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See an overview on Medicare...
This section explains what Medicare is, what “parts” you need and the importance of signing up for coverage. Keep in mind, you’re eligible for Medicare even if you did not contribute to Social Security. STRS Ohio requires you to enroll in Medicare Parts A & B or Part B-only.
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. A common misconception is that Ohio educators do not qualify for Medicare because they did not contribute to Social Security. However, you’re eligible for Medicare when you turn age 65 even if you are not eligible for Social Security retirement benefits.
Most people age 65 or older are eligible for Medicare Part A (hospital insurance) based on their own or their spouse’s employment. You are eligible at age 65 if you are a citizen or permanent resident of the United States and:
If you aren’t yet age 65, you may qualify for Medicare coverage if you have a disability or end-stage renal disease (permanent kidney failure requiring dialysis or a transplant).
Almost every U.S. citizen or permanent resident who is age 65 or older (or under age 65 but eligible for Medicare Part A) can enroll in Medicare Part B. A monthly premium is required.
If you believe you are not eligible for Medicare, STRS Ohio will require a letter from your local Social Security Administration office confirming ineligibility.
While there are several “parts” to Medicare, you only need to sign up for two: Part A (hospital insurance) if it’s available at no cost from Medicare and Part B (medical insurance).
While most people do not have to pay a premium for Part A, everyone must pay for Part B. It's important to understand if premium-free Part A is available from Medicare, STRS Ohio requires you to enroll in Part A. STRS Ohio also requires you to sign up for Medicare Part B and continue to pay a monthly premium to Medicare.
W Take action — Sign up for Medicare Part B and pay a monthly premium to Medicare. Also enroll in Part A if it’s premium-free.
In addition to Parts A & B, Medicare offers Part C (Medicare Advantage plans). Medicare Advantage plans are approved by Medicare and administered by private companies. You do not need to enroll in Part C — enrollment in Parts A & B or Part B-only qualifies you for coverage under a Medicare Advantage plan.
Medicare also offers Part D (prescription drug plans). If you enroll in an STRS Ohio plan, you should not enroll in any other Part D plan — all of the health care plans we offer for enrollees with Medicare Part A and/or Part B already include Medicare Part D prescription drug coverage. Enrollment in any other Part D plan will affect your STRS Ohio eligibility. See “After You Enroll in Medicare” below for details.
You qualify for Medicare at age 65 even if you did not contribute to Social Security
|Coverage type||Am I required to enroll?|
|. Yes — Enroll if it’s available at no cost from Medicare.
\ No — Do not enroll if you must pay a premium to Medicare.
|. Yes — You must enroll and pay a monthly premium to Medicare. (Eligible benefit recipients may receive partial reimbursement toward their Part B premium cost.)|
|\ No — Part D prescription drug coverage is included in your health care plan. You must not enroll in any other Part D plan if you want to keep your STRS Ohio health care plan coverage.|
Medicare Parts A & B do not replace your STRS Ohio coverage. Instead, Medicare works with your STRS Ohio health care plan to provide maximum hospital and medical coverage. In general, when you enroll in Medicare Parts A & B, Medicare becomes the primary payer of your hospital and medical expenses; STRS Ohio becomes the secondary payer. If you’re enrolled in a Medicare Advantage plan or a Medicare HMO, the plan assumes responsibility for paying for covered services and receives payment from Medicare.
After you enroll in Medicare, you will pay two separate monthly premiums — one premium for STRS Ohio coverage (paid to STRS Ohio) and another premium for Medicare Part B coverage (paid to Medicare).
There are several reasons why you need to enroll in Medicare.
STRS Ohio benefit recipients will not receive partial reimbursement for their Medicare Part B premiums until enrollment in Medicare Part B is confirmed. Even if you don’t have STRS Ohio health care coverage, it’s important for you to enroll in Medicare Part B.
If you don’t sign up or don’t provide STRS Ohio with proof of Medicare enrollment, you will be enrolled in the Medical Mutual Basic Plan if you want to continue your STRS Ohio coverage. In addition, your STRS Ohio coverage will be affected as follows:
If you stop paying your monthly Medicare Part B premium, you will lose your Part B coverage. If this occurs, you must apply for reinstatement of coverage with Medicare (See “After You Enroll in Medicare" below for details about late enrollment penalties.) In addition, STRS Ohio will change your enrollment to the Medical Mutual Basic Plan until you provide a current dated letter verifying the effective date of reinstatement. You will be responsible for paying any charges normally paid by Medicare until you provide a letter of reinstatement to STRS Ohio.
If your Part B coverage lapses for any reason, you must notify STRS Ohio immediately as it affects plan eligibility and Part B reimbursement. 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.
If you or your spouse is still employed and covered by a group health plan through the employer, you may choose to delay your enrollment in Medicare Part A and/or Part B. However, if you delay your enrollment, you should be aware of the following:
If you reside outside the United States, your STRS Ohio plan options are limited to the Medical Mutual Plus or Basic Plan. Medicare generally does not cover health care items and services furnished or delivered outside the United States. As a result, you will be responsible for submitting all claims to your plan administrator and for paying 80% of all claims expenses that would have been covered by Medicare.
This section walks you through the Medicare enrollment process...
This section walks you through the Medicare enrollment process. Remember, the process is not complete until you send STRS Ohio a copy of your Medicare Parts A & B or Part B-only card.
You have a seven-month initial enrollment period in which to sign up for Medicare Parts A & B. Your initial enrollment period begins three months before you turn age 65, includes the month you turn age 65 and ends three months after the month of your birthday.
W Take action — Enroll in Medicare before your 65th birthday to avoid a delay in Medicare coverage.
For coverage to be effective the month you turn age 65, you must sign up during the first three months of the initial enrollment period (one to three months before the month of your birthday). If you wait to sign up during the last four months of the period, your effective date of coverage under Medicare will be delayed.
|Initial Enrollment Period for Medicare
Begins three months before and ends three months after the month you turn age 65
|You will have NO DELAY in coverage if you enroll:|
Three months before you turn 65
Two months before you turn 65
One month before you turn 65
|Coverage begins the month you turn 65
(If your birthday is the first of the month, coverage begins the first day of the previous month.)
|You will have a DELAY in coverage if you enroll:|
|The month you turn 65||c
One month after you turn 65
Two months after you turn 65
Three months after you turn 65
|Coverage begins one month after the month you enroll||Coverage begins two months after the month you enroll||Coverage begins three months after the month you enroll||Coverage begins three months after the month you enroll|
If you miss the initial enrollment period, you can enroll during a general enrollment period from Jan. 1 through March 31 each year. However, coverage is not effective until July 1. Also, Medicare Part B premiums will be higher since you may pay a Part B late enrollment penalty for as long as you have Medicare coverage. You are responsible for paying any costs incurred as a result of late enrollment.
Enrolling in Medicare is an easy two-step process. It may take several months for the entire application process to be completed, so be sure to start the process before your 65th birthday.
To enroll in Medicare:
If you visit your local office, find out which documents to bring with you to your appointment. Be sure to apply for Medicare before your 65th birthday so there is no delay in Medicare coverage.
After you’ve enrolled in Medicare Parts A & B or Part B-only, you must send STRS Ohio a copy of your red, white and blue 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:
These are the only documents STRS Ohio can accept in lieu of a copy of your Medicare card or enrollment confirmation letter. Note: STRS Ohio will not accept a letter acknowledging Medicare’s receipt of your enrollment application. Also, please check all information on your Medicare card for accuracy. If it is incorrect, contact Medicare. Medicare will issue you a new card with the correct information. Send a copy of the revised card to STRS Ohio.
The information you send to STRS Ohio must include your Medicare Parts A & B or Part B-only effective date and your Medicare claim number. Please write your STRS Ohio account number on any documents you submit. (If you’re unsure of your account number, call STRS Ohio.) STRS Ohio must receive a copy of your Medicare card by the 15th of the month to begin your enrollment the first of the following month.
Attention Medical Mutual enrollees: If you’re eligible for the Aetna Medicare Plan, you will be enrolled in the Aetna plan after STRS Ohio receives a copy of your Medicare card and Medicare approves your enrollment request. If you do not want the Aetna plan, you must submit your request to be enrolled in the Medical Mutual Basic Plan (or a regional plan if available) when you send us a copy of your Medicare Parts A & B or Part B-only card.
Learn how to select a health care plan after you enroll in Medicare...
After you enroll in Medicare Parts A & B or Part B-only, the STRS Ohio plans available to you will change. Call STRS Ohio toll-free at 1-888-227-7877 to learn about your new plan options and premiums. You can also review this information in the secure Personal Account Information area of our website.
Your plan options as a Medicare enrollee are based on your Medicare status and the location of your permanent residence.
You are eligible for the Aetna Medicare Plan if: (1) you are enrolled in Medicare Parts A & B or Part B-only; and (2) you live in the United States. You must remain enrolled in Medicare Part B and continue to pay your monthly Medicare Part B premium to remain eligible for this plan.
Attention Medical Mutual enrollees: If you qualify for the Aetna Medicare Plan, you will be enrolled in the Aetna plan after STRS Ohio receives a copy of your Medicare Parts A & B or Part B-only card and Medicare approves your enrollment request. If you do not want the Aetna plan, you can “opt out” of the plan and choose the Medical Mutual Basic Plan or a regional plan — AultCare, HealthSpan (formerly Kaiser Permanente) or Paramount — if available. To opt out, call STRS Ohio or submit your request in writing when you send us a copy of your Medicare card.
If STRS Ohio does not receive a copy of your Medicare Parts A & B or Part B-only card, you will be enrolled in the Medical Mutual Basic Plan.
To select a new health care plan, call STRS Ohio toll-free at 1-888-227-7877. You may select a new plan up to three months after your 65th birthday. The effective date of coverage under your new plan will be the first of the month following notification to STRS Ohio, if submitted by the 15th of the month. There will be no interruption in your health care coverage.
W IMPORTANT: If you do not send STRS Ohio proof of Medicare Parts A & B or Part B-only enrollment, your only plan option will be the Medical Mutual Basic Plan. You will be enrolled in the Basic Plan at the end of your initial enrollment period for Medicare and will remain in this plan until STRS Ohio receives proof of Medicare coverage. In addition, your claims will be processed as if you were enrolled in Medicare. This means you will be responsible for 80% of all Part B claim expenses, including physician claims.
Learn about important financial and coverage-related topics for new Medicare enrollees....
Your Medicare Part B premium is not included in your monthly STRS Ohio health care premium. It is a separate premium that must be paid to Medicare, not to STRS Ohio.
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.
Remember, you must pay your monthly Medicare Part B premium before the due date to avoid cancellation of your Medicare Part B coverage. If your Part B coverage is canceled, you will be enrolled in the Medical Mutual Basic Plan. You will also be responsible for 80% of all Part B claim expenses, including physician claims.
W Take action — Sign up for the Medicare Easy Pay plan if your Part B premium is not automatically deducted from a federal retirement payment.
After you enroll in Medicare, the prescription drug coverage included in your STRS Ohio health care plan will be provided under a Medicare Part D prescription drug plan. To be eligible, you must be enrolled in Medicare Parts A & B or Part B-only.
Express Scripts administers the Medicare Part D plan for Aetna, Medical Mutual, AultCare and Paramount enrollees. HealthSpan (formerly Kaiser Permanente) administers the plan for its enrollees.
Because Medicare Part D coverage is already included in your STRS Ohio health care plan, you must not enroll in any other Medicare Part D plan. (Medicare does not allow enrollment in more than one Medicare Part D plan).
W IMPORTANT: Before making any changes to your Medicare Part D prescription drug plan coverage, call STRS Ohio to find out how your STRS Ohio health care coverage will be affected.
If you have specific questions about your prescription drug coverage, please call your prescription drug plan administrator.
If you delay enrollment in Medicare Part B or Part D, the Centers for Medicare & Medicaid Services (CMS) charges a late enrollment penalty.
The cost of paying Medicare late enrollment penalties can add up quickly. To minimize your costs, enroll in Part B when eligible and maintain the Part D coverage included in your STRS Ohio plan to avoid incurring late enrollment penalties.
Medicare Part B and Medicare Part D enrollees with higher annual incomes are subject to monthly Medicare surcharges. Surcharges vary by income levels set by Medicare (currently $85,000+ for individuals; $170,000+ for married couples). For more information, visit www.ssa.gov.
STRS Ohio does not provide subsidies to offset surcharges. Partial reimbursement of the benefit recipient's monthly Medicare Part B premium is determined using the standard premium cost, which does not include surcharges.
Medicare Part B premiums and any Part B or Part D surcharges will be deducted from your monthly Social Security, Railroad Retirement or Civil Service Retirement payment. If you do not receive such payments, you will receive a bill from Medicare. You must pay all applicable surcharges to maintain your Medicare Part B and Part D coverage. Failure to pay surcharges will result in cancellation of your STRS Ohio health care coverage. Payments are made directly to Medicare, not to your plan administrator or STRS Ohio.
Service retirement, disability and survivor benefit recipients who are enrolled in Medicare Part B and provide proof of Medicare Part B enrollment are eligible to receive partial reimbursement to offset the standard monthly premium charged by Medicare for Part B coverage. You do not need to be enrolled in an STRS Ohio health care plan to receive partial reimbursement. If there are multiple beneficiaries on the account, each beneficiary is not eligible to receive the full reimbursement amount. Call STRS Ohio for details.
If you’re eligible to receive a Medicare Part B premium reimbursement through more than one Ohio public retirement system, specific guidelines apply. It’s your responsibility to contact STRS Ohio to determine which system is responsible for providing your reimbursement; you may not receive more than one Part B premium reimbursement. It’s also up to you to provide STRS Ohio with proof of your Medicare Part B enrollment.
If STRS Ohio receives documentation of your Medicare Part B enrollment by the 15th of the month, partial reimbursement of the benefit recipient’s future standard Medicare Part B premium cost will begin the first of the following month. If documentation is received after the 15th of the month, partial reimbursement will begin the first of the second following month.
For information about Medicare Part B premium reimbursement guidelines, call STRS Ohio’s Member Services Center toll-free at 1-888-227-7877. Call Medicare directly at 1-800-633-4227 to learn what amount you will pay for your Medicare Part B coverage.
Medicare Part B covers a limited number of drugs/supplies as determined by the Centers for Medicare & Medicaid Services. Following are examples of drugs/supplies covered by Medicare Part B:
If you are enrolled in a plan administered by Aetna or Medical Mutual, the STRS Ohio Health Care Program will pay your portion of costs for select Medicare Part B-covered drugs/supplies that are coordinated with Medicare. When a claim for a covered drug or supply is coordinated with Medicare Part B, the claim is submitted to Medicare first for primary payment and then to the medical plan for secondary payment, leaving you with no copayment for drugs/supplies dispensed by a participating Medicare retail pharmacy.
Medicare offers a Low-Income Subsidy program to qualified participants in a Medicare Part D prescription drug plan. Under the Low-Income Subsidy program (also called Extra Help), participants may pay a lower deductible and lower copayment amounts for covered prescription drugs. Medicare, not STRS Ohio, determines if participants qualify for the subsidy program.
Under the Medicare Modernization Act of 2003, Medicare works directly with your prescription drug plan administrator to determine if you qualify for assistance. If you qualify, your prescription drug plan administrator will send you a letter informing you about the program. Qualifying Aetna, Medical Mutual, AultCare and Paramount enrollees will receive a letter from Express Scripts; qualifying HealthSpan enrollees will receive a letter from HealthSpan (formerly Kaiser Permanente).
If you receive a letter from your prescription drug plan administrator, you will be automatically enrolled in the subsidy program offered by Medicare. If you do not receive a letter and believe you may qualify for assistance, you can call Medicare directly toll-free at 1-800-633-4227 for more information or to request an application.
Understanding Medicare and its requirements can sometimes be confusing. That’s why we offer the webinar, Medicare Enrollment and STRS Ohio. We’ll guide you through the Medicare enrollment process, provide information specific to new Medicare enrollees and address any questions you submit during the live presentation.