Medicare and Your State of Texas Health Plan
Understanding Medicare
Medicare is the federally funded health insurance program for people age 65 and older, or for individuals under age 65 who receive certain Social Security Administration (SSA) disability benefits or have end-stage renal disease.
Medicare’s four parts cover different health care services:
- Part A is free for most people and covers hospitalizations, skilled nursing facilities, hospice and home health care.
- Part B covers medical services other than hospitalization, such as doctor visits, as well as some preventive services and screenings. It has a monthly premium that is deducted from your SSA payment. (If you aren’t drawing your SSA benefit, you can be billed or have the amount automatically deducted from your bank account.)
- Part C (Medicare Advantage plans) combines Parts A and B (and sometimes Part D) and is managed by private insurance companies approved by Medicare.
- Part D helps cover outpatient prescription drugs.
When should you enroll in Medicare?
View the situation below that applies to you.
If you work for a state agency or higher education institution that participates in the Texas Employees Group Benefits Program (GBP)
When eligible, you should enroll in free Medicare Part A. While you are working, Medicare Part A hospitalization coverage is secondary to your state health insurance. You can delay your enrollment in Medicare Part B until about 90 days before your retirement date.
Note: If you are not eligible for free Medicare Part A, SSA will send you a letter explaining the reason. Upon retiring, send a copy of this notification directly to your health plan administrator so they know they should be the primary payer on claims submitted for Medicare Part A services. If you are not eligible for free Medicare Part A, you can still enroll in Medicare Part B through the SSA.
Split households
The above also applies if you are actively working and a dependent covered on your state health insurance becomes eligible for Medicare.
Three months before your retirement date
If you are not enrolled in Medicare, you should enroll in Parts A and B 90 days before your retirement date. This allows time for your coverage to become effective the first of the month following your retirement date.
When you are retired and you are eligible for Medicare, it becomes your primary coverage. Medicare pays your eligible medical expenses and your state insurance pays secondary. If you do not enroll in Medicare, you will pay most or all of the amount Medicare would have paid.
Once you’ve enrolled in Medicare
Call ERS (or log in to your ERS OnLine account) to provide us with the information located on your Medicare ID card. ERS will confirm your enrollment in Medicare Parts A and B and start the process to enroll you in the HealthSelectSM Medicare Advantage Plan, preferred provider organization (MA PPO), administered by UnitedHealthcare.
Important: Until ERS receives your Medicare information, we cannot begin the process to enroll you in HealthSelect MA PPO. Plan ahead: The process can take 30 to 60 days before your HealthSelect MA PPO coverage begins. During this period, you will be enrolled in HealthSelectSM Secondary. If you need to access medical benefits while enrolled in HealthSelect Secondary, you will be charged a $200 deductible.
HealthSelect MA PPO is a Medicare Part C plan that combines Medicare Parts A and B with your state health insurance. It provides additional group benefits you may not receive with Medicare alone and covers most or all of your medical expenses.
If you don’t provide your Medicare information to ERS
If you were enrolled in HealthSelect of Texas® and are eligible for Medicare, and you don’t provide ERS with your Medicare information to enroll in HealthSelect MA PPO, or, if you choose to opt out of HealthSelect MA PPO, you are enrolled in HealthSelect Secondary. This plan pays secondary to Medicare, but it is not a Medicare Part C plan. It generally costs more than HealthSelect MA PPO and has a $200 deductible based on the calendar year.
Enrollees in HealthSelect MA PPO and HealthSelect Secondary continue to pay Medicare Part B premiums to the SSA.
HealthSelect MA PPO and HealthSelect Secondary enrollees also are enrolled in HealthSelectSM Medicare Rx Part D prescription drug coverage administered by UnitedHealthcare®. There is no additional premium for this coverage through the GBP.
If you are no longer an active employee, you should sign up for Medicare Parts A and B as soon as you are eligible. Medicare pays your eligible medical expenses and your state insurance pays secondary. If you do not enroll in Medicare, you will pay most or all of the amount that Medicare would have paid. If you delay enrollment in Medicare, SSA may also assess a late enrollment penalty if you attempt to enroll at a later date.
Once you’ve enrolled in Medicare
Call ERS (or log in to your ERS OnLine account) to provide us with the information located on your Medicare ID card. ERS will confirm your enrollment in Medicare Parts A and B and start the process to enroll you in the HealthSelectSM Medicare Advantage Plan, preferred provider organization (MA PPO), administered by UnitedHealthcare.
Important: Until ERS receives your Medicare information, we cannot begin the process to enroll you in HealthSelect MA PPO. Plan ahead: The process can take 30 to 60 days before your HealthSelect MA PPO coverage begins. During this time, you will be enrolled in HealthSelectSM Secondary. If you need to access medical benefits while enrolled in HealthSelect Secondary, you will be charged a $200 deductible.
HealthSelect MA PPO is a Medicare Part C plan that combines Medicare Parts A and B with your state health insurance. It provides additional group benefits you may not receive with Medicare alone and covers most or all of your medical expenses.
If you don’t provide your Medicare information to ERS
If you were enrolled in HealthSelect of Texas and are eligible for Medicare, and you don’t contact ERS with your Medicare information to enroll in HealthSelect MA PPO, or, if you choose to opt out of HealthSelect MA PPO, you are enrolled in HealthSelect Secondary. This plan pays secondary to Medicare, but it is not a Medicare Part C plan. It generally costs more than HealthSelect MA PPO and has a $200 deductible based on the calendar year.
Enrollees in HealthSelect Medicare Advantage and HealthSelect Secondary continue to pay Medicare Part B premiums to the SSA.
HealthSelect Medicare Advantage and HealthSelect Secondary enrollees also are enrolled in HealthSelectSM Medicare Rx Part D prescription drug coverage administered by UnitedHealthcare. There is no additional premium for this coverage through the GBP.
If you have received SSA disability benefits for at least 24 months or you have end-stage renal disease (ESRD), you may be eligible for Medicare before age 65.
You should sign up for Medicare Parts A and B when you are first eligible. As your primary coverage, Medicare pays your eligible expenses and your state insurance pays secondary. If you do not enroll in Medicare, you will pay most or all of the amount that Medicare would have paid. SSA may also assess a late enrollment penalty if you attempt to enroll at a later date.
Once you’ve enrolled in Medicare
Call ERS (or log in to your ERS OnLine account) to provide us with the information located on your Medicare ID card. ERS will confirm your enrollment in Medicare Parts A and B and start the process to enroll you in the HealthSelectSM Medicare Advantage Plan, preferred provider organization (MA PPO), administered by UnitedHealthcare.
Retirees and/or dependents with end-stage renal disease (ESRD) are eligible to enroll in HealthSelect MA PPO only after their 30-month coordination period with Medicare has ended.
Important: Until ERS receives your Medicare information, we cannot begin the process to enroll you in HealthSelect MA PPO. Plan ahead: The process can take 30 to 60 days before your HealthSelect MA PPO coverage begins. During this time, you will be enrolled in HealthSelectSM Secondary. If you need to access medical benefits while enrolled in HealthSelect Secondary, you will be charged a $200 deductible.
HealthSelect MA PPO is a Medicare Part C plan that combines Medicare Parts A and B with your state health insurance. It provides additional group benefits you may not receive with Medicare alone and covers most or all of your medical expenses.
If you don’t provide your Medicare information to ERS
If you were enrolled in HealthSelect of Texas and are eligible for Medicare, and you don’t contact ERS with your Medicare information to enroll in HealthSelect MA PPO, or, if you choose to opt out of HealthSelect MA PPO, you are enrolled in HealthSelect Secondary. This plan pays secondary to Medicare, but it is not a Medicare Part C plan. It generally costs more than HealthSelect Medicare Advantage and has a $200 annual deductible based on the calendar year.
Enrollees in HealthSelect MA PPO and HealthSelect Secondary continue to pay Medicare Part B premiums to the SSA.
HealthSelect MA PPO and HealthSelect Secondary enrollees also are enrolled in HealthSelectSM Medicare Rx Part D prescription drug coverage administered by UnitedHealthcare. There is no additional premium for this coverage through the GBP.
How to enroll in Medicare Parts A and B
To enroll in Medicare, visit www.ssa.gov or call the SSA toll-free at (800) 772-1213, or TTY users call (877) 325-0778.
Should I enroll in Medicare Part D?
No. Medicare-eligible retirees, dependents and survivors who are enrolled in Medicare Parts A and/or B, as well as either HealthSelect MA PPO or HealthSelect Secondary, have prescription drug coverage through HealthSelect Medicare Rx. This plan is as good as or better than most private Medicare Part D plans.