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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

Frequently Asked Questions About CalPERS and Medicare

I have decided I do not want Part B benefits. Will this affect my CalPERS-sponsored Medicare plan?

Yes, you must have Medicare Part B to participate in a CalPERS-sponsored Medicare plan. If you cancel your Part B coverage, then you will lose your CalPERS health coverage. However, if your Part B benefits are canceled by the SSA, please let CalPERS know immediately so you can enroll in a non-Medicare (Basic) health plan. If you do not sign up for Medicare Part B when you turn 65 and decide to sign up for it later, you may have to pay a federal Part B Penalty Surcharge. This means that you will pay more for every month of your Part B coverage. Contact the SSA at (800) 772-1213 or TTY (800) 325-0778, for more information about the Part B Penalty Surcharge.
Note: If you want to continue your CalPERS benefits, do not cancel, stop, or choose not to enroll in Part B. If you do so, you will not be able to receive CalPERS-sponsored Medicare health benefits.

Since I must have Medicare Part B in order to keep my CalPERS Health Coverage, how does it help me to have both Part B and a CalPERS-sponsored Medicare plan?

CalPERS-sponsored Medicare plans pay for some of the costs and services not covered by Medicare Part B. For example, eyeglasses are not covered by Part B. (If you have had cataract surgery, you may still qualify for eyeglass insurance under Part B. To learn about your eyeglass coverage, review your current health plan’s Evidence of Coverage booklet.)

If I am retired from the State and the monthly State contribution is more than the plan’s premium, can I get money back when I enroll in a CalPERSsponsored Medicare plan?

As a State retiree, if you (or a family member) are signed up for a CalPERSsponsored Medicare plan and the monthly State contribution is more than the plan’s monthly premium, CalPERS will credit you the difference (excluding penalties) between the two amounts, up to the amount of the Part B premium, to assist you with your Part B premium cost. This credit will be shown on your monthly retirement check under the Special Payments section as a “Medicare Reimbursement.”

How do I switch to a CalPERS-sponsored Medicare plan after retirement?

First, you should sign up for Part B as soon as you qualify. Although most people qualify when they turn 65, some people under age 65 may qualify because of a disability. Once you enroll in Part B, write to CalPERS to let us know that you want to enroll in a CalPERS-sponsored Medicare plan. You must mail us the following:

  • A copy of your Medicare card or Letter of Entitlement from Social Security;
  • A letter asking to change to a CalPERS-sponsored Medicare plan, including your full name as it appears on your Social Security card, your Social Security number, and a daytime telephone number; and
  • Certification of Medicare Status form.

Mail this information to:
Office of Employer and Member Health Services
Attn: Medicare Program
P.O. Box 942714
Sacramento, CA 94229-2714

Your new CalPERS-sponsored Medicare plan will start on the latter of either the first day of the month following your Medicare effective date or the first day of the month after your written request is received and processed by CalPERS.

I lost my CalPERS health benefits because I stopped my Part B insurance. How can I get my CalPERS benefits back?

You must sign up for Part B as soon as possible. If you did not sign up during your Initial Enrollment Period for Medicare, you can only sign up during SSA’s annual General Enrollment Period. You will have to pay the federal Penalty Surcharge described previously. You may request re-enrollment in a CalPERS-sponsored Medicare plan after you get Part B benefits.