Medicare Eligibility

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When you reach age 65 you are considered ‘eligible for Medicare.’  All retirees and spouses are expected to apply for and enroll in both Medicare Parts A & B in a timely manner. If you have not received information regarding Medicare, please contact Social Security Office immediately at 1-800-772-1213 or www.socialsecurity.gov.

NOTE: If you become eligible for Medicare Part A and B prior to age 65, you need to notify Employee Benefits immediately and provide a copy of your Medicare Card to employee.benefits@okc.gov. Enrollment in Medicare may affect plan eligibility and may qualify you for a reduced premium.

Depending on your health insurance plan, you may be allowed or even required to enroll in a new plan. Employee Benefits will send an election form approximately 90 days prior to your 65th birthday.

 

What action do I need to take?

Once you receive your Medicare Card, you need to forward a copy of the card to employee.benefits@okc.gov. Employee Benefits requires a copy of Medicare Card and physical address on file for enrollment to the Medicare Advantage Plan (MAPD). 

What happens if I am on HMO plan?

You will need to select a new plan. If you take no action, Employee Benefits will default you into the BCBS Alternative Plan upon Medicare Eligibility.

What happens if I become Medicare eligible but my spouse is not Medicare eligible or vice versa?

You and spouse are considered a "split" participant, which means one individual is Medicare eligible and the other is not Medicare eligible. If you are a split family, your options include the BCBS Standard Plan or the BCBS Alternative Plan. If you take no action, you will be defaulted into the BCBS Alternate Plan. You will qualify for the Medicare rate upon first Medicare eligibility but no subsequent reduction for future Medicare eligibility.

What happens if both myself and spouse are Medicare Eligible?

You will become eligible to enroll in a Medicare Advantage Plan  (MAPD) at a reduced premium cost. Please refer to the MAPD plan for additional details. Employee Benefits requires copies of Medicare cards and physical address on file for enrollment in the MAPD plan.

Should I enroll in another plan or take additional prescription coverage?

In most circumstances, the coverage provided by Medicare and whatever supplemental or secondary plan you select will provide sufficient coverage to meet your needs.  Typically, the benefits payable with a third medical plan are not sufficient to justify the premiums paid.  The savings realized by not paying premiums for the third coverage will usually cover any deductible and co-insurance you may owe for Medicare Part A and B and your supplemental or secondary plan.

 

Important information regarding the Group Indemnity Plan:

All participants who are eligible for Medicare will have Part D credible prescription coverage, which means you are not required to enroll in a separate Part D prescription plan. Although you are not enrolled in a Part D plan, the prescription drug coverage provided under the Group Indemnity Plan meets or exceeds the minimum requirements for Medicare Part D plans. Please refer to pages 31-34 of the Retiree’s Benefit Guide for additional information. 

For individuals eligible for Medicare coverage, medical claims under the Group Indemnity Plan are processed based on the assumption that you are enrolled in both Medicare Part A and B coverage.  If you fail to enroll in either Medicare Part A or B coverage, you will be held responsible for the portion of the claim that Medicare part A or B would have normally paid.

 

Important information regarding the Medicare Advantage Plan:

All participants in the Medicare Advantage (MAPD) Plan must be enrolled in Medicare Parts A & B. If you are enrolled in Medicare Parts A & B but your spouse is not, you may only enroll in this plan by removing your spouse from City medical coverage. If your spouse is enrolled in Medicare Parts A and B but you are not, you may not enroll in the MAPD Plan.

The MAPD plan incorporates Medicare Part D prescription drug coverage.  You will be disenrolled from the MAPD plan if you enroll in another Part D plan.

 

Important information regarding if you are currently enrolled in other medical coverage:

The Medicare Advantage Plan offered to Oklahoma City retirees incorporate Medicare prescription coverage (Part D).  Medicare regulations only allow an individual to be enrolled in one Medicare Part D prescription plan.

If you are enrolled in another medical plan that incorporates a Medicare Part D prescription benefit, you will need to make a decision of which plan you wish to maintain coverage and terminate coverage with the other plan.  When deciding which plan is best for you, below are some considerations to take into account:

  • Premium Cost

  • Deductible/Co-insurance

  • Out of pocket maximum

  • Eligibility for survivor benefits for spouse

Important information regarding if you enroll in other medical coverage at a future date:

Once you enroll in another medical plan with Part D prescription coverage, Employee Benefits will receive notification from the plan administrator.  After confirmation is received of your enrollment in another Part D prescription plan, Employee Benefits will automatically dis-enroll you from the medical plan you have with the City of Oklahoma City.