Transitioning to Medicare

Also see: Medicare at retirement checklist. A step‑by‑step guide to help you enroll in Medicare and UC retiree coverage in the right order—and avoid late‑enrollment penalties.

Most people become eligible for Medicare — the federal program that provides older adults and those with disabilities or permanent kidney failure with secure access to medical care — when they turn 65. Whether you must enroll right away depends on whether you are still working and covered by an employer medical plan.

If you’re still working when you become Medicare eligible

You may choose to enroll in Medicare Part A (hospital coverage), which typically has no monthly premium, while continuing your coverage through a UC medical plan for non-Medicare employees. While you’re actively working, Medicare Part A is generally secondary to your UC plan. 

Medicare Part B (medical coverage) follows different rules. In many cases, you can delay enrolling in Part B if you are still working and have qualifying employer coverage. However, Medicare Part B has a monthly premium and delaying enrollment without qualifying coverage can result in lifetime penalties, including higher Part B and Part D premiums. Because Medicare rules are complex, it’s important to review your situation carefully using medicare.gov, or by speaking directly with Medicare at (800) MEDICARE (800-633-4227).

If you’re retired when you become Medicare eligible 

If you are retired when you turn 65 — or retire after age 65 — you must enroll in Medicare. If you are eligible for premium‑free Medicare Part A and do not enroll in both Parts A and B when required, you could lose UC‑sponsored medical coverage and may face lifelong Medicare penalties. 

The UC Retirement Administration Service Center (RASC) will send you the required Medicare forms about 90 days before you turn 65 or when you retire, along with instructions and deadlines.

If you’re receiving Social Security benefits

You’ll automatically be enrolled in Medicare Parts A and B, and the Social Security Administration requires you to accept Part A. If you’re still working and covered by a UC active employee medical plan, you can contact the SSA to opt out of Part B. When you later transition to UC retiree medical coverage, you will be able to enroll in Part B during a Medicare Special Enrollment Period without a penalty.

To avoid a permanent Part D late enrollment penalty, you must maintain continuous creditable prescription drug coverage from the time you become Medicare eligible — whether you’re still working or retired. 

A gap of more than 63 days without creditable coverage can result in a lifetime penalty. 

CMS creditable prescription drug coverage Includes:

• A Medicare drug plan (Part D).
• A Medicare Advantage Plan (Part C), such as an HMO or PPO that includes drug coverage.
• A Medicare Supplement (Medigap) plan with prescription drug coverage.
• Employer, retiree, COBRA or individual prescription coverage that meets the Centers for Medicare & Medicaid Services (CMS) standards.

If you anticipate you will have a gap of more than 63 days between UC non-Medicare coverage and your Medicare effective date, enrolling in COBRA may help you maintain creditable coverage and avoid penalties. Contact the Retirement Administration Service Center (RASC) for more information and guidance.

If Medicare later determines that you owe a late enrollment penalty, you’ll receive a notice explaining how to respond and what documentation may be required to request reconsideration.

Once you enroll in Medicare, you will continue to have UC medical coverage, but your coverage will change. UC retiree medical plans are designed to coordinate with Medicare, and each UC non‑Medicare plan has a corresponding Medicare option. 

After you enroll in Medicare and complete the required UC Medicare form, you are automatically enrolled in the UC Medicare plan that aligns with your current coverage. Medicare versions of UC plans may differ from non‑Medicare plans in costs, benefits, provider networks, and service areas. 

If some members of your household are Medicare‑eligible and others are not, your family is considered a split‑Medicare family, and different family members may be enrolled in different plans.

Planning tip: During the Open Enrollment period before you enroll in Medicare, review the Medicare version of your current plan. Open Enrollment is the time to make changes if you want to transition to a different plan when you enroll in Medicare.

If you’re enrolled in a UC Medicare Supplement PPO plan (UC Medicare PPO, UC Medicare PPO without PrescriptionDrugs or UC High Option Supplement to Medicare) administered by Anthem Blue Cross, Medicare becomes your primary insurance and pays first for Medicare‑covered services.

To receive the highest level of benefits, see providers who accept Medicare assignment for Medicare-covered services.

Once you’re enrolled in Medicare and a UC Medicare Supplement PPO plan, understanding how claims are handled can help prevent delays. 

When a claim is submitted correctly, your provider bills Medicare first. Medicare processes the claim and pays its portion. Your provider receives a Medicare remittance explaining how the claim was handled, and you receive a Medicare Summary Notice, which is not a bill but a summary of services and payments. 

After Medicare processes the claim, it is sent to Anthem with details about what Medicare paid. Anthem then processes the claim as secondary coverage and sends you an Explanation of Benefits showing what was paid and what (if anything) you owe the provider.

To help ensure smooth claims processing, make sure all of your health care providers have both your Medicare card and your Anthem ID card. If a provider sends a claim to Anthem before billing Medicare, Anthem will deny the claim and instruct the provider to bill Medicare first.

In many cases, Medicare automatically sends claims to Anthem through a process called Medicare crossover. This reduces paperwork and billing errors by eliminating the need for providers to submit claims to both Medicare and Anthem. While crossover setup usually happens automatically, it can take several months. During this time, Medicare remains your primary coverage, and there should be no interruption to care or cancellation of services. Medicare does not automatically send claims to tertiary plans.

Medicare premiums are separate from UC medical premiums. Medicare Part A is usually offered at no cost, while Parts B and D typically have monthly premiums based on income. These premiums are in addition to what you pay for UC retiree medical coverage.

If you transition to Medicare mid-year 

If you move to a UC Medicare Supplement PPO plan mid-year after being enrolled in a UC faculty/staff non-Medicare PPO plan, you may be eligible for a credit for out-of-pocket medical costs you paid earlier in the year. For more information, contact Anthem Health Guide at (844) 437-0486 after you enroll in a UC Medicare Supplement PPO plan. This credit does not apply to out-of-pocket pharmacy costs.

If you have a Health Savings Account, enrolling in Medicare affects how you can contribute to and use your account. 

If you have not applied for Medicare or Social Security, you may be able to continue contributing to your HSA. The IRS and Medicare recommend stopping HSA contributions about six months before enrolling in Medicare to avoid tax penalties. 

Once you are enrolled in any part of Medicare, you can continue using your HSA funds for qualified medical expenses. After age 65, you may also use HSA funds for non‑medical expenses, though those withdrawals are generally taxed as income.

Start with the Medicare at Retirement Enrollment Checklist.

UC Retirement Administration Service Center (RASC)

(800) 888-8267 
Monday–Friday, 8:30 a.m.–4:30 p.m. PT
You can also join a weekly RASC Medicare Q&A session to get expert answers to your questions. Register for a Medicare Q&A session.

Medicare

medicare.gov
(800) MEDICARE (800-633-4227)