Retirees: Medicare

If you and/or your covered dependent(s) become eligible for Medicare, you can enroll in one of the State Health Benefit Plan (SHBP) Medicare Advantage plan options which includes Part A (hospitalization), Part B (provider services), and Part D (prescription drugs). However, to enroll in a SHBP Medicare Advantage plan option, you must first enroll in Medicare Part B.

Frequently Asked Questions

Below are a few frequently asked questions we receive about Medicare.

  • Who is the Social Security Administration (SSA) and What Is Their Role in Medicare Part B?

    The Social Security Administration (SSA) is the federal agency responsible for Medicare enrollment, and the SSA is also responsible for the issuance of Medicare Part B which is required to enroll in a SHBP Medicare Advantage plan option.

  • When Should I Apply for Medicare Part B?

    To ensure you meet SHBP’s requirements,  we strongly suggest you contact the SSA to apply for Medicare Part B at least 90 days prior to your 65th birth month (i.e., the month you turn age 65) to ensure that you receive your Medicare Part B timely. 

  • What if I Don’t Receive My Medicare Part B in time?

    SHBP is not responsible for your enrollment in Medicare Part B nor any delays you encounter with enrolling in Medicare Part B. If you have not provided SHBP your (or your Dependent’s) Medicare Part B information at least one month prior to your (or your Dependent’s)  65th birthday or your retirement date if you continued to work past age 65, you will remain in a SHBP Commercial (non-Medicare Advantage) plan option, your premium will not be subsidized by SHBP, and you will be responsible for the entire costs of coverage which is substantially higher than your current premium. You may reduce your premiums prospectively if you provide your Medicare Part B information to SHBP.

  • Do I Have to Pay Both Medicare Part B Premiums to SSA and Retiree Premiums to SHBP?

    Yes. If applicable, please continue to pay your Medicare Part B premiums to SSA. Medicare Part B premiums, if applicable, are in addition to and are not the same as your SHBP premiums. Failure to do so will result in SSA notifying the Centers for Medicare & Medicaid Services (CMS) of your failure to pay your Medicare Part B premiums. CMS will then require SHBP disenroll you from your SHBP Medicare Advantage plan option, and SHBP will enroll you in a SHBP Commercial (non-Medicare Advantage) plan option requiring you pay the unsubsidized premium for health coverage (i.e., full cost of coverage), which is substantially higher than the premiums you paid prior to retirement.

  • What are the Advantages of Enrolling in SHBP Medicare Advantage Plan Options?
    • An all-inclusive plan covering hospitalization, physician and ancillary services, prescription drug coverage, and other additional benefits;
    • A plan that replaces standard Medicare coverage offered under SSA;
    • A SHBP Medicare Advantage card to use instead of your standard Medicare card. (NOTE: DO NOT destroy your standard Medicare card. Put it away in a safe place should you ever need to provide proof of Medicare eligibility); and
    • You can see any medical services provider that accepts Medicare.
  • ​​​​​​​What is a Split Option?

    If all family members are not eligible to enroll in a SHBP Medicare Advantage plan option, only the person(s) enrolled in Medicare Part B will be enrolled in a SHBP Medicare Advantage plan option, and the remaining family members will remain in their current Commercial (non-Medicare Advantage) plan option. This scenario is a Split Option.

  • Who is the Centers for Medicare & Medicaid Services (CMS) and What Is Their Role in Medicare Part B?

    CMS is the Federal agency that sets guidelines for enrollment in all Medicare Advantage plans. Therefore, your enrollment in any of the SHBP Medicare Advantage plan options is subject to CMS approval. If CMS denies your enrollment in an SHBP Medicare Advantage plan option or disenrolls you from an SHBP Medicare Advantage plan option for any reason, you will remain in your current SHBP Commercial (non-Medicare Advantage) plan option or SHBP will automatically enroll you in a SHBP Commercial (non-Medicare Advantage) plan option, your premium will not be subsidized by SHBP and you will be responsible for the entire costs of coverage which is substantially higher than your current premium. You will be responsible for the unsubsidized rate until you enroll in or reestablish your Medicare Part B and premiums will be reduced prospectively not retroactively.

    • CMS does not allow retroactive enrollments.
    • CMS requires you have a physical street address. 
    • CMS does not allow a participant to enroll in more than one Medicare Advantage, Medicare Prescription Drug Plan or Medicare Supplement Plan. If you enroll in a third party non-SHBP Medicare Advantage, Medicare Prescription Drug Plan or Medicare Supplement Plan, you will be automatically disenrolled or become ineligible to enroll in a SHBP Medicare Advantage plan option.  To ensure you do not have a lapse in coverage, you will be automatically enrolled in a SHBP Commercial (non-Medicare Advantage) plan option, your premium will not be subsidized by SHBP, and you will be responsible for the entire costs of coverage which is substantially higher than your current premium.