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How Medicare Affects Your Coverage

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How Medicare Affects Your Coverage

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'll only need to focus on these three if you enroll in a 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 the retirement system's insurance and prescription drug plans. To allow for processing time, 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 the Michigan Office of Retirement Services (ORS) receives all required forms and proofs.

If you're disenrolled from Medicare for any reason, you'll 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 before 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.

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'll be eligible for Medicare when you retire, you should contact the Social Security Administration to enroll in both Medicare Part A (hospital) and Part B (medical) three months before your retirement effective date. You'll get a Medicare number once you're enrolled that you'll need to provide to ORS when you enroll in a retiree 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 in miAccount. You'll 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, your selected carrier(s) will send you ID cards and welcome kits. 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 to enroll in a retiree insurance plan or your coverage.

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 the 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 to ORS.
  • 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.

When ORS receives the Medicare number and effective dates for parts A and B, we'll 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, your spouse, 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 are 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 in the retirement system's insurance plans.

Effects of other coverage

It's your responsibility to keep ORS informed of any changes that may affect your, your spouse's, 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 a completed Insurance Enrollment/Change Request (R0452C) form to ORS. 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 the miAccount Message Board.

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

Timely application and proofs

If you have Medicare, we need your enrollment request and proofs more than one month before 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 your enrollment request and proofs after the first of the month, one month before your retirement effective date, but before the end of the month, you will not be enrolled until a month later.

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

Opting Out

Before you're enrolled in the Medicare plans, your insurance carrier will send you 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 insurance effective date, complete the opt-out form and send it to ORS. If you opt out, you'll be completely disenrolled from the retiree insurance plans.

If you, your spouse, or your dependents are already enrolled in Medicare 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 the individual's 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'll 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, your carrier will send you ID cards and a welcome kit. If you apply for insurance 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.

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 the 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 to ORS.
  • 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, your spouse, 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 retiree insurance plan for that person will be canceled and a request for reenrollment may not take effect for six months. If your coverage is cancelled, your spouse and 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 retiree insurance plan at any time, you, your spouse, and your dependents will not be able to reenroll.

Effects of other coverage

It's your responsibility to keep ORS informed of any changes that may affect your own, your spouse's, 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 a completed Insurance Enrollment/Change Request (R0452C) form to ORS. 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 the miAccount Message Board.

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

Timely application and proofs

If you have Medicare, we need your enrollment request and proofs more than one month before 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 your enrollment request and proofs after the first of the month, one month before your retirement effective date, 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 June 1, for a retirement effective date of July 1, your insurance effective date will be Aug. 1.

Opting Out

Before you're enrolled in the Medicare plans, your insurance carrier will send you 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 Medicare start date, you can complete and send an opt-out form to ORS. If you do opt out, you'll be completely disenrolled from the retiree insurance plans.

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 plans. 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're enrolled in Medicare (or auto-enrolled by Medicare) you'll 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.

  • Log in to miAccount and send a secure message on the 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 to ORS.
  • 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 Medicare start 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're currently enrolled in prescription drug coverage through the retirement system, we'll enroll you in a Part D plan offered by that carrier when you age into Medicare.

Medicare enrollment is automatic for most people if:

  • They've paid into Medicare for 10 years.
  • They're turning 65.
  • They're receiving Social Security income.

Learn more and sign up for Medicare.

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 retiree insurance for that person will be canceled and a request for reenrollment may not take effect for six months. If your coverage is cancelled, your spouse and all your dependents' enrollment in that coverage will also be cancelled. Note: If you have the Personal Healthcare Fund and are disenrolled from the retiree insurance 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'll need to provide your Medicare number to ORS so we can enroll you in the appropriate insurance plan. To send us your Medicare number, log in to miAccount and 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) form that includes your Medicare number.

Effects of other coverage

It's your responsibility to keep ORS informed of any changes that may affect your own, your spouse's, 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 a completed Insurance Enrollment/Change Request (R0452C) form to ORS. 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 the miAccount Message Board.

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

Opting Out

Before you're enrolled in the Medicare plans, your insurance carrier will send you 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 Medicare start date, complete the opt-out form and submit it to ORS. Your insurance carrier(s) will send an opt-out notice to you listing the full conditions for opting out. If you do opt out, you'll be completely disenrolled from the retiree insurance plans.

If you or anyone else covered by your retiree health and prescription drug plans 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're enrolled in Medicare (or automatically enrolled by Medicare) you'll 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 the 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 to ORS.
  • 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 spouse and 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's your responsibility to keep ORS informed of any changes that may affect your own, your spouse's, 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 a completed Insurance Enrollment/Change Request (R0452C) form to ORS. 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 the miAccount Message Board.

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

Opting Out

Before you're enrolled in the Medicare plans, your insurance carrier will send you 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 Medicare start date, you can complete the opt-out form and submit it to ORS. If you do opt out, you'll be completely disenrolled from the retiree health and prescription drug plans.