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California State University, Long BeachCalifornia State University, Long Beach

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

How Do You Coordinate Benefits? (continued)

Some CalPERS members may qualify for the Social Security Administration’s Low-Income Assistance Program. If you qualify for this program, you will need to decide if it is in your best interest to discontinue your CalPERS health benefits enrollment and continue enrollment in a non-CalPERS Medicare Part D plan. You may contact the Health Insurance Counseling and Advocacy Program (HICAP) at (800) 434-0222 for assistance with your decision.

CalPERS-Sponsored Medicare Health Plan Choices
Your health plan choices depend on where you live. Upon reaching age 65, if you do not specifically choose which CalPERS-sponsored Medicare plan you want, you will automatically be enrolled in your current health plan’s Medicare plan.

Preferred Provider Organization (PPO) Supplement to Medicare Plans

  • PERS Choice
  • PERS Select
  • PERSCare
  • Peace Officers Research Association of California (PORAC) Police and Fire Health Plan*

With these plans, your provider bills Medicare for most services, and your health plan pays for some services not covered by Medicare. If your doctors participate in Medicare, your health plan will pay most bills for Medicare-approved services.
If any of your doctors does not accept Medicare assignment, you will have to pay for a larger portion of your health care bills. You can find out if you will have to pay more by asking your doctors if they accept Medicare assignment.
This means that they accept the Medicare limits on fees for services and will not charge more than those limits. If the doctor accepts Medicare rates, you will not be responsible for excess charges. If your doctor does not accept Medicare rates, you must pay for any part of the bill that your plan does not cover. Your responsibility for filing a claim for services depends on your PPO Supplement to Medicare plan and if the providers accept Medicare assignment. In most cases, your doctor, Medicare, or the health plan will coordinate claim payments. Some doctors opt out of Medicare and ask you to sign a contract stating the doctor has opted out of Medicare, and you agree to pay the doctor’s charges. Neither Medicare nor CalPERS PPO Supplement to Medicare plans allow any payment for doctors who have opted out of Medicare. If a doctor has been excluded from Medicare, that is, no longer receives payments for items or services from Medicare, no payment will be made under your CalPERS PPO Supplement to Medicare plan.

Health Maintenance Organization (HMO) Supplement to Medicare Plans

Effective January 1, 2016, Anthem Blue Cross Select HMO and Traditional HMO, Blue Shield Access+ HMO and Net Value HMO, Health Net HMO and Sharp HMO will not longer be available as a supplemental plan to Medicare.

United HealthCare

With this type of plan, you must use the plan’s contracted providers, except for emergency or out-of-area urgent care services. You pay no additional costs, other than applicable co-payments when you receive pre-authorized services from the HMO’s contracted providers. The plan’s providers bill Medicare for each visit or service. The plan reimburses providers for some services not covered by Medicare.

In an HMO Supplement to Medicare plan, you will receive nearly all services from the HMO’s providers and will only be responsible for applicable co-payments. Your primary care provider will coordinate all your medical care and approve visits to specialists. You will have little or no paperwork to complete. You keep costs low by seeing doctors and specialists who are part of the HMO’s network. You may use your Medicare card to obtain services outside of your HMO network. However, when you use non-contracting providers, you are responsible for any co-payments or deductibles not covered by Medicare (except for emergency or out-of-area urgent care services).

HMO Medicare Managed Care Plan (Medicare Advantage)

Kaiser Permanente Senior Advantage

With an HMO Medicare Managed Care plan (Medicare Advantage), you work closely with your main doctor – your Primary Care Provider (PCP) – to get the care you need. You pay no additional costs, other than applicable co-payments when you receive services from the HMO’s network of providers. If you go to out-of-network doctors or hospitals, you will have to pay for all services (except for emergency or out-of-area urgent care services). A Medicare Managed Care plan has been approved by the Medicare program and receives a monthly premium directly from Medicare for your care. When enrolled in this plan, you must assign your Medicare benefits to Kaiser using the Kaiser Permanente Senior Advantage Election form. To obtain this form, visit or call Kaiser Permanente in your region. After you assign your Medicare benefits to Kaiser, your CalPERS health benefits are coordinated, including payment for authorized services.
Note: The Kaiser Permanente Senior Advantage plan is geographically restricted – you must live in an approved Kaiser Senior Advantage service area or region to enroll. If you cannot enroll in Senior Advantage because you do not reside within an approved Kaiser Senior Advantage region, you must select another Medicare plan available in your service area.

Medicare and COBRA

  • If a former employee/enrolled dependent(s) has a Medicare entitlement prior to the election of COBRA, the individual may continue the enrollment through COBRA.
  • If a former employee/enrolled dependent(s) becomes Medicare eligible after the election of COBRA, the health plan can cancel the COBRA enrollment.
  • Dependents may continue COBRA basic coverage for whatever time remains on their COBRA eligibility or until they become Medicare eligible.