If you are under age 65 when you retire, you can elect to remain in the same basic health plan you were in as an active employee, or you can change to a different plan during the next open enrollment period. Note that some of the HMO plans are limited to certain regions of California. You should take that into consideration if you plan on moving. The CalPERS website provides information about the basic health plans available active members and retirees under 65, and the HR Office on campus also has information available.
Regardless of the health plan you choose, if you plan on moving you should consider the availability and quality of healthcare services in the area where you plan to move.
CalPERS requires all annuitants to enroll in Medicare when they reach age 65. You will be able to choose either traditional (fee for service) Medicare (Medicare Parts A and B) or one of the Medicare Advantage HMO Plans (Medicare Part C) that CalPERS offers. If you choose to enroll in traditional Medicare, you will need to enroll in both Medicare Part A (hospital coverage) and Medicare Part B (medical coverage). In addition, you will need to select one of the CalPERS Supplement to Medicare Policies. CalPERS also will enroll you in its own Medicare Part D (drug) plan.
If you choose one of the Medicare Advantage HMO plans, it will include hospital coverage, medical coverage, and drug coverage. In addition, some of the HMO plans provide some benefits not covered by Medicare. The CalPERS Supplement to Medicare plans also provide some coverage for certain things not covered by Medicare Parts A and B, and the CalPERS Medicare Part D plan also offers some coverage for certain drugs not covered by Medicare Part D.
[A note on choosing between traditional Medicare and a Medicare Advantage Plan: Under traditional Medicare you are free to choose your medical providers whether or not the provider accepts Medicare assignment. If the provider (doctor or hospital) accepts Medicare assignment, Medicare plus your CalPERS supplement to Medicare will cover all or nearly all the costs of your treatment (there are some deductibles during the year). However, if the provider does not accept Medicare assignment, you will be reimbursed by Medicare and your CalPERS supplement to Medicare for what they would have paid under the Medicare assignment. You are responsible for any additional charges from your provider.
Under a Medicare Advantage Plan generally you must use the providers (doctors and hospitals) within the plan's network, but except for some minor deductibles all costs are covered. If you use providers outside the network you most likely will not be covered unless it is an emergency situation that prevents you from being treated by providers in your plan's network.]
Note that whether you enroll in traditional Medicare or a Medicare Advantage plan a monthly Medicare premium will be deducted from your Social Security Check. There is a means test and people with high incomes may pay more than the basic Medicare premium. CalPERS reimburses you for the basic Medicare premium. If you are paying more than the basic Medicare premium, you may be eligible for an additional rebate (you will need to contact CalPERS to determine this). Each December Social Security will send you letter that will tell you what your Medicare premium will be for the coming year, and whether or not you have to pay more because of your income level. (Note that some Medicare Advantage plans may have an additional premium above the basic Medicare Part B premium. This depends on how many family members are covered and the monthly contribution from CSU to CalPERS for each annuitant's health care costs.)
Here are some additional guidelines:
If your spouse is covered under your health plan and reaches 65 before you do, ask to have Medicare Part B coverage for your spouse DEFERRED (do NOT turn it down). Then when you also reach 65, you can both qualify for Medicare and the CalPERS supplemental plans (or a CalPERS Medicare Advantage plan) without going through a waiting period.
Like all legal residents in the U.S. aged 65 and over, your primary health insurance is now either tradtional Medicare (Parts A and B) or a Medicare Advantage Plan (Part C). For those choosing traditional Medicare, Part A is “free”; we pay for part B. (If you are collecting Social Security, the cost of part B is deducted from your Social Security check.) You continue to be covered by CalPERS which pays for your supplemental coverage. You may be able to upgrade your supplemental insurance significantly at this time, to go on any plan offered by PERS, at no additional cost. Many people choose to switch to one of the CalPERS PPO supplemental plans at this time. Shortly before you turn 65 (about three months), Social Security sends you a notice to enroll in Medicare. Follow these instructions carefully, noting to Social Security that you are covered by CalPERS. It is important not to delay this process or otherwise you might find yourself without coverage during the transition period. (If you do not receive such notification, be sure to contact your nearest Social Security office 90 days before your 65th birthday to ensure that you receive coverage.)
When you turn 65, CalPERS will send you a form asking you to certify that you have enrolled in Medicare parts A and B. You must then make a choice about which supplemental plan you want. The CalPERS website lays out those options. Insert the word Medicare in the search box. That will take you to a page with links to several documents that provide information about Medicare enrollment and supplemental health plans available through CalPERS.
Prescription Drug Coverage: Medicare Part D
It is very important that you do not enroll in an INDIVIDUAL Medicare Part D drug benefit plan. Such enrollment could affect your eligibility for future CalPERS health benefits. Also, do not give any personal information to telemarketers who many solicit you on behalf of such plans. If you have chosen traditional Medicare you will be enrolled by CalPERS in its own Medicare Part D drug plan. If you have chosen one of the Medicare Advantage health plans offered by CalPERS, your drug coverage will be included with the plan.
The full premium for dental insurance is still paid by the state, but your co-payments may increase. Upon retirement you are switched from DeltaCare, and Delta Dental “Enhanced Plans” to the “Basic Plans”. A chart comparing the differences between the “Enhanced” and “Basic” plans is available from the campus human resources office.
Editor's note: If you are participating in the Faculty Early Retirement Program (FERP) your dental benefits remain at the "Enhanced" level while you are in FERP.
Vision coverage does not continue after retirement but you can elect a COBRA (Consolidated Omnibus Budget Reconciliation Act-an odd acronym for something that means continuing coverage after one has left employment) to continue coverage. If you are on FERP, vision coverage does continue during the FERP period although there is a gap in the first year for those not teaching in the Fall and not teaching again until the Spring term.
For a family of two, the current cost of a COBRA is slightly less than $10.00 a month, and coverage may be continued for up to 18 months. The cost of nearly $120 per year comes close to covering an eye exam and a pair of glasses at a regular vendor. (The College of Optometry offers discounts for CSUF folks and for those in Kaiser, optometry is a covered benefit. Other PERS health plans may also have a vision benefit.) There also is a voluntary vision plan for CSU retirees. The retiree pays the entire premium for the plan, but these premiums are reduced somewhat since it is a large group plan.
Note that these plans provide coverage for refractions and prescription eyeglasses or contact lenses. Medical eye conditions such as cataracts are covered by Medicare.
Starting at age 62 you will be eligible for Social Security but you will not receive full monthly benefits if you start collecting before you reach “full retirement age”. This is determined by the year of your birth. The best source of information about your benefits is through your yearly statement that you should have from Social Security. Social Security can be reached via the web at www.ssa.gov. If you continue to work, e.g. through FERP, your benefits may be reduced until you reach your “full retirement age”. For more information on this “offset” go to www.ssa.gov/pubs/10069.html.
You should contact Social Security approximately 90 days before you wish to begin collecting your retirement benefit.