LACERS - Age 65 Medicare Enrollment Requirement

Medicare Enrollment Requirement

Turning Age 65

In order to qualify for a LACERS medical plan premium subsidy and be eligible for coverage in a LACERS-sponsored medical benefit plan at age 65, the Los Angeles Administrative Code (Sec. 4.1103.2) and LACERS Board Rules (HBA 10.0) require retired members, eligible surviving spouses/domestic partners and dependents to:

Enroll in all parts of Medicare (Medicare Part A or Part B or Medicare Parts A and B) for which they are eligible, upon turning age 65; and
Provide proof of enrollment to LACERS [i.e., Medicare card or an eligibility printout from the Social Security Administration (SSA)].

LACERS recommends that you enroll in Medicare Part B three months prior to turning age 65 per Social Security’s enrollment requirements and to prevent a lapse of your LACERS medical coverage. Also, you and your dependent(s) are required to enroll in Medicare Part A, but only if you are eligible for it premium-free (at no cost to you).

Contact Social Security at (800-772-1213/TTY 800-325-0778) for a Medicare enrollment appointment at your local SSA office.

NOTE: You will lose your medical plan premium subsidy and your existing LACERS medical plan coverage if you do not enroll in Medicare by age 65 and maintain your Medicare enrollment. Consider the Medicare Easy Pay Program to avoid a lapse in coverage by calling (800) MEDICARE/800-633-4227 (TTY 877-486-2048).

Exception – Living Outside the U.S.

You may not need to enroll in Medicare if you reside permanently outside the U.S. and its territories. However, Social Security may penalize you if you do not enroll in Medicare by age 65 or allow your Medicare premiums to lapse while living outside the U.S. and later decide to reside in the U.S. Be sure to contact the SSA regarding Medicare rules, regulations or penalties that may affect your medical plan coverage.

Medicare Part B Reimbursement

The Los Angeles Administrative Code (Sections 4.1104 and 4.1104.1) states that retired members enrolled in Medicare Parts A and B who are participating in a LACERS medical plan or the Medical Plan Premium Reimbursement Program (MPRP) may be entitled to reimbursement of their basic Medicare Part B premiums by LACERS. However, other LACERS beneficiaries, such as a spouse, domestic partner, or surviving spouse/domestic partner, are not eligible for this reimbursement.

NOTE: LACERS does not reimburse members for any Medicare Part B premiums if they are enrolled in the Anthem Blue Cross PPO Out-of-Country plan.

Medicare Part B Reimbursement and IRMAAs

As a result of federal legislation which became effective in 2007, higher-income earning Medicare enrollees are now required to pay higher Medicare Part B premiums that consist of the Part B basic premium rate and an Income-Related Monthly Adjustment Amount (IRMAA).

The Los Angeles Administrative Code (Section 4.1104.1) states that:

“Reimbursement shall be paid to such retiree for Medicare Part B basic premium (Medical Insurance for an insured or covered period beginning on or after January 1, 1978, when sufficient proof of the retiree’s enrollment and coverage and of the premium’s payment has been made as required by the Board.”

The Medicare Part B basic premium does not include the IRMAA portion of your premium.

Medicare Part D

Do not enroll in Medicare Part D separate from your LACERS plan. LACERS Senior Plans already include Medicare Part D.

If you enroll in Medicare Part D on your own or through another group plan, LACERS may terminate your LACERS medical coverage.

Exception for MPRP Enrollees

If enrolled in MPRP and your non-LACERS medical plan does not include Medicare Part D, you may enroll in supplemental Medicare Part D insurance.

Medicare Part D IRMAAs

Social Security will charge higher-income Medicare enrollees higher Medicare Part D premiums. As part of their Medicare Part D premiums, these Medicare enrollees are assessed an Income-Related Monthly Adjustment Amount (IRMAA).

Social Security will notify members about their Medicare premiums and whether they are required to pay Medicare Part B and Part D IRMAAs. Social Security notification will refer to Medicare Part D as “your prescription drug coverage.” Social Security will deduct the IRMAA from the Social Security checks of those retirees receiving Social Security benefits. The Centers for Medicare and Medicaid Services will bill retirees who do not receive a Social Security check directly for the IRMAAs.

Members enrolled in a LACERS Senior Plan (e.g. Anthem Medicare Supplement, SCAN, SecureHorizons, or Kaiser Permanente Senior Advantage plan) are automatically enrolled in Medicare Part D and their medical plan premiums already include the cost of their Medicare Part D basic premiums.

NOTE: You must pay any Medicare Part B and Part D IRMAAs assessed by Social Security. Because LACERS requires you to maintain your Medicare enrollment in order to continue receiving your medical plan premium subsidy, failure to pay your IRMAAs will result in the termination of your LACERS medical benefits.

Also, if enrolled in LACERS Medical Premium Reimbursement Program, you may receive reimbursement of your supplemental Medicare Part D basic premium in order to maintain coverage. However, your LACERS reimbursement will not include any IRMAAs.

Medicare Part D Low Income Subsidy

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call CMS (the Centers for Medicare & Medicaid Services) at 1-800-MEDICARE (1-800-633-4227), TTY users should call 1-877-486-2048, 24 hours a day/7days a week; or SSA at 1-800-772-1213 between 7 a.m. and 7 p.m. Monday through Friday, TTY users should call 1-800-325-0778; or your state Medicaid office.

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