Medicare Transition

Whether you are a new retiree eligible for Medicare medical benefits, or a current retiree transitioning from an early retiree status upon turning 65, it's important to understand how your medical benefits correspond with your Medicare eligibility. 

If you are turning 65 and will continue to work at the County, please review the Employee Medicare Eligibility Section and Employee FAQs below. 

Retiree Medicare Eligibility

For retirees and their dependents, turning 65 is a Qualifying Event to transition to a County sponsored Medicare plan. To be eligible for a County Medicare plan, the member turning 65 must enroll in Medicare Part A & Part B through the Social Security Administration (SSA).

Please note: This is only a qualifying event for a member to transition to a supplemental medical Medicare plan; no other changes for dental and vision coverage are permitted.

Transitioning to Retiree Medicare Benefits

About 60 - 90 days before the member's 65th birthday, you will receive a Medicare enrollment packet from our third-party administrator, Benefits Coordinators Corporation (BCC). The enrollment packet will ask you to either select a new Medicare plan or opt out/waive County medical insurance. 

  • To enroll in a County Medicare plan, you must be enrolled in Medicare Parts A & B.
  • You must provide your Medicare Beneficiary Number (BMI), located on your Medicare card and provide your Medicare Part A & B effective dates.
  • You must provide a copy of your Medicare card.

Make sure your address is up-to-date in BenXcel before this period to ensure your packet is sent to the correct address. 

  • If you need to update your address, contact the Retiree Enrollment Line at (833) 574-1838. 

You must complete and postmark the enrollment form to BCC by your 65th birthday to either transition to a Medicare plan or to opt out of County medical coverage. Failure to complete and return this form will be considered opting out of County Medical and will result in termination of your non-Medicare medical plan.

Didn't receive your Medicare transition packet in the mail? Download the PDF version below, complete, print and send to our TPA BenXcel for processing at [email protected]. 

Download the Medicare Transition Packet Here!

Retiree County Medicare Plans

The County offers Coordination of Benefit (COB) plans that are designed to cover the costs that Medicare does not. Medicare is the primary payer and your Blue Shield plan is the secondary payer. Present both your Medicare card and Blue Shield ID card to your provider and always confirm that your provider accepts Medicare. Providers that do not accept Medicare are not covered even if they are in Blue Shield's network.

In regards to your pharmacy benefits, the County's Medicare plans do include a Part D prescription benefit. Do not enroll in a separate Part D plan or your County medical plan will be terminated by the Center for Medicare and Medicaid Services. For more information on your Medicare prescription coverage, contact Express Scripts at (844) 468-0428.

Employee Medicare Eligibility

For employees and their medically covered dependents, turning 65 is NOT a qualifying event. Turning 65 does not allow employees or their dependents to make any changes to their County medical enrollment. 

Employees Enrolling in Medicare

When an employee or their medically covered dependent turns 65, they will want to enroll in Medicare Part A through Social Security Administration (SSA). Enrolling in Medicare does not allow you or your dependents to drop County medical coverage. 

As long as you (or your dependent) are enrolled in a County medical plan, you may defer your Medicare Part B enrollment. Once you are no longer covered under the County medical insurance, you may need the Medicare CMS L-564 form completed. 

  • The CMS L-564 form indicates that you had employer-sponsored coverage. With this form, you will not receive a penalty for enrolling late in Medicare Part B. 
  • You can access this form on the Medicare website: https://www.cms.gov/cms-l564-request-employment-information
  • Complete the employee portion and email it to [email protected] for the Benefits Team to complete the employer portion. 

To view more information on the County Medicare Plans, including Summary of Benefits and Evidence of Coverage documents, visit the Compare Retiree Medical Plans page.

Retiree Medicare Education and Resources

Download "Your Guide to Medicare" PDFReview this overview from Alliant Medicare Solutions to help you understand Medicare and the choices available to you
Medicare 101 VideoWatch the Medicare 101 video to learn about what is Medicare, the various Medicare parts (A, B, D, etc.), and other general Medicare education

Call Alliant Medicare Solutions at  (866) 273-6420

Call Alliant Medicare Solutions for assistance with enrolling in Medicare and finding the medical Medicare benefits that are right for you and your family. 

Call HICAP at (805) 928-5663

The Health Insurance Counseling & Advocacy Program (HICAP) provides free and objective information and counseling about Medicare to the community in SLO County. 
Review the Retiree Benefits BrochureFind more information on the Medicare transition along with FAQs, current plan information, and information on Medicare Part D Pharmacy

FAQs

To get your Medicare card, you will need to contact your local Social Security Administration (SSA) office.
  • This card is needed to enroll in a County Medicare plan.
  • You will also need to present both your Medicare card and County medical ID card for any medical appointments.
If you choose to enroll in a County Medicare plan, you will receive a new medical ID card. County Medicare medical ID cards will show PRISM/County of SLO - MCP on the bottom right. 

Non-Medicare dependents may receive a new ID card as well if their enrollment is affected by the retiree's Medicare transition. 
  • If the retiree enrolls in the County Medicare PPO plan, non-Medicare dependents will have a medical ID card that says PRISM/County of SLO - Choice PPO on the bottom right.
  • If the retiree enrolls in the County Medicare EPO plan, non-Medicare dependents will have a medical ID card that says PRISM/County of SLO - EPO on the bottom right.
If you are enrolled in County medical, the County will contribute towards your benefits premiums. The amount per month the County will contribute is subject to change each year. Please review the Retiree Benefits Brochure premiums pages to find the County contribution. 

If you are not enrolled in a County medical plan, you will not receive a County contribution towards your retiree benefits premiums. 
The County has three main types of retiree medical plans: Early Retiree (under 65), combo (Medicare/non-medicare), and Medicare plans. 
  • If the retiree are their dependents are all under 65, they will be enrolled in an Early Retiree plan. 
  • If one member is over 65 (Medicare) and another member is under 65 (non-Medicare), they will be enrolled in a combo plan with each member on their respective plan.
  • If both retiree and dependents are over 65, they will be on the County Medicare plan.
For the Medicare Transition, the retiree medical enrollment dictates the dependent enrollment. 
  • If the retiree enrolls in the County Medicare plan, any enrolled non-Medicare dependents will be enrolled in corresponding non-Medicare plan.
    • If retiree chooses Medicare PPO, then dependent enrolled in Early Retiree Choice PPO.
    • If retiree choses Medicare EPO, then dependent enrolled in Early Retiree EPO.
  • If the dependent turns 65 before the retiree, they will be enrolled in the County Medicare plan while the retiree remains on the non-Medicare plan. If the dependent chooses to opt out of County medical, the retiree will maintain their enrollment. 
  • If the retiree waives County Medicare, any enrolled non-Medicare dependents will be terminated from County coverage as well. 
To understand your pharmacy coverage while on Medicare, review the Pharmacy section of the Retiree Benefits Brochure. To check on the cost and coverage of specific medications, contact Express Scripts at (844) 468-0428.
Open Enrollment Medicare Transition
Open Enrollment is your annual opportunity to make changes to your benefits. The County's Open Enrollment period is typically in October, with all changes effective January 1 of the new year. Allowable changes include:
  • Enrolling or Dropping Dental and/or Vision coverage
  • Dropping County medical coverage
  • Adding/dropping dependents from exisiting coverages
 With your Medicare Transition, you must decide whether to:
  1. Enroll in a County Medicare plan
  2. Waive or drop County medical insurance
You are not allowed to make dental/vision enrollments changes with your Medicare Transition. Whether you enroll or waive County medical, the change will be effective the first of the month of your 65th birthday (i.e. Turning 65 on Oct. 11 - enroll/waive County medical effective 10/01).
 
If you are turning 65 in October, November or December If you are turning 65 in January
You cannot enroll in the County Medicare plan during Open Enrollment. Since Open Enrollment changes are effective Jan. 1, your Medicare Transition would happen before any Open Enrollment changes would be effective.  You cannot enroll in the County Medicare plan during Open Enrollment. Even though your Medicare election will also be effective Jan. 1, you are not eligible for Medicare during Open Enrollment, so you cannot elect a Medicare plan. 
During Open Enrollment, you should make any changes to dental/vision as you are not allowed to change those enrollments during your Medicare Transition. 
You will need to wait until your birthday month to make changes to your County medical insurance. Review the Medicare Transition webpage for information on this process.
Your Medicare Transition election will be effective the first of your birthday month (Oct - 10/01, Nov - 11/01, Dec - 12/01). This election will rollover into the new year.  Your Medicare Transition will be effective Jan. 1, in addition to any Open Enrollment dental/vision changes you made.
You do not need to notify the County when you turn age 65. Turning 65 is not a qualifying event while you are an active employee and it does not impact your benefits enrollment.
You do not have to defer Medicare Part B enrollment. 

When you turn 65, you are required to enroll in Medicare Part A; however, Medicare Part B enrollment is optional. Once you separate/retire from the County or lose County medical coverage, you will need to enroll in Medicare Part B with the CMS L-564 form to avoid penalty fees.

Medicare Part B has a standard monthly premium. By deferring, you do not have to pay that premium, but you may enroll at age 65 if you choose. 
All County employees enrolled in a County medical plan will receive a cafeteria contribution towards their medical, dental, and vision premiums. Enrolling in Medicare Part A does not affect your County medical enrollment and therefore does not impact your cafeteria contribution.

If you choose to enroll in Medicare Part B, there is a monthly premium. Your County cafeteria contribution will not go towards the Medicare Part B premium and it will not be adjusted.