, as well as surviving spouses and children, are eligible if their Medicare information is on file with ERS and they are:

  • at least age 65 or certified as disabled by the SSA with Medicare,
  • enrolled in Medicare Part A (hospital) and Part B (other medical) coverage and
  • living in the United States or Puerto Rico.
NOTE: A retiree and any eligible dependents (spouse and/or disabled children) enrolled in Medicare must have the same health plan.

Not eligible:
  • Active employees
  • Active employees' dependents (even if retired or certified as disabled by the SSA with Medicare) 
  • Persons under 65 (unless certified as disabled by the SSA and enrolled in Medicare)
  • Persons living outside the United States or Puerto Rico
  • Retirees who return to state employment
  • Members and/or dependents who have ESRD and are still within their 30-month coordination period

Yes. Here are some extra benefits with HealthSelect MA PPO:

  • Well Dine® - free precooked frozen meals delivered to your home after a hospital stay
  • Hearing aids and care - free hearing exam and discounts on hearing aids
  • Lifeline Medical Alert Systems - discounted rates for products and services
  • EyeMed discount - discount on eye exams, eyewear, contacts, and laser vision correction
  • Dental discount program - discounts on dental services
  • HumanaFirst - a toll-free nurse advice line
  • Smoking cessation program
  • Weight management discount - through NutriSystem Silver
  • SilverSneakers - provides free gym memberships at selected local fitness center
  • Go 365 - wellness program that rewards you with a healthier lifestyle and other perks
Once you a’re retired and Medicare eligible, you must sign up for Medicare Parts A and B. When you receive your Medicare information, contact ERS to provide your Medicare information and be enrolled in HealthSelect MA PPO. The process works the same way if you a’re retired and your dependent becomes eligible for Medicare. Once your enrollment is complete, you will receive a Welcome Kit directly from Humana providing information on your enrollment date.

If you decide you would like to stay in your current plan at the current premium rate, you wi’ll need to update your Medicare options prior to your start date with HealthSelect MA PPO. To do this, log in to your online account from the ERS website or call ERS at (877) 275-4377. 
Yes. Once your enrollment has been approved, you will receive a new ID card from Humana for HealthSelect MA PPO shortly after you receive your Welcome Kit. If you need to access services and haven’t received your ID card by the plan start date, you can call Humana for your ID and group numbers to give your doctor. If you lose your ID card, you can request a replacement.
Yes. Contact your primary care provider to make sure he or she accepts Medicare and is willing to bill Humana for your medical services. If he or she is not willing to bill Humana, you may pay for your services up front and submit claims to Humana for reimbursement.

Call Medicare toll-free at (800) 633-4227 to find health providers who accept Medicare. 
If you choose not to enroll in HealthSelect MA PPO, you can remain in your current health plan or re-enroll in your previous non-Medicare Advantage Plan as a secondary coverage to Medicare.

You can choose to stay in HealthSelect of Texas® or a health maintenance organization (HMO), but your plan will become secondary to Medicare. Generally, there are higher out-of-pocket costs associated with the plans compared to HealthSelect MA PPO and the monthly premiums are higher for retirees whose premiums are not paid 100% by the state, dependents and survivors.

You are eligible if you are enrolled in Medicare Parts A and B, ERS has your Medicare information on file, and you live in one of the following counties:

  • Brazoria,
  • Chambers,
  • Fort Bend,
  • Galveston,
  • Harris,
  • Liberty,
  • Montgomery or
  • Waller.
Medical coverage is provided through doctors and specialists in the Kelsey-Seybold network. You must use a provider in this network; however, you do not need to designate a primary care provider (PCP) or get referrals to see a specialist.
You can only be enrolled in one Medicare Advantage plan at a time. If you enroll in a GBP Medicare Advantage plan, Medicare will cancel your enrollment in the other Medicare Advantage plan and you will remain on your health plan through the GBP.
Your prescription drug coverage will be HealthSelect Medicare Rx if you enroll in:
  • HealthSelect MA PPO,
  • KelseyCare Advantage HMO or
  • HealthSelect Secondary.
You must be retired and enrolled in Medicare Parts A and/or B. Once you contact ERS with your Medicare information you will be enrolled in HealthSelect Medicare Rx, administered by UnitedHealthcare®. Once enrolled, you will receive a letter directly from UnitedHealthcare that provides information on your benefits and enrollment date. You will also receive a new ID card shortly after you receive the letter. The same process applies if you are retired and have Medicare eligible dependents.
ERS offers Medicare Preparation seminars around Texas and webinars for active employees and retirees approaching Medicare eligibility. Find a seminar near you.