Public Employees Retirement System

Medicare Enrollment

As a PHIP member, it is your responsibility to notify PHIP when you become Medicare eligible. If you do not enroll in a PHIP Medicare plan at the time you become first eligible for Medicare Parts A and B, you may forfeit any future opportunity to enroll in a PHIP medical plan.

If you do not enroll in a PHIP Medicare plan when initially eligible for Medicare, whether due to age or disability, you will be terminated from your PHIP non-Medicare plan.

Additionally, once you become Medicare eligible, you are no longer eligible to receive the Retiree Health Insurance Premium Account (RHIPA) premium subsidy. If you receive the RHIPA premium subsidy beyond your Medicare eligibility, you will have to repay any subsidy funds back to PERS for the time period in which you were ineligible to receive the RHIPA subsidy.

However, if you were eligible for the RHIPA subsidy, you will automatically qualify for the Retiree Health Insurance Account (RHIA) subsidy upon enrollment in to a PHIP Medicare plan.

Medicare at age 65

You will become eligible for Medicare at 65, regardless if you are receiving a Social Security benefit at the time. You are entitled to Medicare the first day of the calendar month during which you turn 65. If your birthday falls on the first day of the month, you are entitled to Medicare the first day of the prior month.

If you receive Social Security benefits, you will automatically be enrolled in Medicare. You should receive your Medicare information, including your Medicare Parts A and B card, approximately three months prior to your 65th birthday.

If you ARE NOT receiving Social Security benefits, you will need to contact the Social Security Administration or visit your local Social Security office approximately three months prior to your 65th birthday and apply for Medicare Parts A and B.

To enroll in a PHIP Medicare plan you must submit a new PHIP Enrollment Request Form 30 days prior to becoming Medicare eligible. Failure to submit a new PHIP Enrollment Request Form for Medicare coverage will result in cancellation of your current PHIP non-Medicare health plan coverage, with the possibility of no future enrollment opportunities.

Medicare due to disability

If you are receiving Social Security Disability, you will automatically be enrolled in Medicare Parts A and B on the first day of the 25th month after Social Security benefits begin. This would be considered your initial Medicare eligibility to enroll in PHIP Medicare coverage. Aging in to Medicare later will not be considered an enrollment opportunity under PHIP.

If you are enrolled on a non-Medicare PHIP plan and become Medicare eligible, you will no longer be able to continue on the PHIP non-Medicare plan. Your non-medicare coverage will cease the end of the month immediately preceding your Medicare eligibility date.

To enroll in a PHIP Medicare plan you must submit a new PHIP Enrollment Request Form 30 days prior to becoming Medicare eligible. Failure to submit a new PHIP Enrollment Request Form for Medicare coverage will result in cancellation of your current PHIP non-Medicare health plan coverage, with the possibility of no future enrollment opportunities.

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Avoid a gap in coverage

If you submit your PHIP Medicare election after your PHIP non-Medicare coverage ends you will have a gap in coverage. Remember your PHIP effective date will be based on the receipt date of your PHIP Enrollment Request Form.