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The Transition to Medicare Advantage Plans at Age 65
for STRS Retirees
by Bill Threlfall
Fall 2009
 I am about to turn 65, and as an STRS retiree, I
thought I'd share my recent experience preparing for the transition to
Medicare plus a District-funded Medicare-Advantage HMO and Medicare
prescription drug plan. In my circumstances, this event involved a
blizzard of paperwork and a certain amount of confusion.
For many years, I had expected that I would never
make this transition because I was not eligible for Social Security
benefits based on my earnings record, which included mostly STRS-related
income. To my surprise, I found that I was nevertheless eligible for
both Social Security benefits and Medicare based on my spouse's earning
record.
As I set out to apply, here's what I learned:
(If
you've been paying better attention than I did, you may already know
most of this.)
Medicare has several parts:
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Part A – Hospital Insurance. Most people
eligible for Social Security benefits don't have to pay for Part A.
-
Part B – Medical Insurance. Optional at extra
cost, but required by the District and your cost is compensated by
the District.
-
Part C - Medicare Advantage Plans – these
combine Part A, Part B, and, usually Part D coverage. The District
provides a Kaiser or Anthem Blue Cross Medicare Advantage plan to
serve you after age 65, replacing your previous Kaiser or Blue Cross
coverage.
-
Part D - Medicare prescription drug coverage.
The District's Medicare Advantage plan will include part D coverage.
You don't need to try to select one of these plans yourself.
The District requires you to apply for Medicare for
yourself and for your spouse or domestic partner during the initial
Medicare enrollment period.
Your initial enrollment period starts three
months before you turn 65. Penalties may result if you enroll late. Even
if you are not eligible for Medicare based on your own earnings, you may
be eligible as a dependent of your eligible spouse.
You can't apply for Medicare online.
There is no online application form
or process, although you apply for Social Security benefits online.
After you are determined to be eligible for Social Security benefits,
your Medicare enrollment will occur automatically. About 3 months before
you turn 65, you'll get a Medicare card in the mail.
Of course, all my annual Social Security reports advised that I was
not
eligible for benefits, so I did not expect to receive a Medicare
enrollment package without taking some special action.
If you are not Social Security eligible but your spouse is, you'll need
to apply for Social Security benefits based on your spouse's earning
records.
However, if you complete the online application for Social
Security benefits, you'll discover that applying on the basis of your
spouse's record is impossible. You enter your spouse's name, SSN,
marriage date & location, but nowhere is there an option to use the
spouse's earnings to determine eligibility. Apparently you need to make
an appointment at your local office to perform this unusual sort of
application.
Not anticipating this limitation, I completed my application for Social
Security benefits online. I included a remark that I was attempting to
determine my eligibility for Medicare on the basis of my spouse's
record. A few weeks after submitting my application, I received a
telephone call from a Social Security representative at the local
office, who was able to modify my online application information so that
it was based on spousal contributions. Success was achieved, even though
I had taken the wrong approach by applying online.
A few weeks later, I received a cheerful letter from Social Security
indicating that my application for spouse's benefits had been approved.
However, it noted that benefits would "not be paid because two-thirds of
the amount of my STRS pension is larger than my monthly Social Security
benefit". This statement reflects the "Government Pension Offset"
described in
this CalSTRS document. I expected that result, but the
approval letter meant I had been found eligible for Medicare as a
dependent of my spouse, though it did not explicitly say so. Sure
enough, a few months before I turned 65, I received the "Welcome to
Medicare" package with my Medicare ID and part B card.
Bottom line: If you need to apply based on your spouse's earnings (and
many STRS retirees will need to take this course), you
should apply at your local office rather than online.
Be sure to enroll in Medicare part B by keeping your Medicare parts A &
B card you receive in your "Welcome to Medicare package".
The District
requires that you enroll in part B. At age 65, your existing medical
plan will be changed to a Medicare advantage plan incorporating parts A,
B and D, and the District will reimburse you for the monthly cost of
your Medicare part B enrollment.
Don't apply for Medicare part D! (a prescription drug program)
If the
District has provided prescription drug coverage to you before age 65,
the new plan may include part D to provide similar prescription drug
coverage, but you don't need to enroll in one on your own; doing so may
cause conflicts with the District program, and these can be difficult to
resolve.
Resist mail solicitations for Medicare supplement or advantage programs.
You'll likely receive mail pitches to sign up for various programs as
you approach your 65th birthday. Don't! Again, doing so may cause
conflicts with the District program.
If you receive an STRS pension, you can arrange to have STRS pay your
Medicare part B bill and deduct the payments from your pension.
STRS
will mail the necessary form HB-0986 to you automatically as you
approach age 65. Don't pay your part B bill, just return a copy of it to
STRS along with form HB-0986. This convenience option eliminates the
need to write a quarterly check for your Medicare part B bill.
Expect a paper blizzard and misdirection.
About the same time you
receive your "Welcome to Medicare" package, the District will send you
the appropriate forms to create you enrollment in your new Medicare
Advantage program. Easy to complete, but these forms will trigger
changes with your insurance provider and a possible consequent onslaught
of letters, booklets, and membership identifications.
 For example, in the last three weeks, my wife and I
actually received 14
Anthem Blue Cross cards, 10 plan booklets (including duplicates and
inapplicable plans), and three "Thank you for enrolling in Blue Cross MedicareRX" letters. All of the ID cards
were supplied with a letter that
says to destroy your old card and immediately begin presenting the new
one. Clear enough, but my new cards won't be effective until my Medicare
effective date, five weeks in the
 future. Until then I can only use the
"old card" which I was instructed to destroy. Even more confusing, some
of my wife's new cards are effective now while others must await her
Medicare effective date some two months away, and there is no indication
of these dates on the cards or attached letters. I was only able to
discern which cards to use by noting the card's group number and comparing it to the old group for me and my wife. Be prepared for
confusion and don't destroy the old cards as directed.
If you are in doubt about anything, contact the District HR staff before
taking action. There are many different plans and circumstances that
necessitate individualized advice. And buy a bigger file cabinet…
After the transition, three ID cards will replace your old medical card.
You'll need to carry your government Medicare card, your Medicare
Advantage medical card (parts A&B) and your Medicare RX prescription
drug card (part D). Now you need a fatter wallet…
back
Retiree Medical Benefits - District Position
Spring 2007
 On
January 23, 2007, the District announced a
decision not to change
existing benefits for most retirees. The Chancellor's action letter is available
here.
Read the February 2, 2007 Hayward
Daily Review article regarding the District's action.
During the past months, the CARE board has taken an active role in
monitoring developments and defending the current status of retiree medical benefits,
and we are pleased by the District's decision. Glenys Wilson has done
her usual great job for us, and John McKinley and Past President Art
Larson have continued their efforts. In addition, Sharon Trethan,
with her broad knowledge of district operations, has been an invaluable
resource. We are so lucky to have people of this caliber working
on our behalf!
Read the CARE President's letters to the
CLPCCD Board and
CLPFA President
regarding the health benefits issue and actions.
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