State Health Plan Information for Medicare Primary Retirees
State Health Plan Medicare retirees have several options for health plan coverage. These options include the following plans:
To view a plan comparison chart of each plan option, click here.
To view Frequently Asked Questions, click here.
When You Reach Age 65 and Remain Actively Working
The State Health Plan mails a Medicare eligibility letter 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 you the Medicare eligibility election form.
The State Health Plan will be your primary coverage and Medicare will be secondary.
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.
If you have questions about Medicare enrollment, you may contact Seniors' Health Insurance Information Program at 800-443-9354.
When You are Retiring and 65 or Older
- Retiring members and/or dependents that are Medicare-eligible whose retirement is processed 60 days or greater from the benefit effective date will be automatically enrolled into a Group Medicare Advantage Base Plan with either Humana or UnitedHealthcare. These base plans are premium-free for retiree-only coverage. Retirees will have up to 30 days prior to their benefit effective date to change plans. If no action is taken, retirees will remain in the Medicare Advantage Plan in which they were assigned. Changes to plan elections can be made during the next Open Enrollment period. If the retiree has dependents that are non-Medicare Primary, they will be automatically enrolled into the health plan they were enrolled in as an active dependent.
- Retiring members that are Medicare-eligible and whose retirement is processed less than 60 days prior to the benefit effective date will be automatically enrolled in the Traditional 70/30 Plan. This plan is also premium-free for retiree-only coverage. Changes to plan elections can be made during the next Open Enrollment period. If retirees have dependents that are non-Medicare Primary, they will be automatically enrolled into the health plan they were enrolled in as an active dependent.
* Accurate and timely State Health Plan coverage is dependent on the retiring employee's Health Benefits Representative processing the retirement in a timely fashion.
When You are Retiring and Not Yet 65
- Retiring members who are under 65 will be automatically enrolled in the health plan they were enrolled in as an active employee along with any covered dependents.
Retiring employees with questions about their health plan options should contact the Eligibility and Enrollment Support Center at (855) 859-0966.
Seniors' Health Insurance Information Program at 800-443-9354
Social Security Administration at 800-772-1213 (TTY 800-325-0778)
Centers for Medicare and Medicaid Services