What You Need to Know About Medicare

STRS Ohio requires all eligible health care plan participants to enroll in Medicare Part B at age 65 or whenever eligible. You are also required to enroll in Medicare Part A if it is available to you at no cost. Be sure to read the following information that provides important details about Medicare and how it affects you as an STRS Ohio Health Care Program enrollee.

When you enroll in Medicare, Medicare becomes the primary payer of your hospital and medical expenses, and STRS Ohio becomes the secondary payer. There are several advantages to enrolling in Medicare:

You significantly reduce your STRS Ohio monthly health care premium.
You reduce your out-of-pocket expenses for covered services normally paid by Medicare. As a Medicare enrollee, this means you will pay less money out of pocket for covered services than you would if you were eligible for Medicare but not enrolled.
You receive partial reimbursement from STRS Ohio for a portion of your monthly Medicare Part B premium (benefit recipients only).
You decrease STRS Ohio’s expenditures for health care, which will help extend the life of the STRS Ohio Health Care Stabilization Fund used to pay health care expenses.

What is Medicare?
Medicare is a federal health insurance program for people age 65 and older, some people with disabilities under age 65 and people with end-stage renal disease (permanent kidney failure requiring dialysis or a transplant).

Medicare has two parts that help STRS Ohio health care plan enrollees: Part A (hospital insurance) and Part B (medical insurance).

Medicare also offers Part D (prescription drug insurance). However, you do not need to enroll in a separate Medicare Part D prescription drug plan if you enroll in an STRS Ohio health care plan. All of the health care plans we offer include creditable prescription drug coverage, which means coverage is as good as or better than the standard Medicare Part D coverage.

Who is Eligible for Medicare?
Generally, you are eligible for Medicare if you are age 65 or older. You may also be eligible for Medicare if you are under age 65 and have a disability or end-stage renal disease. Some Ohio educators may think they do not qualify for Medicare because they did not contribute to Social Security. However, you do not need to contribute to Social Security to be eligible for Medicare.

What is Medicare Part A?
Medicare Part A is hospital insurance. It helps pay for your inpatient care in hospitals, including critical access hospitals (small facilities that give limited services to people in rural areas), and skilled nursing facilities (not custodial or long-term care). It also helps pay for hospice care and some home health care.

Most people get Part A automatically when they turn age 65 and do not have to pay a monthly premium because they or a spouse paid Medicare taxes while they were working. If you or your spouse did not pay Medicare taxes while you worked and you are age 65 or older, you may still be able to enroll in Part A for a monthly premium.

If Part A is not available to you without a monthly premium from Medicare, STRS Ohio will not require you to enroll because your STRS Ohio coverage is comparable to Medicare Part A. This means you do not need to pay a premium to Medicare for Part A coverage.

What is Medicare Part B?
Medicare Part B is medical insurance. It helps pay for your doctors’ services and outpatient care. It also helps pay for some other medical services that Part A doesn’t cover, such as some physical and occupational therapy, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary.

You pay a monthly premium for Part B. Eligible STRS Ohio service retirement, disability and survivor benefit recipients who are enrolled in Medicare Part B receive partial reimbursement toward the cost of their Medicare Part B premium, regardless of whether they are enrolled in an STRS Ohio health care plan. (Note: Specific guidelines apply.) This reimbursement is added to the benefit recipient’s STRS Ohio monthly benefit payment. Dependents do not receive reimbursement.

If you receive a monthly Social Security, Railroad Retirement or Civil Service Retirement payment, your Medicare Part B premium will be automatically deducted from this payment. Otherwise, Medicare will send you a bill for your Part B premium every three months, or you can have your premium payment automatically deducted from your savings or checking account through the Medicare Easy Pay plan.

Why You Need to Enroll in Parts A & B
If you are eligible for Medicare, it is critical for you to enroll in Parts A & B. When you enroll, Medicare becomes the primary payer of your hospital and medical expenses, and STRS Ohio becomes the secondary payer. As a result, STRS Ohio’s expenditures for health care are reduced, and you pay a lower monthly premium for health care coverage under STRS Ohio. Benefit recipients also receive partial reimbursement from STRS Ohio for their Medicare Part B premium.

If Part A is not available to you without a monthly premium from Medicare, your STRS Ohio Aetna, Medical Mutual or AultCare coverage is comparable to Medicare Part A. This means you do not need to enroll in Medicare Part A if you are enrolled in one of these indemnity or PPO plans. However, you must still enroll in Medicare Part B.

What Happens if You do not Enroll in Medicare or You Discontinue Medicare Coverage?
If you are eligible for Medicare but fail to sign up or discontinue coverage, you are still considered “eligible for Medicare” in determining coverage under the indemnity and PPO plans. As a result, your claims will still be processed as if you were enrolled in Medicare, which means that you will be responsible for paying charges normally paid by Medicare. You will also pay a higher monthly STRS Ohio health care premium until you enroll in Medicare for the first time or reenroll in Medicare and notify STRS Ohio of your enrollment.

In addition, if you do not enroll in Medicare Part B or you discontinue Medicare Part B coverage, you will not be eligible to receive partial reimbursement from STRS Ohio for your Medicare Part B premium. If you terminate your Medicare Part B coverage, you must notify STRS Ohio immediately. Please request a letter from the Social Security Administration that states the date your coverage ended, and send a copy of this letter to STRS Ohio.

How to Enroll in Medicare
The seven-month individual enrollment period for Medicare begins three months before and ends three months after the month in which you turn age 65. You should enroll in Medicare Parts A & B three months before your 65th birthday to ensure uninterrupted health insurance coverage. Remember, you do not need to enroll in a separate Medicare Part D prescription drug plan because the prescription drug coverage included in your STRS Ohio health care plan is as good as or better than the standard Medicare Part D coverage.

If you miss the individual enrollment period or discontinue Medicare coverage, you can enroll or reenroll during a general enrollment period from Jan. 1 through March 31 each year. However, when you enroll in Medicare during this general enrollment period, coverage is not effective until July 1. Also, Medicare premiums are higher than if you had enrolled when you were first eligible or had not discontinued coverage. You are responsible for paying any higher premiums incurred as a result of late enrollment.

To enroll in Medicare:

Contact your local Social Security Administration office. If you are unable to locate the nearest office using your local telephone directory, call Social Security toll-free at 1-800-772-1213.
After you’ve enrolled in Medicare Parts A & B, promptly send STRS Ohio a copy of your Medicare card or a copy of a letter from Social Security confirming Medicare enrollment. (Note: STRS Ohio will not accept a letter acknowledging Medicare’s receipt of your enrollment application. You must provide us with verification of actual Medicare enrollment.) Please write your STRS Ohio account number on any documents you submit. STRS Ohio will then adjust your monthly health care premium accordingly. STRS Ohio will also begin reimbursing part of the cost of the eligible benefit recipient’s monthly Medicare Part B premium beginning the first of the month after STRS Ohio receives confirmation of Medicare enrollment.

Important note: You will be charged a significantly higher health care premium until STRS Ohio receives confirmation of Medicare enrollment.

For additional information about Medicare, call Medicare toll-free at 1-800-633-4227 or visit www.medicare.gov.

After You Enroll in Medicare Parts A & B
If you are not eligible for Medicare when you first enroll in an STRS Ohio health care plan, you will need to enroll in Medicare Parts A & B at age 65. The following answers to frequently asked questions will help you better understand how your enrollment in an STRS Ohio health care plan is affected after you enroll in Medicare Parts A & B.

How do I notify STRS Ohio of my enrollment in Medicare?
After you’ve enrolled in Medicare Parts A & B, you need to send STRS Ohio a copy of your Medicare card or a copy of a letter from Social Security confirming Medicare enrollment. If you do not have a Medicare card or a letter from Social Security, you can send STRS Ohio a copy of any of the following Social Security Administration forms: Retirement, Survivors and Disability Insurance Notice of Award; Report of Confidential Social Security Benefit Information; or Notice of Health Insurance Entitlement. The information you send to STRS Ohio must include the Medicare effective date.

Please write your STRS Ohio account number on any documents you submit. After we receive notice of Medicare enrollment, STRS Ohio will adjust your monthly health care premium accordingly and begin reimbursing part of the benefit recipient’s cost of the Medicare Part B premium, if applicable.

Will my health care plan options change after I enroll in Medicare Parts A & B?
Yes. Since eligibility for health care plans is based on Medicare status and the location of your permanent residence, you will have the option of changing STRS Ohio health care plans after you enroll in Medicare Parts A & B.

STRS Ohio will send you a Medicare information packet three months before you turn age 65. This information explains the importance of enrolling in Medicare and how Medicare enrollment affects your STRS Ohio health care coverage. (If you do not receive this information, please call STRS Ohio’s Member Services Center toll-free at 1-888-227-7877.) This will allow you enough time to make your plan selection and complete any necessary applications. All requests to change plan administrators can be made effective the first of the month of your 65th birthday. If you or a dependent becomes eligible for Medicare before age 65, please call STRS Ohio’s Member Services Center to discuss your plan options.

Please note that you and any eligible dependents covered under your STRS Ohio account must enroll under the same plan administrator. In addition, if you change plan administrators, your current deductible and out-of-pocket accumulations, if applicable, will not be transferred to the new plan administrator.

How do I find out which plans are available to me as a new Medicare enrollee?
You should call STRS Ohio’s Member Services Center toll-free at 1-888-227-7877 to learn about the plans available to you.

How do I pay for my monthly Medicare Part B premium?
If you receive a monthly Social Security, Railroad Retirement or Civil Service Retirement payment, your Medicare Part B premium will be automatically deducted from this payment. Otherwise, Medicare will send you a bill for your Part B premium every three months. Another payment option is to have your Part B premium automatically deducted through the Medicare Easy Pay plan. This is a free, electronic payment option offered by Medicare. Through the Medicare Easy Pay plan, Medicare automatically deducts the premium payment from your savings or checking account. To sign up for the Medicare Easy Pay plan, call Medicare toll-free at 1-800-633-4227.

Who will be the primary payer of my hospital and medical expenses after I enroll in Medicare?
If you’re enrolled in an indemnity, PPO or commercial HMO plan, Medicare becomes the primary payer of covered expenses, and STRS Ohio becomes the secondary payer. (The only exception to this is enrollees with end-stage renal disease, in which STRS Ohio is the primary payer for the first 33 months.) If you’re enrolled in a Medicare HMO, the plan assumes the responsibility of paying for covered in-network services.

Will my plan administrator submit my Medicare Part B medical claims to Medicare for payment?
If you’re enrolled in a plan administered by Aetna, Medical Mutual or AultCare, you may be eligible to enroll in an automatic claims-filing program between Medicare and your health care plan administrator. This program is often referred to as “Medicare crossover.” By participating in this program, Medicare Part B claims submitted to Medicare by your provider will automatically be sent to your plan administrator for secondary payment and coordination of benefits. Contact STRS Ohio to request an authorization form to enroll in this automatic claims-filing program.

Who is the primary payer for medications covered under Medicare Part B?
Select medications are covered under Medicare Part B. If you’re enrolled in a plan administered by Aetna or Medical Mutual, you may need to sign an authorization of benefits form so that claims for Medicare Part B-covered medications can be submitted directly to Medicare for payment.