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Medicare and Your CalPERS-Sponsored Health Plan
Work Together to Keep You Covered

How Do You Coordinate Benefits?

If you are a retiree, you must take the following steps to coordinate your CalPERS and Medicare benefits:

  • Find out whether you qualify for premium-free Medicare Part A by referring to your or your spouse’s Social Security Statement Letter of Entitlement, or calling the SSA at (800) 772-1213 or TTY (800) 325-0778.
  • If you do not qualify for Part A based on your work or that of a spouse (current, former, or deceased), you may continue your Basic health plan coverage without changes.

Important Reminder

If you or your family members are in a CalPERS-sponsored Medicare plan, you may not change back to the CalPERS Basic plan. This rule does not apply if SSA cancels your Medicare benefits, or you permanently move outside the United States, or you return to work and are eligible for employer group health plan coverage.

  • If you qualify for Part A, you must enroll in Part B as soon as you are first eligible.
  • Complete the CalPERS Certification of Medicare Status form, including your Medicare information, and return it to CalPERS. (You must complete the form even if you are not eligible for Medicare.)
  • Once you are enrolled in Parts A and B, you must then enroll in a CalPERS-sponsored Medicare plan. You may remain in your current health plan or you may select a different plan.

Calculating Medicare Part B Premiums

The Medicare Prescription Drug, Improvement and Modernization Act established new rules for calculating Medicare Part B premiums. Effective January 1, 2007, the SSA began basing Part B premiums on individual annual incomes. This means that Medicare beneficiaries with higher incomes will pay higher Part B premiums. This process is referred to as the Medicare Part B
Income Related Monthly Adjustment Amount (IRMAA). The SSA will notify you annually of your new Part B premium based on your income.  If you are a State annuitant, and you or your family member is enrolled in a CalPERS Medicare plan, California law requires CalPERS to reimburse you for a portion of your Medicare Part B premiums. This payment may not exceed the difference between the maximum employer contribution and the amount of premium for the health plan in which you are enrolled, or the Part B premium, whichever is lower.  If you are a State annuitant who is impacted by IRMAA, and you might qualify for an additional Medicare Part B reimbursement, please notify us. Make a photocopy of the entire SSA notice and mail it to:

CalPERS
Office of Employer and Member Health Services
Medicare Program
P.O. Box 942714
Sacramento, CA 94229-2714
Submit the new information to CalPERS each year and any time your income level changes.

CalPERS, Medicare, and Your Prescription Drug Plan

Medicare Part D is the federal voluntary outpatient prescription drug benefit that was added to the Medicare program beginning January 1, 2006. As a CalPERS Medicare health plan member, you already have prescription drug coverage, so you do not need to enroll in an external Medicare Part D plan. If you do enroll in a non-CalPERS Medicare Part D plan, you will lose your CalPERS health coverage.

For most CalPERS health plans, CalPERS applies for a Retiree Drug Subsidy for each retiree enrolled in Medicare Part A and/or Part B. The Retiree Drug Subsidy helps CalPERS offset your prescription drug costs and provide prescription drug coverage that is, for most members, as good as or better than non-CalPERS Medicare Part D prescription drug coverage.

Note: CalPERS does not apply for a Retiree Drug Subsidy for members enrolled in Kaiser’s Senior Advantage plan and its Medicare Advantage Prescription Drug plan.  Since Kaiser is a Medicare Advantage plan, CalPERS Kaiser members sign one election form and receive all health care services, including prescription drug benefits, through CalPERS Kaiser Permanente Senior Advantage Plan.

In order for CalPERS to receive the federal subsidy, and provide those drug benefits to Medicare enrollees, Medicare health plan members may not be enrolled externally in a Medicare Part D prescription drug plan.

Here are some important reminders about Medicare Part D:

  • When you retire, if you or your spouse is covered by another health plan that includes Medicare Part D Prescription Drug Plan benefits, you must first cancel your non-CalPERS Medicare Part D plan to enroll in, or continue enrollment in, a CalPERS health plan.
  • If you are eligible for other group health coverage that includes Medicare Part D, you must choose to be covered by only one health plan that includes Part D.
  • If you enroll in a non-CalPERS Medicare Part D plan, you will lose your CalPERS health coverage.
  • If you are retired and want to continue your CalPERS health coverage, you should not voluntarily enroll in a non-CalPERS Medicare Part D plan.
  • If you are already enrolled in a non-CalPERS Medicare Part D plan, but would like to continue your CalPERS health coverage, you should disenroll from your non-CalPERS group-, union-, or retirement-provided health coverage.

Examples of non-CalPERS plans that include Medicare Part D are Tricare, Medicaid (“MediCal” in California), and the American Association of Retired Persons (AARP). Sources of other Medicare Part D coverage can include coverage from a spouse (past or present), or coverage from your or your spouse’s retirement group or employer group health plan coverage.