Part A: Provides coverage for costs associated with inpatient care in hospitals, skilled nursing facilities, hospice care, and some home health care. Part A has an inpatient hospital deductible for each benefit period.
Part B: Provides coverage for costs associated with doctors' services, durable medical equipment, and outpatient hospital care, such as physical and occupational therapists and some home health care. Most people pay a monthly premium for Part B.
Part D: Provides coverage for prescription drugs, including insulin supplies and certain vaccines.
*Note: Medicare supplemental plans are offered to PEBA retirees to cover the remaining portion of Medicare negotiated costs that Medicare does not pay. You may receive requests from vendors unrelated to the PEBA plan while you are actively employed or retired. Most of these plans may include prescription coverage, thereby, making Part D unnecessary if the prescription coverage is the same or better than Part D offered under Medicare. South Carolina Public Employee Benefit Authority (PEBA) Insurance Benefits, the primary administrator for state employer-sponsored group health insurance plans, offers prescription coverage that is the same as or better than Part D. Therefore, Part D is not necessary if you have secured a plan under PEBA.
Active Employer-Sponsored Group Health Coverage During Medicare Eligibility
If you are an active employee and covered under an employer-sponsored health insurance plan, you may defer enrollment in Part B until that active employer-sponsored group health coverage terminates. Your employer-sponsored insurance plan is your primary insurance, and Medicare is your secondary insurance until you terminate employment. Once you terminate employment, Medicare becomes your primary insurance and Medicare Part B enrollment is required.
If you are an active employee, your spouse is covered under your health insurance plan, and either of you are eligible for Medicare, enrollment in Part A must take place, while enrollment in Part B is deferred until your active employer-sponsored group health coverage ends. Part B enrollment should be completed prior to your termination so that it is effective at the date of termination.
Note: If you are an active employee and you, your covered spouse or your covered child is eligible for Medicare due to a disability, Part A enrollment must occur while deferring enrollment in Part B, until active employer-sponsored group health coverage ends. Your employer-sponsored insurance plan is your primary insurance during this time. However, when coverage terminates, Medicare will be primary. At that time, Part B enrollment should be completed prior to your termination.
If you and/or your covered spouse/child is Medicare eligible as a result of end-stage renal disease (ESRD) and have ended or are ending your 30-month coordination period, please notify PEBA Insurance Benefits within 31 days of your eligibility end date by forwarding a copy of your Medicare Card. At the conclusion of the 30-month coordination period for ESRD, Medicare will become your primary insurance (regardless of your active group insurance participation), and you will need to ensure that you are enrolled in Part B.
Leaving Active Employment After Age 65
The Social Security Administration has special enrollment guidelines for employees ending active employment after age 65. You should contact the Social Security Administration at least 90 days before you terminate employment to ensure that you and/ or your covered spouse/child's Medicare Part A and Part B coverage begins at the point of employment termination.
The Social Security Administration will provide you with a special enrollment form to be completed by the Benefits office or your Campus HR Representative. Please check with the Social Security Administration to ensure you are enrolled in Medicare Parts A and B. Enrollment in Medicare Parts A and B should be in place at the time of termination because Medicare becomes primary as of the date active employer-sponsored group health coverage terminates. If you and/or your covered dependent(s) are military and enrolled in TRICARE, please consult your military installation for assistance.
You may want to explore Medicare supplemental coverage which will assist with costs not covered by Medicare. If you qualify for retiree insurance offered through SC PEBA, Medicare supplemental coverage is offered. Enrollment must take place within 31 days of the date active employer-sponsored group health coverage ends. Upon enrollment in the Medicare Supplemental Plan, coverage for any covered health plan member not covered by Medicare will default to the Standard Plan.
Enrollment in both Medicare Parts A and B are necessary to receive full benefits of Medicare coverage in conjunction with any Medicare Supplemental Plan. Opting out of Medicare after leaving employment will require the impacted party to provide payment for the costs that were not covered as a result of opting out of Medicare Parts A and/or B.
Returning to Employment and Employer-Sponsored Group Health Coverage Eligibility
According to Federal law, when you return to employment and active employer-sponsored group health coverage is offered, Medicare coverage becomes secondary and the employer-sponsored coverage becomes primary. If benefits are not provided when you return to employment, your retiree group coverage (if applicable) continues as your primary insurance, and no adjustments need to be made with the Social Security Administration.
In contrast, if employer-sponsored health coverage is offered, the decision to opt out may be detrimental because Medicare will generally consider the coverage to be primary and consequently, will not pick up costs for services incurred under that coverage. If you are returning to work and will be offered employer- sponsored group health coverage, it is recommended that retiree coverage be suspended temporarily and enrollment within 31 days of coverage with the active employer-sponsored group health coverage takes place. The Social Security Administration should be contacted to defer Medicare coverage during this time.
Should there be a return to work and a change in status to allow election of active employer-sponsored group health coverage, the following benefits are available:
- Health coverage
- Dental coverage
- Vision coverage
- Basic, Dependent, and Optional Life coverage
- MoneyPlus Flexible Spending Accounts (You must have completed one year of continuous state-covered service by January 1 after the October enrollment to qualify for a Medical Spending Account. This time should be established as of the date you return to work.)
- Basic and Supplemental Long Term Disability coverage
When active employer-sponsored group health coverage ends, reenrollment in retiree coverage needs to take place within 31 days of the termination from active group coverage. Additionally, the Social Security Administration should be notified to initiate reenrollment in Medicare Part B coverage in the event it was dropped as a result of this circumstance.