Medicare

Medicare

Medicare is the federally funded health insurance program for people who are:

  • age 65 or older,
  • certified as medically disabled by the Social Security Administration (SSA) or
  • of any age with end-stage renal disease (ESRD) or Lou Gehrig’s disease.

Medicare’s four parts cover different health care services:

  • Part A helps cover hospitalization, skilled nursing facilities hospice and home health care.
  • Part B helps cover medical services like doctor visits and outpatient care. Part B also covers some preventive services including screenings and vaccines, and some durable medical equipment like wheelchairs and walkers. Medicare Part B has a monthly premium.
  • Part C refers to Medicare Advantage plans that are managed by private insurance companies approved by Medicare. Part C plans combine Part A, Part B and sometimes Part D coverage and must cover medically necessary services.
  • Part D helps cover outpatient prescription drugs. Part D may help lower your prescription drug costs and protect against higher costs in the future.

You are eligible for Medicare when you turn 65. Generally, you should sign up for Medicare as soon as you are eligible. When you choose to enroll may depend on whether you are covered by another health plan (such as the Texas Employees Group Benefits Program (GBP)) or whether you are certified as disabled by the Social Security Administration (SSA). 

Regardless, it’s important to plan ahead. View Medicare and Your State of Texas Health Plan for guidance about when to enroll based on your situation. ERS also offers Medicare Preparation seminars and webinars. View a schedule of Medicare Preparation Seminars on the ERS Events page. 

To enroll in Medicare, visit www.ssa.gov or call the Social Security Administration toll-free at (800) 772-1213, TTY: (877) 325-0778.

Yes, but your timeframe for enrolling in each depends on whether you are retired or still working at age 65.

In most cases, if you are drawing Social Security Administration (SSA) benefits, you will be automatically enrolled in Medicare Part A and Part B. The coverage is effective the first day of the month you turn 65.

If you are retired but not getting SSA benefits, contact SSA to enroll in Medicare Parts A and B during your initial enrollment period. This seven-month period begins three months before your 65th birthday and continues for three months after your birthday month. (Consider contacting the SSA in the three months before your birthday to avoid any delay in coverage.) Read more at Medicare and your State of Texas Health Plan.

If you still work for a state agency or higher education institution when you turn 65 and have medical insurance benefits through the Texas Employees Group Benefits Program (GBP), you should sign up for free Medicare Part A when you are eligible. You can delay your Part B enrollment. 

When you are getting ready to stop working, contact the SSA to enroll in Part B. They will provide a form to verify your employment status. (If you are retired and do not enroll in Part B when you are first eligible, you may be subject to a late enrollment penalty if you attempt to enroll later.)

If you are under age 65 and are certified as disabled by the SSA, you may be automatically enrolled in Medicare Part A and Part B after you’ve received SSA disability payments for 24 months.

Medicare Advantage plans, also known as Medicare Part C plans, are managed by private insurance companies approved by Medicare. These plans combine Medicare Part A, Part B and sometimes Part D coverage. They may provide extra benefits not provided by Medicare Parts A and B. 

If you are enrolled in a Medicare Advantage plan, you continue your enrollment in Parts A and B and pay Part B premiums.

There typically is no cost for Medicare Part A.

Medicare Part B has a monthly premium. The amount you pay for Medicare Part B and Part D (if applicable) is based on the income reported on your most recent tax return (your modified adjusted gross income). If you have an income that is higher than the threshold set by Medicare, you will pay extra. This is called the income-related monthly adjustment amount, or IRMAA. ERS does not pay IRMAA premiums. For questions about how your Medicare premiums are calculated, contact the Social Security Administration (SSA) toll-free at (800) 772-1213 or go to www.ssa.gov.

If you participate in a Texas Employees Group Benefits Program (GBP) health plan, you must continue paying your Medicare Part B premium and, if applicable, Part D premium to the federal government.

Find detailed information on the premiums for Medicare Part B and Part D in the Medicare & You handbook on the Medicare website.

If you are retired and you are eligible for Medicare, it becomes your primary coverage and is applied to your medical expenses before your retiree state insurance.

If you do not sign up for Medicare Parts A and/or B when you are first eligible, you will pay most of your out-of-pocket health care costs for Parts A and B services that Medicare would have paid. Also, the Social Security Administration (SSA) may add a penalty to your monthly premium if you are retired and do not enroll in Part B when you are first eligible. See Question 4: Do I need to enroll in both Medicare Parts A and B?

Important: Contact ERS as soon as you receive your Medicare ID card. Log in to your ERS OnLine account and click “Medicare Information,” or call us toll-free at (877) 275-4377 and say “Medicare number” when prompted, to provide your Medicare Beneficiary ID and the effective dates of your Medicare Parts A and B.
 

Your Medicare premium is automatically deducted from your Social Security Administration (SSA) payment. If you aren’t drawing your SSA benefit, you are billed every three months, or you can set up Medicare Easy Pay and have the premium deducted directly from a bank account.

If you need assistance paying your Medicare premium, contact the SSA toll-free at (800) 772-1213.

Retirees, dependents and survivors who are enrolled in Medicare will be enrolled in the HealthSelectSM Medicare Advantage Plan preferred provider organization (MA PPO), a Medicare Part C plan offered by ERS and administered by Humana. See HealthSelect Medicare Advantage for Retirees. When you are retired and eligible for Medicare, it is considered your primary coverage and your state insurance pays secondary.

If you 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 HealthSelectSM Secondary for Retirees. HealthSelect Secondary includes a $200 annual deductible, based on the calendar year. (If you were enrolled in an HMO, you will remain enrolled in your HMO as secondary coverage to Medicare.)

If you’re retired, enrolled in Medicare Parts A and B and have provided your Medicare information to ERS, you are eligible for the HealthSelectSM Medicare Advantage Plan preferred provider organization (MA PPO), a Medicare Part C plan administered by Humana. In addition to medical coverage, HealthSelect MA PPO offers no-cost gym memberships and an array of extra benefits and wellness programs. View HealthSelect Medicare Advantage Plan Extra Benefits.

To be eligible for HealthSelect MA PPO, retirees, survivors and their dependents must be:

  • 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: Eligible dependents (spouse and/or disabled children) enrolled in Medicare must have the same health plan.

Retirees who return to work for the state or a higher education institution in a benefits-eligible position are not eligible for HealthSelect MA PPO. As a return-to-work retiree, your coverage reverts to your previous non-Medicare Advantage health plan and prescription drug coverage.

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.

 
After you sign up Medicare Parts A and B, contact ERS to provide your Medicare Beneficiary Identifier number (located on your Medicare card). ERS will enroll you in HealthSelectSM Medicare Advantage Plan preferred provider organization (MA PPO). Do the same for a covered dependent who becomes eligible for Medicare. Humana, administrator of HealthSelect MA PPO, will send you a Welcome Kit with details about your coverage and premium.

If you want to stay in your current plan at the current premium rate, you will need to update your Medicare options before your start date with HealthSelect MA PPO. To do this, log in to your ERS OnLine account and click “Medicare Plan Options” to opt out of HealthSelect Medicare Advantage, or call ERS at (877) 275-4377.  

Yes. Humana will send your HealthSelectSM Medicare Advantage Plan ID card shortly after you get your Welcome Kit. If your coverage has started and you need health care services, but you don’t have your ID card, call Humana to request your ID and group number to give your doctor. 

If you lose your ID card, you can request a replacement. 

Check with your primary care provider to make sure he or she accepts Medicare. If he or she does not bill Humana, you may have to pay for your services up front and submit a claim 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 HealthSelectSM Medicare Advantage Plan, you can remain in your current health plan or re-enroll in your previous non-Medicare Advantage Plan. This coverage is secondary 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.

No. Medicare-eligible retirees, dependents and survivors who are enrolled in Medicare Parts A and/or B, as well as HealthSelectSM Medicare Advantage Plan, HealthSelectSM Secondary or KelseyCare Advantage HMO have prescription drug coverage through HealthSelectSM Medicare Rx. This plan, administered by UnitedHealthcare®, is as good as or better than many private Medicare Part D plans. You must be enrolled in Medicare Parts A and/or B to be eligible for Medicare Part D.

If you remain enrolled in Community First Health Plans or Scott and White Care Plans after you enroll in Medicare, you will have prescription drug coverage through those plans.

Once you have enrolled in Medicare, contact ERS with your Medicare information (located on your Medicare card) to begin the enrollment process for HealthSelect Medicare Rx. The same process applies if you are retired and have Medicare-eligible dependents.  

UnitedHealthcare will send you information about your benefits and enrollment date, and shortly after, a plan ID card. 

Read details and answers to questions about HealthSelect Medicare Rx at HealthSelect Medicare Rx FAQs.

You can opt out of HealthSelect Medicare Rx coverage. If you do, you won’t have prescription drug coverage through the Texas Employees Group Benefits Plan (GBP). ERS recommends you sign up for a private Part D plan within 63 days of ending your GBP prescription drug coverage. If you delay enrolling in Part D coverage, you may be subject to a penalty from the Social Security Administration. 

You can only be enrolled in one Medicare Advantage plan at a time. If you enroll in a Medicare Advantage plan through the Texas Employees Group Benefits Program (GBP), Medicare will cancel your enrollment in the other Medicare Advantage plan and you will remain on your health plan you have through the GBP.

If you live in one of the following southeast Texas counties, and you are enrolled in Medicare Parts A and B (and ERS has your Medicare information), you are eligible for KelseyCare Advantage HMO.

  • Brazoria
  • Chambers
  • Fort Bend
  • Galveston
  • Harris
  • Liberty
  • Montgomery
  • Waller
Medical coverage is provided through doctors and specialists in the Kelsey-Seybold network. You must use a provider in this network. You do not need to designate a primary care provider (PCP) or get referrals to see a specialist. 
ERS offers Medicare Preparation seminars and webinars for active employees and retirees approaching Medicare eligibility. See a list of upcoming Medicare Preparation sessions.