FREQUENTLY ASKED QUESTIONS ABOUT TURNING 65

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1 EVERGREEN TEACHERS ASSOCIATION HEALTH AND WELFARE TRUST MAILING ADDRESS: P.O. BOX 5057, SAN JOSE, CA PHONE (408) S. BASCOM AVE., SAN JOSE, CA ADMINISTRATORS UNITED ADMINISTRATIVE SERVICES FREQUENTLY ASKED QUESTIONS ABOUT TURNING 65 So, you re turning 65. Well, you may have several questions about what exactly you will need to do. Below are some of the more common questions and answers we have encountered. If you still have additional questions, please feel free to contact us at and we will walk you through the process. Q #1: A #1: Q #2: A #2: Q #3: A #3: Do I need to enroll in Medicare while I am an active employee of the Evergreen Elementary School District after age 65? No, you will need to start the Medicare enrollment process a few months before you retire in order to have your Medicare benefits set up by the time you retire. There will be no penalty from Medicare for not signing up while you are actively working. When you are thinking about retiring, follow the steps in Answer #2. Do not enroll in any Medicare program with Kaiser or Blue Shield while you are still an Active employee. I am retired and will be turning 65 soon, what do I need to do to ensure that I will receive Trust benefits? At least three months before you turn 65, you need to do the following: Contact Medicare at MEDICARE and they will walk you through signing up for Medicare. If you do not qualify for Medicare Part A, please see Question #8. Contact the Trust via United Administrative Services to obtain the necessary paperwork to transition to Senior Advantage (Kaiser) or Blue Shield s Medicare Plan. Return the paperwork to United Administrative Services, not Kaiser or Blue Shield. Send United Administrative Services a copy of your Medicare card once it is received. When forms ask for my Employer Name what do I fill in? Since you are a member of a group plan, you will list Evergreen School District as your employer.

2 Q #4: A #4: Q #5: A #5: Q #6: A #6: What medical benefits does the Trust cover? The Trust pays the monthly premium for either Kaiser or Blue Shield as long as you remain active in Medicare. The Kaiser Senior Advantage Plan replaces Medicare coverage and the Blue Shield plan coordinates with Medicare as explained in Question #10. The Medicare Part B premium is required to be paid by the member (usually can be deducted from your Social Security check). If I waive medical coverage, can I re-enroll in Trust benefits at a later date? You may re-enroll in a Trust medical plan if you provide a Certificate of Creditable Coverage (HIPAA Certificate) from your prior plan within 30 days of the loss of coverage. Does the Trust offer a Medicare Supplement plan? No, a Medicare Supplement plan is a specific type of medical plan that only pays for certain benefits. The Trust does not offer any Supplement plans. Q #7: What is Medicare Part A? A #7: Medicare Part A is that part of the Medicare insurance program that covers hospitals, skilled nursing facilities, home health agencies, etc. Q #8: As a teacher, am I eligible for Medicare Part A? A #8: If you (or your spouse of at least ten years) have at least 40 quarters of Medicare eligible employment, you will qualify for Medicare Part A on your own and there is no additional premium. If not, you can coordinate to obtain Medicare coverage through CalSTRS at (800) The Social Security office will be able to provide you with the necessary paperwork at the time you sign up for Medicare/Social Security. Q #9: What is Medicare Part B? A #9: Medicare Part B is that part of the Medicare insurance program that covers physician and outpatient services. Q #10: A #10: What is the monthly Part B premium? This premium is set by CMS (Centers for Medicare and Medicaid Services) and can be obtained at any Social Security office. This premium must be paid to CMS by all participants that are eligible for Medicare.

3 Q #11: What if I do not participate in Medicare A and B? A #11: If you do not participate in Medicare A and B, you will be responsible to reimburse the Trust for the additional premiums that it incurs as a result of your non-participation. Q #12: What is Medicare Part D? A #12: Medicare Part D is a federal program to subsidize the costs of prescription drugs for Medicare beneficiaries. Q #13: A #13: Should I enroll in a Medicare Part D plan? No, the benefit that you receive through the Trust exceeds that provided by Medicare. Do not enroll in a Medicare Part D plan or you will be disenrolled from the Trust plan. Refer to Question 12. Q #14: Are the Blue Shield and Kaiser plans the same after age 65? A #14: In regard to Blue Shield, the benefits are the same after age 65. However, after age 65, Medicare becomes your primary insurance and Blue Shield becomes secondary. This means that all claims will go through Medicare first and then Blue Shield will calculate what portion of the bill they are responsible for up to the amount claimed. For example: If a bill is submitted with charges of $150, Medicare may pay $80 (these are all hypothetical numbers). When Blue Shield receives the bill, they may calculate their responsibility as $90. However, Medicare's $80 + Blue Shield's $90 would exceed the total amount due so Blue Shield will only pay $70 since that would fully pay the claim (Medicare $80 + Blue Shield $70 = $150). You will still be responsible for the office visit copay. In regard to Kaiser, upon reaching age 65, all Kaiser members are required to assign their Medicare benefits to Kaiser (Senior Advantage). This means that you would have no Medicare benefits outside of Kaiser. Also, at age 65, the office visit copay for Kaiser members currently goes to $10. Q #15: A #15: What is my drug coverage "in the gap"? You will not have a "gap". The "gap" applies to people who have Medicare Part D only and no other prescription plan. Since you are on a group medical plan that includes prescription coverage, the Blue Shield or Kaiser plan becomes your prescription plan. However, you will need to assign your Medicare Part D benefits to Blue Shield or Kaiser at age 65. All enrollments will be coordinated through United Administrative

4 Services. Do not send forms directly to either carrier or you may be enrolled in an individual plan. Once you enroll in the group Blue Shield or Kaiser Medicare Part D plan, that then becomes your prescription plan. If a drug is covered by Medicare, but not Blue Shield or Kaiser, then it is considered a non-covered drug. You do not have the option of obtaining that drug under Medicare as you have assigned your Medicare Part D benefits to either Blue Shield or Kaiser. However, many drugs not covered by Medicare are covered by Blue Shield or Kaiser. Q #16: A #16: Q #17: A #17: Q #18: A #18: Is it possible to switch plans? Yes, members can elect to change plans (between Blue Shield and Kaiser) at open enrollment each year. If you choose to do so, you must first disenroll from the current plan in order to enroll in the other plan. This takes time and some paperwork but it is possible. Open Enrollment is the month of September for an October 1st effective date. There is no lapse in coverage between one plan and the other. This is NOT the Medicare Open Period. The Medicare Open Period applies to people who have chosen not to elect Medicare when they are eligible and wish to do so at a later date. The Evergreen Trust does not allow participation after age 65 without application to Medicare so this Open Period would not apply to you. What happens if I move outside of the Kaiser service area? If you move out of the Kaiser service area (the ZIP Code list provided with your application) you may switch to the Blue Shield plan. You must notify United Administrative Services within 30 days to ensure a smooth transition. What is the December Medicare Election period (the one in all of the advertisements on TV)? If I need to apply for Medicare three months before I turn 65, why is there a Medicare Open Enrollment period? Since you are enrolled in a group plan through the Evergreen Trust, this Medicare Open Enrollment period does not apply to you. The Medicare Open Enrollment period is an annual period from November 15 th to December 31 st for individuals who are on the Medicare Part D program which allows them to either choose a plan for the first time or for existing beneficiaries to look over their plans and see if they need to switch.

5 Q #19: A #19: Q #20: A #20: Q #21: A #21: Q #22: A #22: Q #23: A #23: When is my spouse covered by the Trust? Your spouse s medical premium is paid for by the Trust as soon as you turn 65 no matter what your spouse s age. Prior to your turning 65, refer to the ETA negotiated contract for benefit information. Your spouse should contact Medicare to investigate their options. Can my spouse or California Registered Domestic Partner continue with Trust benefits if I die? The surviving spouse or California Registered Domestic Partner will receive benefits under the Trust when the Employee would have reached age 65 if the participant had met all eligibility requirements, and if the insurance carrier allows the spouse or California Registered Domestic Partner in the plan. However, if a surviving spouse or California Registered Domestic Partners remarries or re-registers, he/she will no longer be eligible for Trust benefits. Can I be on the Trust s Kaiser or Blue Shield plan and also my spouse s plan? Medicare Part D only subsidizes one plan at a time. You can certainly be enrolled in a secondary medical plan; however, your secondary plan (spouse s coverage) may charge you for the additional premiums that they will incur as a result of your multiple enrollments. Can my spouse be on the Trust s Kaiser or Blue Shield plan and also their own plan? Medicare Part D only subsidizes one plan at a time. Your spouse can certainly be enrolled in a secondary medical plan; however, since the Evergreen Trust will be charged additional premiums if your spouse is on more than one plan, this additional cost is passed along to the member. If you are interested in the cost associated with your spouse being enrolled in multiple plans, please contact United Administrative Services at Do I still have life insurance? Life insurance is provided by the Trust to Actively working Trust members. Once you retire, you no longer have life insurance through the Trust.

6 Q #24: A #24: Q #25: A #25: Do I still have Long Term Care benefits? Yes, please refer to section VI of the Trust Benefits Booklet for a complete description of the benefit. Do I still have Income Protection benefits? You still have Income Protection benefits as long as you are a benefit eligible active employee of the Evergreen School District. Q #26: Who do I call if I have more questions? A #26: Please contact United Administrative Services at for additional assistance. Sep-08