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 reenrollment, 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're receiving Social Security income prior to age 65. If you're not already receiving Social Security income, you must apply for Medicare parts A and B three months before you turn 65. Visit the Social Security Administration website to learn more and to sign up for Medicare or call them toll-free at 800-772-1213.

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.
  2. Are already on Medicare when you enroll in the retiree insurance plan.
  3. Become eligible for Medicare after enrolling in the retiree insurance plan.
  4. Become eligible for Medicare before age 65 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 Parts A (hospital) and Parts B (medical) 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 two 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 plan of your choice, you can expect ID cards and welcome kits from your selected carrier(s). If you apply at least three 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 carrier's website. Waiting to enroll in Medicare could affect your eligibility and coverage.

    New Medicare Card

    Medicare will be removing Social Security numbers from Medicare cards and issuing new Medicare cards to help guard against identity theft. The new Medicare card will show an 11-digit number that is unique to you. Medicare began mailing new cards in April 2018. People with Medicare received their new Medicare cards between April 2018 and the end of the 2019 calendar year.

    Tell ORS your Medicare number and effective dates for parts A and B

    If your new 11-digit Medicare card arrives after you apply to retire, tell ORS your Medicare number as soon as you receive your card.

    You can submit your Medicare enrollment information one of the following ways:

    • Log in to miAccount and send a secure message on Message Board, using the Submit My Medicare Number category. Include the name, Medicare number, and effective dates for parts A and B in your message for the individual going on Medicare.
    • Update your insurance enrollment information in miAccount to include your new Medicare information. Print the confirmation page and mail or fax it to ORS.
    • Make a copy of your Medicare card. Write your name, member ID, address, and date of birth on the copy and mail or fax the copy of your card.
    • Mail or fax a completed Insurance Enrollment/Change Request (R0452C) form to ORS with your Medicare information. The form can be printed by navigating to the ORS website, selecting your retirement system, and clicking on the Forms and Publications tab. Click the For Retirees link and the Insurance Enrollment/Change Request (R0452C) form will be available on the next page.
    • Call ORS and provide your Medicare number and coverage start dates over the phone.

    When ORS receives the Medicare number and effective dates for parts A and B, we will send it to your insurance provider and adjust your insurance rate. ORS will change your enrollment to the Medicare plan offered by the carrier(s) you chose on your retirement application.

    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 reenrollment 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 reenroll.

    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) form. 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

    If you have Medicare, we need your application and proofs more than one month prior to your retirement effective date. If your last day of work is in June and you want your insurance coverage to start July 1, your retirement effective date, we need your required proofs before June 1. If we get the request and proofs after the first of the month, one month prior to your retirement, but before the end of the month, you will not be enrolled until a month later. 

    For example, if you submit your application and proofs on June 1, for a retirement effective date of July 1, your actual insurance effective date will be Aug. 1.

    Opting Out

    Before you are enrolled in the Medicare plans, your insurance carrier will send an opt-out notice listing the full conditions for opting out. If you do not want our coverage, you can opt out by completing the form and mailing it to ORS. If you enroll in the Medicare plans but change your mind before your effective date, complete the opt-out form and submit it to ORS. 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 Part A but not Part B when you first enroll in one of the retiree insurance plans, apply for Part B at least three months before your retirement effective date. Visit the Social Security Administration website to learn more and to sign up for Part B or call them toll-free at 800-772-1213. Then tell ORS your Medicare number and effective dates for parts A and B.
    • 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 three 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 carrier's website.

    New Medicare Card

    Medicare will be removing Social Security numbers from Medicare cards and issuing new Medicare cards to help guard against identity theft. The new Medicare card will show an 11-digit number that is unique to you. Medicare plans began mailing new cards in April 2018. People with Medicare will receive their new Medicare cards between April 2018 and the end of 2019. 

    Tell ORS your Medicare number and effective dates for parts A and B

    When your new 11-digit Medicare card arrives, tell ORS your Medicare number as soon as you receive your card. 

    • Log in to miAccount and send a secure message on Message Board, using the Submit My Medicare Number category. Include the name, Medicare number, and effective dates for parts A and B in your message for the individual going on Medicare.
    • Use miAccount to update your Medicare information and complete a plan change to enroll in the Medicare health and prescription drug plan. Print the confirmation page and mail or fax it to ORS. 
    • Make a copy of your Medicare card. Write your name, member ID, address, and date of birth on the copy and mail or fax the copy of your card.
    • Mail or fax a completed Insurance Enrollment/Change Request (R0452C) form to ORS with your Medicare information.
    • Call ORS and provide your Medicare number and coverage start dates over the phone.

    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 reenrollment may not take effect for six months. If you are cancelled from the coverage all your dependents' enrollment in that coverage will also be cancelled. 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 reenroll.

    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) form. 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

    If you have Medicare, we need your application and proofs more than one month prior to your retirement effective date. If your last day of work is in June and you want your insurance coverage to start July 1, your retirement effective date, we need your required proofs before June 1. If we get the request and proofs after the first of the month, one month prior to your retirement, but before the end of the month, you will not be enrolled until a month later.

    For example, if you submit your application and proofs on June 1, for a retirement effective date of July 1, your actual insurance effective date will be Aug. 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 completing 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. 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 health and prescription 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

    As soon as you or anyone else covered by your health insurance becomes eligible for Medicare, that person must enroll in both Part A (hospital) and Part B (medical). You must have Medicare parts A and B to enroll in retiree insurance and prescription drug programs. 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 and there is a six-month wait to reenroll.

    Tell ORS your Medicare number and effective dates for parts A and B

    Once you are enrolled in Medicare (or auto-enrolled by Medicare) you will receive your Medicare card from Social Security. As soon as you receive your card, tell ORS your Medicare number and effective dates for parts A and B. 

    • Log in to miAccount and send a secure message on Message Board, using the Submit My Medicare Number category. Include the name, Medicare number, and effective dates for parts A and B in your message for the individual going on Medicare.
    • Use miAccount to update your Medicare information and complete a plan change to enroll in the Medicare health and prescription drug plan. Print the confirmation page and mail or fax it to ORS.
    • Make a copy of your Medicare card. Write your name, member ID, address, and date of birth on the copy and mail or fax the copy of your card.
    • Mail or fax a completed Insurance Enrollment/Change Request (R0452C) form to ORS with your Medicare information.
    • Call ORS and provide your Medicare number and coverage start dates over the phone.

    If you apply for Medicare three months before your effective date, your cards will usually arrive before your coverage begins. Tell ORS about your Medicare enrollment as soon as you receive your Medicare card and you should receive your ID cards and welcome kits from your health insurance and prescription carrier within a few weeks. 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 carrier's 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 in a Part D plan offered by that carrier when you age into Medicare.

    Medicare enrollment is automatic for most people if:

    • You have paid into Medicare for 10 years.
    • You are turning 65.
    • You 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 reenrollment may not take effect for six months. If you are cancelled from the coverage all your dependents' enrollment in that coverage will also be cancelled. 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 reenroll.

    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 Message Board or click Insurance Plans to begin updating your information. You can also send ORS a completed Insurance Enrollment/Change Request (R0452C) form, 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) form. 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 completing the form and mailing it to ORS. If you enroll in the Medicare plans but change your mind before your effective date, complete the opt-out form and submit it 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.

     


4. Medicare Before 65

  • If you or anyone else covered by your retiree health and prescription insurance becomes eligible for Medicare before age 65, that person must enroll in both Part A (hospital) and Part B (medical). If you, your spouse, or your dependents don't enroll in Medicare parts A and B when first eligible, the insurance for that person will be canceled and there is a six-month wait to reenroll.

    Tell ORS your Medicare number and effective dates for parts A and B

    Once you are enrolled in Medicare (or automatically enrolled by Medicare) you will receive your Medicare card from the Social Security Administration. As soon as you receive your card, tell ORS your Medicare number and effective dates for parts A and B. 

    You can submit Medicare information to ORS one of the following ways:

    • Log in to miAccount and send a secure message on Message Board, using the Submit My Medicare Number category. Include the name, Medicare number, and effective dates for parts A and B in your message for the individual going on Medicare.
    • Use miAccount to update your Medicare information and complete a plan change to enroll in the Medicare health and prescription drug plan. Print the confirmation page and mail or fax it to ORS.
    • Make a copy of your Medicare card. Write your name, member ID, address, and date of birth on the copy and mail or fax the copy of your card.
    • Mail or fax a completed Insurance Enrollment/Change Request (R0452C) form to ORS with your Medicare information.
    • Call ORS and provide your Medicare number and coverage start dates over the phone.

    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 reenrollment may not take effect for six months. If your coverage is canceled, the coverage for your dependents will also be canceled. 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 reenroll.

    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) form. 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 an opt-out notice listing the full conditions for opting out. If you do not want our coverage, you can opt out by completing 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 the opt-out form and submit it to ORS. If you do opt out, you will be completely disenrolled from the retiree health and prescription plans.