Retiree Frequently Asked Questions (FAQs)
- How does Medicare coordinate with the health plans?
- If you are a retiree and become eligible for Medicare, the State Health Plan becomes your secondary coverage, and Medicare becomes your primary coverage. The State Health Plan will pay up to the amount that would have been paid had the State Health Plan been primary.
- Once I become eligible for Medicare, should I enroll in Medicare Part B?
- Yes. If you do not enroll in Medicare Part B, 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.
- Do I need to get a Medicare supplement?
- An additional Medicare supplement insurance is generally not needed. The Plan provides group coverage that is secondary to Medicare for retirees. That means Medicare pays first, and the Plan pays after Medicare has paid. The State Health Plan also covers services that Medicare does not, such as more comprehensive preventive services like annual routine physicals and the shingles vaccination. For these services, the State Health Plan pays primary. Most Medicare supplement plans do not cover services if the service is not covered by Medicare.
A good resource to assist you is the Seniors Health Insurance Information Program (SHIIP). This free service, provided by the North Carolina Department of Insurance, is designed to assist Medicare primary seniors in understanding their current health coverage. SHIIP can be reached at 800-443-9354.
- Does the State Health Plan offer a Medicare supplement?
- No, at this time the State Health Plan does not offer any Medicare supplements.
- Is there a premium for retirees on the State Health Plan?
- With the enactment of Senate Bill 323 and House Bill 578 becoming effective September 1, 2011, there will now be a premium for retirees enrolled on the 80/20 Standard plan. Medicare primary retirees will pay $10/month and State Health Plan primary retirees will pay $21.62/month. The Basic 70/30 plan remains a premium free option.
- How will premiums be collected for retirees?
- Premiums are collected a month in advance of the month they are applied. For example, the premium for September will be collected in August. Retirees who receive a pension from the state will have the premium automatically deducted each month.
Retirees who do not receive a pension will receive a direct bill from Blue Cross and Blue Shield of North Carolina. You do have the option of having your payment automatically drafted through the EasyPayBlueSM program. Look for information included with your first direct bill statement on how to sign up for automatic draft.
- What happens if a retiree does not pay the premium?
- If your premium is not received within 30 days after your premium due date, claims for you and any dependents will be placed on hold or will be denied during the period for which the premium has not been paid. If your premium is not received within 60 days, you will be moved to the 70/30 Basic plan and coverage for your dependents will be terminated as of the last day of the month through which premiums have been paid.
- Does the State Health Plan cover the shingles vaccine?
- Yes. The vaccine is covered at 100%. You are, however, responsible for the office visit copayment if it is administered by your provider.
- What if my doctor's office doesn't have the shingles vaccine?
- Your doctor may write you a prescription to buy the shingles vaccine at a pharmacy. You then take the shingles vaccine to your pharmacy for him or her to administer. The shingles vaccine must be kept frozen until it's used. You will have to pay full price at the pharmacy, but will be reimbursed by the State Health Plan. To receive reimbursement, you will need to complete and return a Medical Claim Form. Medical Claim Forms are available on our website here or by calling Customer Service at 888-234-2416.
- What if Medicare is my primary coverage?
- The vaccine is not covered by Medicare. Ask your provider to file the shingles vaccine directly with the State Health Plan.
- Should I consider getting the shingles vaccine?
- Ask your provider if it is medically appropriate for you to receive the shingles vaccine.
- Are there ways to save money at the pharmacy for retirees?
- Yes, visit the Pharmacy's ways to save page on the State Health Plan website to learn about ways to save on your next trip to the Pharmacy.
- I am an active state employee but my spouse is on my plan and is Medicare eligible. Why do I have to pay the higher non-Medicare Employee/Spouse premium instead of the lower Medicare Primary for Dependent premium?
- Federal regulations state that Medicare-eligible dependents of active employees are primary under the State Health Plan until the active employee retires. That means the Plan pays their benefits first, and there is no reduction in Plan cost of coverage due to Medicare eligibility. Because of this federal requirement for the Plan to remain primary, the higher monthly spousal premium is applicable. The only exception involves dependents who are eligible due to end-stage renal disease.
As dependent spouses reach age 65 and become eligible for Medicare, many subscribers/employees evaluate whether to continue to cover their dependents under the State Health Plan. Options include canceling their dependents from Plan coverage and instead:
These options may be less expensive than staying on the State Health Plan as a dependent once that dependent is Medicare eligible. For help in choosing what option works best for you, contact the Seniors' Health Insurance Program (SHIIP) at 800-443-9354.
- opt to enroll them in and purchase Medicare Part B, in addition to separately purchasing a Medicare Supplement Plan and a Part D prescription drug plan;
- purchase a Medicare Advantage Plan with prescription drugs.
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