How Medicare Affects Your Coverage

Medicare card example Medicare is the federal health insurance program for people who are 65 or older, or otherwise receiving Social Security Disability benefits.

Medicare is divided into four different parts, which cover specific services. You will only need to focus on these three if you enroll in a state-sponsored retiree insurance plan:

  • Part A (Hospital)
  • Part B (Medical)
  • Part D (Prescription Drug)

What you need to know

If eligible, you must have Medicare Parts A and B to enroll in retiree insurance and prescription drug programs. To allow for processing, we recommend you enroll in Medicare three months before you turn 65 or otherwise become eligible. For most people, Medicare begins at age 65 or after 24 months of Social Security disability.

If you, your spouse, or your dependents don't enroll in Medicare Part B when first eligible, the insurance for that person will be canceled. If you request re-enrollment, coverage will begin on the first day of the sixth month after ORS receives all required forms and proofs.

If you become disenrolled from Medicare for any reason, you will be disenrolled from the retiree insurance plan. You may be billed for the services Medicare would have covered back to the date of disenrollment.

Enrolling in Medicare

Medicare enrollment may be automatic for you if:

  • you have paid into Medicare for 10 years, and
  • are turning 65, and
  • are receiving social security income.

Your timelines and enrollment process will depend on whether you, your spouse, and eligible dependents:

  1. enroll in the retiree insurance plan and Medicare at the Same Time, or
  2. are Already on Medicare when you enroll in the retiree insurance plan, or
  3. become eligible for Medicare After enrolling in the retiree insurance plan.

Click on the corresponding tab below:

1. Same Time

  •  

     

    If you, your spouse, or your dependents are enrolling in both Medicare and one of the retiree insurance plans at retirement, you have specific timelines you need to meet to ensure your coverage begins on your retirement effective date.

    What you need to do

    If you will be eligible for Medicare when you retire, you should contact Social Security to enroll in both Medicare Part A (hospital) and Part B (medical) at least three months before your retirement effective date. You will get a Medicare number once you are enrolled that you will need to provide to ORS when you enroll in an insurance plan.

    When you apply to retire, you'll have a chance to enroll in a retiree insurance plan in step 2 of the online application. You will pick a carrier from the list of available options in your area and ORS will enroll you in the respective Medicare Advantage Plan. Once you're enrolled in the Medicare plans of your choice, you can expect ID cards and welcome kits from your selected carrier(s). If you apply at least 3 months before your insurance effective date, your cards will usually arrive before your coverage begins. If you need health services before your cards arrive, contact the insurance carrier directly to get your policy number or to verify coverage. For more information, go to your insurance carriers website. Waiting to enroll in Medicare could affect your eligibility and coverage.

    Do not enroll yourself or your eligible dependents in an individual Part D plan (or any plan outside of one offered by the retirement system). All prescription drug plans offered by the retirement system for Medicare members are Part D plans, including those offered by our HMO options.

    Consequences of not enrolling on time or disenrolling

    If you, your spouse, or your dependents don't enroll in both Medicare Parts A and B when first eligible, or become disenrolled from Medicare for any reason, the insurance for that person will be canceled and a request for re-enrollment may not take effect for six months. Note: If you have the Personal Healthcare Fund and are disenrolled from the plan at any time, you, your spouse, and your dependents will not be able to re-enroll.

    Effects of other coverage

    It is your responsibility to keep ORS informed of any changes that may affect your own and your dependent's eligibility and/or coverage, so be sure to notify ORS when anyone on your insurance has coverage under another insurance plan. You can do this in miAccount or by sending in a completed Insurance Enrollment/Change Request (R0452C). Enrolling in another health or prescription drug plan may result in termination of your retiree coverage for you, your spouse, and enrolled dependents. If you aren't sure if you'll be affected, send a secure message to an ORS representative using message board.

    If you and your spouse are both Michigan public school retirees and enrolled with the same carrier, you will be covered together under one contract.

    Timely application and proofs

    To ensure your coverage begins on your requested insurance enrollment date, follow these guidelines for submitting your insurance enrollment and required proofs.

    For retirees with Medicare, if we get your request and proofs by the 15th of the month, we will enroll you the first of the following month. If we get the request and proofs later, you will not be enrolled until a month later.

    For example, if you submit your application and proofs on July 25th, for a retirement effective date of August 1, your insurance effective date will be September 1.

    Opting Out

    Before you are enrolled in the Medicare plans, your insurance carrier will send out an opt-out notice listing the full conditions for opting out. If you do not want our coverage, you can opt-out by filling out the form and mailing it to ORS. If you enroll in the Medicare plans but change your mind before your effective date, you can complete and submit an opt-out form to ORS. Your insurance carrier(s) will send out an opt-out notice to you listing the full conditions for opting out. If you do opt-out, you will be completely disenrolled from the retiree insurance plans.

     


2. Already on Medicare

  •  

     

    If you, your spouse, or your dependents are already enrolled in Medicare Parts A and B when you first enroll in one of the retiree insurance plans, you're already half done.

    What you need to do

    Apply for insurance in miAccount and enter your Medicare numbers when prompted. You will pick a carrier from the list of available options in your area and ORS will enroll you in the respective Medicare Advantage Plan. Once you're enrolled in a Medicare Advantage plan you can expect ID cards and a welcome kit from your carrier. If you apply at least 3 months before your insurance effective date, your cards will usually arrive before your coverage begins. If you need health services before your cards arrive, contact the insurance carrier directly to get your policy number or to verify coverage. For more information, go to your insurance carriers website.

    Do not enroll yourself or your eligible dependents in an individual Part D plan (or any plan outside of one offered by the retirement system). All prescription drug plans offered by the retirement system for Medicare members are Part D plans, including those offered by our HMO options.

    Consequences of disenrolling

    If you, your spouse, or enrolled dependent become disenrolled from Medicare for any reason, the insurance for that person will be canceled and a request for re-enrollment may not take effect for six months. You may be billed for the services Medicare would have covered back to the date of disenrollment. Note: If you have the Personal Healthcare Fund and are disenrolled from the plan at any time, you, your spouse, and your dependents will not be able to re-enroll.

    Coverage for disabled dependents

    To ensure coverage for your incapacitated child, you will need to provide a current letter from the attending physician stating the child is totally and permanently disabled and incapable of self-sustaining employment and detailing the disability, and the IRS form 1040 that identifies the child as your dependent. In some cases we may ask for additional information to determine medical eligibility. Sometimes this may delay enrollment. You may also be asked to furnish proof of incapacitation and dependency each year.

    Effects of other coverage

    It is your responsibility to keep ORS informed of any changes that may affect your own and your dependent's eligibility and/or coverage, so be sure to notify ORS when anyone on your insurance has coverage under another insurance plan. You can do this in miAccount or by sending in a completed Insurance Enrollment/Change Request R0452C). Enrolling in another health or prescription drug plan may result in termination of your retiree coverage for you, your spouse, and enrolled dependents. If you aren't sure if you'll be affected, send a secure message to an ORS representative using message board.

    If you and your spouse are both Michigan public school retirees and enrolled with the same carrier, you will be covered together under one contract.

    Timely application and proofs

    To ensure your coverage begins on your requested insurance enrollment date, follow these guidelines for submitting your insurance enrollment and required proofs.

    For retirees with Medicare, if we get your request and proofs by the 15th of the month, we will enroll you the first of the following month. If we get the request and proofs later, you will not be enrolled until a month later.

    For example, if you submit your application and proofs on July 25th, for a retirement effective date of August 1, your insurance effective date will be September 1.

    Opting Out

    Before you are enrolled in the Medicare plans, your insurance carrier will send out an opt-out notice listing the full conditions for opting out. If you do not want our coverage, you can opt-out by filling out the form and mailing it to ORS. If you enroll in the Medicare plans but change your mind before your effective date, you can complete and submit an opt-out form to ORS. Your insurance carrier(s) will send out an opt-out notice to you listing the full conditions for opting out. If you do opt-out, you will be completely disenrolled from the retiree insurance plans.

     


3. Medicare After

  •  

     

    If you, your spouse, or your dependents are enrolled in retiree insurance before becoming eligible for Medicare, the information below will help you understand what you need to do to streamline the process.

    Aging-in to Medicare coverage

    If you, your spouse, or eligible dependent are enrolled in a non-Medicare retiree health insurance plan (BCBSM/OptumRx or an HMO) and become eligible for Medicare at age 65, we will enroll you in the Medicare plans offered by your current carrier(s). You can expect ID cards and welcome kits from your carrier(s) within a few weeks. Once you enroll in Medicare (or are auto-enrolled by Medicare), you will receive your Medicare card from Social Security. If you do not enroll in Medicare Parts A and B, your enrollment will be denied and you will be disenrolled from the retiree insurance plan(s). Please make sure you are enrolled in both Medicare Parts A and B prior to the month in which you turn 65.

    If you apply at least 3 months before your insurance effective date, your cards will usually arrive before your coverage begins. If you need health services before your cards arrive, contact the insurance carrier directly to get your policy number or to verify coverage. For more information, go to your insurance carriers website.

    Do not enroll yourself or your eligible dependents in an individual Part D plan (or any plan outside of one offered by the retirement system). If you are currently enrolled in prescription drug coverage through the retirement system, we will enroll you the in a Part D plan offered by that carrier when you age into Medicare.

    Again, Medicare enrollment is automatic for most people if:

    • you have paid into Medicare for 10 years, and
    • are turning 65, and
    • are receiving social security income.

    You can learn more and sign up for Medicare here.

    Consequences of not enrolling on time or disenrolling

    If you, your spouse, or your dependents don't enroll in both Medicare Parts A and B when first eligible, or if you, your spouse, or enrolled dependent become disenrolled from Medicare for any reason, the insurance for that person will be canceled and a request for re-enrollment may not take effect for six months. Note: If you have the Personal Healthcare Fund and are disenrolled from the plan at any time, you, your spouse, and your dependents will not be able to re-enroll.

    Becoming eligible for Medicare before age 65

    If you become eligible for Medicare before age 65, you will need to provide your Medicare number to ORS to enroll you in the appropriate insurance plan. To send us your medicare number, simply log in to miAccount and either send a secure message on the Message Board or click Insurance Plans to begin updating your information. You can also send ORS a completed Insurance Enrollment/Change Request (R0452C), complete with your Medicare number.

    Effects of other coverage

    It is your responsibility to keep ORS informed of any changes that may affect your own and your dependent's eligibility and/or coverage, so be sure to notify ORS when anyone on your insurance has coverage under another insurance plan. You can do this in miAccount or by sending in a completed Insurance Enrollment/Change Request (R0452C). Enrolling in another health or prescription drug plan may result in termination of your retiree coverage for you, your spouse, and enrolled dependents. If you aren't sure if you'll be affected, send a secure message to an ORS representative using message board.

    If you and your spouse are both Michigan public school retirees and enrolled with the same carrier, you will be covered together under one contract.

    Opting Out

    Before you are enrolled in the Medicare plans, your insurance carrier will send out an opt-out notice listing the full conditions for opting out. If you do not want our coverage, you can opt-out by filling out the form and mailing it to ORS. If you enroll in the Medicare plans but change your mind before your effective date, you can complete and submit an opt-out form to ORS. Your insurance carrier(s) will send out an opt-out notice to you listing the full conditions for opting out. If you do opt-out, you will be completely disenrolled from the retiree insurance plans.