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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. 4.1111(f)] 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 a benefit verification letter eligibility printout from the Social Security Administration (SSA)].

LACERS recommends that you enroll in Medicare Part B three months prior to turning age 65 pursuant to 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 or 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 or 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 Administration (SSA) 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.

If you later decide to reside in the U.S., continued Medicare enrollment should be discussed with the SSA in advance.

Medicare Part B Reimbursement
The Los Angeles Administrative Code Section 4.1113 (b) states that Retired Member and who receive a LACERS medical plan premium subsidy, are enrolled in Medicare Parts A & B, and 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 Medicare Part B premium 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 Medical 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 you are enrolled in LACERS’ Medical Premium Reimbursement Program (MPRP) and your non-LACERS medical plan does not include Medicare Part D, you may enroll in supplemental Medicare Part D insurance in order to maintain creditable coverage.

Medicare Part D IRMAAs
Medicare 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).

Medicare 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 monthly 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 Medical Plan are automatically enrolled in Medicare Part D; their medical plan premiums include the cost of their Medicare Part D basic premiums.

LACERS Senior Medical Plans include:

    • Anthem Blue Cross Life & Health Medicare (Medicare Supplement) Plan (for Retirees with Medicare Parts A & B)
    • Anthem Blue Cross HMO (for Retirees with Medicare Part B Only)
    • Anthem Blue Cross PPO (for Retirees with Medicare Part B Only)
    • SCAN Health Plan (for Retirees with Medicare Parts A & B)
    • UnitedHealthcare Medicare Advantage HMO (for Retirees with Medicare Parts A & B)
    • Kaiser Permanente Senior Advantage (for Retirees with Medicare Part B Only, or with Medicare Parts A & B)

NOTE: You must pay any Medicare Part B and Part D IRMAAs assessed by Medicare. 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.

Termination of your LACERS Medical Plan
If you default on your Medicare Part B premiums and are terminated from your LACERS Medical plan, your and your dependents’ Medicare Part D will also be canceled. Medicare may assess lifetime penalties when you re-enroll in Medicare Part D.

CMS Medicare Plan Requirement
The Centers for Medicare & Medicaid Services (CMS) allows you to have only one Medicare Advantage plan. If you enroll in a Medicare Advantage plan outside of your LACERS medical plan, you may lose your LACERS medical coverage, even if you enroll in a plan from the same insurance company but sponsored by a different organization (for example, the Los Angeles County Employees’ Retirement Association’s Kaiser Permanente Senior Advantage plan).

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 (800) MEDICARE [(800) 633-4227)]; TTY users should call (877) 486-2048, 24 hours a day/7 days a week; or SSA at (800) 772-1213 between 7 a.m. and 7 p.m. Monday through Friday; TTY users should call (800) 325-0778; or your state Medicaid office.

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