Becoming Eligible for Medicare
Enrolling in Medicare when You Turn 65
Medicare is a federal medical insurance program for people age 65 or older, those under age 65 (when certified as eligible by Social Security), and those of any age with end-stage renal disease. Find more information at www.medicare.gov.
You are typically eligible for Medicare on the first day of the month you turn 65. Disabled individuals may qualify prior to age 65. Your Medicare eligibility date may not be the same as your Social Security eligibility date. Contact Social Security three (3) months before you turn 65 to initiate Medicare coverage.
Once you receive your Medicare card, make a copy and send it to: FCPS, Department of Human Resources, Office of Benefit Services, 8115 Gatehouse Road, Suite 2700, Falls Church, VA 22042
Your Medicare initial enrollment period begins 3 months before you turn 65 and ends 3 months after. If you miss this deadline, you must wait until the Medicare General Enrollment Period, held January 1 through March 31 each year. If you do not enroll during your initial enrollment period, you may incur a penalty that will increase your monthly premium as long as you have Medicare coverage (see "Exceptions" below). Medicare is generally the primary coverage for a retiree and/or spouse age 65 or older who has medical benefits through FCPS. Medicare enrollees generally receive the same level of coverage, but Medicare pays first. Your FCPS retiree medical plan becomes your secondary coverage. As an FCPS retiree eligible for Medicare, you can enroll either in the Aetna Medicare Advantage or the Kaiser Permanente Medicare Advantage plan (provided you reside in the Kaiser Permanente Medicare service area).
All FCPS retiree medical plans require retirees, spouses, and their dependents to enroll in Medicare Parts A and B when they become eligible for Medicare (see "Exceptions" below). The chart below will help you understand the different parts of Medicare.
|Medicare Part A||Medicare Part B||Medicare Part D|
|Hospital Coverage pays for care in a hospital, skilled nursing facility, home health care, and/or hospice care. Most retirees do not pay for Medicare Part A coverage; you have already paid for it as part of your Social Security taxes while you were working.||Medical insurance helps pay for doctors and other medical services. You pay a monthly premium to Social Security when you enroll in Medicare Part B.||Medicare Part D is a prescription drug plan available to Medicare-eligible individuals. If you elect Medicare Part D, you pay a monthly premium directly to the plan with which you are enrolled. You are not required to enroll in a Medicare D plan - all FCPS health plans contain prescription drug benefits.|
Exceptions to Medicare Enrollment and Coverage
- If you are retired and covered by your spouse who continues to work for FCPS, you do not need to enroll in Medicare when you become eligible. As a dependent of an active employee, your FCPS coverage remains primary.
- Prior to your spouse’s retirement, you should obtain the Medicare Form CMS-L564 that FCPS will complete to verify your enrollment in the active plan. This rule applies only if your spouse is covered through FCPS as an active employee. If you or your spouse is retired and re-employed as a substitute teacher or a non-benefits-eligible employee, your benefits are provided as a retiree and you must elect Medicare coverage.
- You must elect Medicare if you are retired, working for another employer, and eligible for Medicare. Since you are covered by FCPS as a retiree, your Medicare benefits will pay as primary, and FCPS benefits pay as secondary.
- If you retire on June 30 your employee coverage will continue through August 31; however, Medicare becomes your primary plan effective July 1.
Cigna Open Access Plus
- If you are covered by the Cigna Open Access Plus (OAP) plan, FCPS will transfer you and your dependents to the Aetna Medicare Advantage plan.
- If you do not want to participate in the Aetna Medicare Advantage plan, you may elect to enroll in Kaiser Permanente Medicare Advantage plan (subject to service area restrictions described below).
- You may not elect the Cigna OAP plan once you are eligible for Medicare.
Kaiser Permanente Medicare Advantage
- If you want to continue with Kaiser when you become eligible for Medicare, you must take action to enroll in the Kaiser Permanente Medicare Advantage plan. Medicare’s rules do not allow for automatic enrollment in the Medicare Advantage Plan.
- If you are age 65 or older, contact Kaiser Permanente for the Medicare form and return the form to FCPS' Department of Human Resources, Office of Benefit Services.
- Under the Kaiser Permanente Medicare Advantage plan, Kaiser Permanente generally provides all your medical care. Out-of-network providers can only be utilized if you have been referred by a Kaiser Permanente physician, and for emergency care or urgently needed care while outside of the service area.
- Enrollment in the Kaiser Permanente Medicare Advantage plan is subject to federal government guidelines that require residence in the plan’s Medicare service area. You must live—and your Social Security address must be—in the Kaiser Medicare service area, which may be different than the Kaiser Permanente Service area. Therefore, submitting an application does not guarantee your enrollment in the Kaiser Permanente Medicare Advantage plan. You should contact Kaiser Permanente’s customer service unit at 301-468- 6000 to ensure that your residential zip code is in the service area.
Medicare Rx (Medicare Part D)
- Your FCPS prescription coverage—either with CVS Caremark/SilverScript (for Aetna members) or Kaiser Permanente—is currently more comprehensive than Medicare Part D provisions and meets the Centers for Medicare and Medicaid Services (CMS) creditable coverage requirements.
- If you elect to participate in either the Aetna Medicare Advantage plan or the Kaiser Permanente Medicare Advantage plan, you automatically have prescription drug coverage with CVS Caremark/SilverScript or Kaiser Permanente. You are not required to enroll in a Medicare Rx plan. Enrollment in a separate Medicare Rx plan will cause your FCPS prescription drug coverage to be canceled.
- If you choose to enroll in a Medicare Rx plan and later cancel that coverage, you will be eligible to resume prescription drug coverage under an FCPS plan if you provide FCPS with a Medicare prescription drug coverage termination notice within 30 days of termination.
Did you know?Medicare is the primary payer for a retiree or spouse age 65 or older who has retiree health benefits through FCPS; your FCPS retiree health plan becomes your secondary coverage.
Medicare is also the primary payer for certain individuals under age 65 with disabilities. If you are a retiree or dependent of a retiree under age 65 and eligible for Medicare, you must elect Medicare coverage; FCPS’ medical plan will pay as secondary.