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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

Health Plan Choices for CalPERS Retirees Who Are Working

If you are a working retiree covered by your current employer’s health plan, you do not need to enroll in Medicare. However, if you are not enrolled in your current employer’s health plan and are eligible for Medicare Parts A and B, you must enroll in a CalPERS-sponsored Medicare plan. You may enroll in a CalPERS-sponsored Medicare plan as follows:

  • Any CalPERS Supplement to Medicare (PPO, HMO, or EPO) plan available in either your home or work ZIP code.
  • Kaiser Permanente’s Medicare Managed Care Plan (Senior Advantage) based on your home ZIP code.

Working CalPERS retirees who are eligible for CalPERS health benefits, may enroll in a health plan based on their current work ZIP code. Contact CalPERS at 888-CalPERS (or 888-225-7377), visit www.calpers.ca.gov, or contact the plan to obtain a list of eligible ZIP codes before enrolling to assure your work ZIP code is covered by the plan.

Note: By federal rule, the Kaiser Permanente Senior Advantage plan is geographically restricted. Working CalPERS retirees who enroll in Kaiser Senior Advantage cannot use their work ZIP code, only their residential ZIP code.

How Do You Change Your CalPERS-Sponsored Medicare Health Plan?

You may request a plan change within 60 days of yourinitial eligibility for Medicare, when you move to a new area, or during any Open Enrollment period. Open Enrollment is held each fall. Retirees who wish to enroll in a health plan, change health plans, or add/delete eligible dependents during Open Enrollment should complete and return the form to CalPERS. Changes will take effect the following January 1.

Returning to WorkAfter Enrolling in Medicare

If you return to work after retirement, and you enrollin your employer’s or your working spouse’s health plan, you must contact CalPERS immediately to change to a Basic plan until you retire or cancel yourother group health plan.

Important Reminders

  • Do not cancel yourPart B after you have signed up for a CalPERS-sponsored Medicare plan. If youcancel your Part B, you will no longer qualify for CalPERS health benefits.
  • If the SSA cancelsyour Part B for non-payment, you will no longer qualify for CalPERS healthcoverage. You will not be allowed to enroll in a Basic plan.
  • When you turn 65 and retire, you must sign up for Medicare Parts A and B. Family members who qualify for Part A through your health insurance must also sign up for Medicare.

Medicare Plan Enrollment Exceptions

In some cases, retirees or their family members do not qualify for Medicare.  Under certain circumstances, they can stay in the CalPERS Basic health plan they had before they retired.

Exception 1: You do not currently qualify for Medicare Part A.

You may not qualify for Part A if you did not earnenough “credits” while you worked. Those credits are earned through jobs covered by Social Security and Medicare. Most people need 40 credits, or 10 years of work to qualify for premium-free Part A. Call the SSA at (800) 772-1213 or TTY (800) 325-0778 to find out if you have enough credits. If you did not earn enough credits, you may still be able to get Part A. For example, you may qualify for Part A if your current, former, or deceased spouse earned enough work credits. Once that person is 62, ask SSA if you qualify for Medicare Part A under their entitlement. If neither you nor your spouse has enough work credits, you may remain in a CalPERS Basic health plan. If you later qualify for Medicare Part A, you must sign up for Medicare Part B and transfer to a CalPERS-sponsored Medicare plan. It is important to consider enrolling in Part B when you are 65, especially if you or your spouse continues to work after age 65 and earn work credits through that employment.

Exception 2: You or your spouse work past age 65 and has coverage through an employer.

If after age 65, you or your spouse has health insurance from a current employer, you may be eligible to defer your Part B enrollment. Contact the SSA for more information.

Note: This exception does not apply to workers in the CSU System Faculty Early Retirement Program (FERP).

Exception 3: You qualified for Medicare Parts A and Bbefore January 1, 1985, but you never signed up for Part B.

If this exception applies to you, you can keep the CalPERS Basic health plan you have now. However, you can sign up for Part B if you would like to do so. If you do sign up for Part B, you must contact CalPERS at 888 CalPERS (or 888-225-7377) to enroll in a CalPERS-sponsored Medicare plan.

Exception 4: You retired from CSU and qualified for Medicare Parts A and B before January 1, 2001, but never signed up for Part B.

You may sign up for a CalPERS-sponsored Medicare plan if you retired from CSU and turned 65 between January 1, 1985 and January 1, 2001.

Note: CSU retirees who qualified for Medicare Parts A and B after January 1, 2001 must enroll in a CalPERS-sponsored Medicare plan to keep their CalPERS health coverage.

Note: If you signed up for Part B, you are not exempt and must contact CalPERS to enroll in a CalPERS-sponsored Medicare plan.

Exception 5: You had Medicare because of a disability, but the SSA determines that you are no longer disabled.

If you are younger than 65 and lose your SSA disability benefits, you will also lose your Medicare coverage. In this case, you must sign up for a CalPERS Basic health plan.

Note: If you choose to end your Part B benefits, this exception does not apply to you.

Exception 6: You are retired and move outside of the United States.

You cannot use Medicare outside the United States. If you leave the country for more than six months, you must choose a CalPERS Basic health plan. If you permanently return to the United States, you:

  • Must sign up for Part B during the SSA’s General Enrollment period
  • May pay a federal surcharge in addition to the Part B premium
  • Must enroll in a CalPERS-sponsored Medicare plan

When you move outside of the United States, you may contact the SSA about canceling Part B when you change your address. However, when you return to the United States, you must re-enroll in Medicare and may pay the surcharge.

Note: If you are living outside the U.S., both your foreign and U.S. addresses must be on file; the member and dependents still require Medicare certification.