Medicare Coverage

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Medicare Coverage
Medicare is a federal health insurance program for people:
Age 65 or older
Under age 65 with certain disabilities
With End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or
a kidney transplant)
Medicare coverage consists of the following:
Medicare Part A (Hospitalization) – Government program
Hospital coverage includes inpatient confinement, skilled nursing facility services and  hospice care.
You need at least 40 quarters of Social Security credit to be eligible for Medicare Part A coverage at no cost.
You may qualify for Medicare Part A coverage through a spouse’s work record if you do
not have enough quarters to receive Medicare Part A at no cost.
If you do not qualify for Medicare Part A, you must send proof of this (a letter from
Social Security) to OPERS. Once this letter is received, your OPERS health care plan
will provide substitute coverage for Medicare Part A. The centers for Medicare &
Medicaid Services (CMS) regulations do not allow OPERS to enroll retirees in some
HMOs if they are not eligible for free Medicare Part A.
Medicare Part B (Medical) – Government program
Medical coverage includes doctor visits, lab work, diagnostic services and outpatient
surgery.
Everyone is eligible to enroll in Medicare Part B once they reach age 65 (or have a
qualifying illness or disability).
Regardless of re-employment, you must enroll in Medicare Part B when it is first
offered. If you do not sign up, refuse or stop your Medicare Part B enrollment, we
still consider you to be eligible for Medicare Part B. The OPERS health care plan
will estimate what Medicare Part B would have paid and will subtract that amount
from the charges before making a payment. You will be responsible for the amount
that would have been paid by Medicare Part B.
You will also be considered eligible for Medicare Part B if you refuse coverage because
you or your covered dependents are covered by an employer’s plan. The OPERS health
care plan will estimate what Medicare Part B would have paid and will subtract that
amount from the charges before making a payment. You will be responsible for the
amount that would have been paid by Medicare Part B.
If you or your covered dependents do not enroll in the Medicare Part B program
when it is first offered, you cannot be enrolled in Kaiser or Humana.

Medicare Part C (Administration of Medicare Parts A and B) -
Medicare Part C combines Part A and Part B options and covers all medically needed
services. Participants in the OPERS health care plan that are Medicare-eligible (regardless of
Medical plan administrator) will be automatically enrolled into the Humana Medicare
Advantage Plan which is a Medicare Part C plan.
The Humana Medicare Advantage Plan is the only medical coverage choice for Medicare-
eligible participants at retirement unless you are eligible to enroll in the Kaiser Permanente
HMO.
Medicare Part D (Prescription Drug) -
Participants in the OPERS health care plan that are Medicare-eligible (regardless of Medical
plan administrator) will be automatically enrolled into the OPERS Medicare D Prescription
Plan administered by Express Scripts.
The OPERS Medicare D Prescription Plan is geared toward Medicare participants, requires
no additional premium (unless high income) and will provide OPERS with cost savings. The
plan features its own formulary customized for the needs of Medicare-eligible participants
and maintains regular copays during the coverage gap (“donut hole”).

Getting More Information

SOCIAL SECURITY
ADMINISTRATION
1-800-772-1213 (toll free)
Every day, 24 hours a day
(automated assistance)
Monday – Friday
7 a.m. to 7 p.m.
(to speak to a
representative)
www.ssa.gov
TTY: 1-800-325-0778

CENTERS FOR MEDICARE
AND MEDICAID SERVICES
1-800-MEDICARE (toll free)
Every day, 24 hours a day
www.medicare.gov
TTY: 1-877-486-2048

OHIO PUBLIC EMPLOYEES
RETIREMENT SYSTEM
1-800-222-7377 (toll free)
weekdays, 7:30 a.m. – 5 p.m.
www.opers.org

 

Medicare replacement (PDF download)

AARP health insurance plans (PDF download)

AARP life insurance (PDF download)

AARP MedicareRx Plans United Healthcare (PDF download)

life insurance (PDF download)

life insurance quotes (PDF download)

medicare benefits (PDF download)


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