My Pharmacy Benefits

State Health Plan Information for Medicare Primary Retirees

When You Reach Age 65

The State Health Plan mails a Medicare eligibility letter approximately 60 days prior to your 65th birthday. The letter asks that you confirm your eligibility for Medicare benefits. If you are actively employed, your Health Benefits Representative (HBR) will receive and forward to you the Medicare eligibility election form.

If you are still actively working, the State Health Plan will be your primary coverage and Medicare will be secondary. If you are retired, Medicare is primary and the State Health Plan is secondary.

The State Health Plan coordinates benefits with Medicare. The Plan is a secondary insurance and not a supplement. In other words, the State Health Plan will pay up to what the Plan would have paid had the Plan been primary. This includes continuing to cover services that Medicare does not, such as annual physicals and the shingles vaccination.

Medicare consists of two parts:

  • Part A: Pays inpatient hospital bills and skilled nursing facility bills. It is normally provided at no charge to those eligible for Medicare.
  • Part B: Pays outpatient hospital, doctor and other professional bills and requires a monthly payment from the person eligible for Medicare.

When you become eligible for Medicare, it is recommended that you enroll in Medicare Part B if you are no longer actively working. If you do not enroll, your health plan will reduce your claim by the benefit that would have been available to you under Medicare Part B, and then pay the remaining claim amount under the terms of your health plan. As a result, you will be responsible for the amount that would have been paid by Medicare Part B.

For more details, please see your Benefits Booklet.

If you need to make a change to your plan benefits because of a life event, you will have to make those changes online. Life events include changes such as marriage, birth and death. You can find instructions for completing life event changes on this form.

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