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All HSS members who are eligible for Medicare are required to enroll in Medicare Part A & Part B.

Health Service System rules require enrollment in both premium-free Medicare Part A and Medicare Part B by all eligible retired members and any enrolled, eligible dependents of a retired member. (There is a premium due to the federal government for Medicare Part B.) Failure by you or your enrolled dependents to comply with HSS rules regarding Medicare enrollment by required deadlines will mean a change in, or loss of, medical plan coverage.

What Is Medicare?

Medicare is a federal government health insurance program for people age 65 years or older and for people under age 65 with Social Security-qualified disabilities or End Stage Renal Disease. Medicare has three parts that are important for you to understand. Medicare Part A is hospital insurance. Part B covers the cost of physician and other outpatient medical services. You must pay a monthly premium to the Social Security Administration for Medicare Part B. Medicare Part D provides prescription drug coverage. There are two types of Part D coverage - individual and group.

How do I know if I qualify for Medicare?

If you’re receiving Social Security benefits, the Social Security Administration will notify you prior to your 65th birthday regarding your eligibility for Medicare. For information about Medicare eligibility and enrollment, call the Social Security Administration, the federal agency responsible for handling Medicare. You can reach them at (800) 772-1213 (TTY: (800) 325-0778) or visit them at the office most convenient for you. You can also obtain information from the Social Security Administration’s official website at www.ssa.gov.

  • If you’re not currently receiving Social Security benefits, it’s your responsibility to contact the Social Security Administration prior to your 65th birthday to apply for Medicare. Failure to do so could result in penalties being assessed by the Social Security Administration and the Health Service System.
  • If you are under age 65, but have a Social Security-qualified disability or kidney disease requiring hemodialysis or transplant, you must contact the Social Security Administration to apply for Medicare.

What are the Health Service System rules for Medicare participation?

Anyone who is retired, enrolled in an HSS medical plan and eligible for Medicare due to age or disability is required to enroll in premium-free Medicare Part A and Medicare Part B. (There is a premium for Medicare Part B.) It is your responsibility to notify HSS about your Medicare eligibility and enrollment status.

What if I’m not eligible for Medicare Part A?

You must submit a statement to HSS from the Social Security Administration indicating that you’re not eligible for premium-free Medicare Part A (hospital) coverage. We will update our records accordingly. HSS still requires that you enroll in Medicare Part B, regardless of your eligibility status for non-contributory (free) Medicare Part A.

What if I didn’t enroll in Medicare Part B when I was originally eligible?

If you did not enroll in both parts of Medicare when you attained the age of 65, or upon retirement after age 65, you may be assessed a penalty by the Social Security Administration for each year in which you failed to enroll when eligible. Nevertheless, you’re still required to enroll in Medicare in accordance with the Health Service System rules.

What if I don’t enroll despite HSS rules?

If you’re a retired HSS member and eligible for Medicare but don’t enroll, you will lose your current medical plan coverage. You will automatically be enrolled in the City Health Plan 20 until you provide proof of Medicare enrollment to HSS. Under the City Health Plan 20, your out-of-pocket costs will significantly increase. You will be responsible for paying the 80% that Medicare would have paid for any Medicare eligible claims, plus any amounts above usual and customary fees. In addition, your yearly out-of-pocket limits will increase to $10,950.

What if I am retired, but my enrolled eligible dependent does not enroll despite HSS rules?

If your enrolled eligible dependent is eligible for Medicare but does not provide proof of enrollment to HSS, medical plan coverage for that dependent will be terminated.

What if I am an active employee, but my enrolled eligible dependent is eligible for Medicare?

Opposite sex spouses of active employees have the option, but are not required, to enroll in Medicare when they become eligible, so long as they are covered on the active employee's medical plan. When the employee retires, the opposite sex spouse is then required to enroll in Medicare Part A and Part B. A same sex spouse or domestic partner (of either gender) must enroll, and remain enrolled, in premium-free Medicare Part A and Part B upon reaching age 65, or sooner, due to End-Stage Renal Disease or disability. A same sex spouse or domestic partner who fails to enroll in Medicare when eligible may be charged significant late enrollment penalties by the federal government.

What if I’m a Kaiser member?

If you are eligible, you must enroll in non-contributory Medicare A and Medicare Part B. (There is a premium for Medicare Part B.) In addition, you must enroll in the Kaiser Senior Advantage Plan. If you fail to do so, your healthcare coverage will be terminated by Kaiser. HSS will then automatically enroll you in the City Health Plan 20. Under the City Health Plan 20, your out-of-pocket costs will significantly increase. You will be responsible for paying the 80% that Medicare would have paid for any Medicare eligible claims, plus any amounts above usual and customary fees. In addition, your yearly out-of-pocket limits will increase to $10,950. Contact Kaiser for more information about enrolling in Senior Advantage: (800) 443-0815.

What if I’m a Blue Shield member?

Blue Shield members must enroll in Medicare Part A and Medicare Part B as soon as they are eligible.

In addition, you must enroll in the Blue Shield of California 65 Plus (Medicare Advantage) plan if you permanently reside in a zip code serviced by this plan. When you are enrolled in Blue Shield 65 Plus, you assign your Medicare benefits to the plan. You must obtain service from within the Blue Shield network of providers. If you seek medical services outside the HMO network those services will not be covered by Medicare or Blue Shield. 65 Plus includes enhanced group Medicare Part D prescription drug coverage.

Some Medicare eligible Blue Shield of California enrollees may permanently reside in a service area not covered by Blue Shield 65 Plus. These members will be enrolled the Blue Shield Access+ (Medicare Coordinated) plan and will not assign Medicare benefits to Blue Shield. In this case, if you go outside the Blue Shield network Medicare benefits will apply and you will be responsible for costs not covered by Medicare. Participants in this plan are required to enroll in Blue Shield of California Medicare Rx, an enhanced group Medicare Part D plan. This group Part D prescription drug plan is part of your HSS administered coverage.

If you’re 65 years old and are eligible for both Medicare Part A and Part B but don’t enroll in both parts, your healthcare coverage will be terminated by Blue Shield and the Health Service System will automatically enroll you in the City Health Plan 20. Under the City Health Plan 20, your out-of-pocket costs will significantly increase. You will be responsible for paying the 80% that Medicare would have paid for any Medicare eligible claims, plus any amounts above usual and customary fees. In addition, your yearly out-of-pocket limits will increase to $10,950.

What about Medicare Part D?

Do not enroll in an individual Medicare Part D plan. The medical plan you and your dependents are enrolled in through the Health Service System includes groupr Part D prescription drug coverage that is better than the available individual Medicare Part D coverage. In order to be able to continue to offer you such coverage, it is important that you and your dependents do not enroll in an individual Medicare Part D plan. If you do enroll, the Health Service System will not benefit from CMS subsidies that are helping us to offer you better coverage at a reasonable cost, and you will jeapordize your enrollment in your HSS retiree medical plan.