Retiree Medical Home

Medicare

Are you, your spouse or your dependent children eligible for Medicare?

Age 65 or older

OR

Under age 65 but disabled

You need to enroll in Medicare Parts A and B—even if you elect PG&E-sponsored retiree medical coverage.

Why? Two reasons:

  1. If you don’t enroll in Medicare Parts A and B, you won’t get full benefits. After you retire, Medicare will be your primary insurance. Your PG&E-sponsored plan won’t pay any charges that Medicare would have covered. You’ll have to pay those charges—usually about 80% of the cost—out of your own pocket.
  2. Your choice of PG&E-sponsored plans will be limited. You won’t be able to enroll in the Medicare Supplemental Plan (MSP), a Medicare Coordination of Benefits (COB) HMO or a Medicare Advantage HMO.
DO YOU HAVE TO PAY FOR MEDICARE?

Everyone has to pay for Medicare. The Medicare taxes deducted from your paychecks cover your future Medicare Part A premiums. You pay for Medicare B after you sign up for it.

Most people pay for Medicare Part B with automatic deductions from their monthly Social Security benefit. If you don’t get a monthly Social Security benefit, you’ll be billed for your Part B premiums.

How much will you have to pay for Medicare Part B?

Most people pay the standard Part B premium, which is set annually by the federal government. Medicare beneficiaries with higher incomes may be assessed an income-related adjustment, which results in a higher monthly premium. You can find details about Medicare Part B premiums at medicare.gov.

PG&E-paid monthly credit

Age 65 or older? You and your spouse will each get a $15 monthly credit toward your Medicare Part B premium when you’re enrolled in Medicare Part B and a PG&E-sponsored medical plan.

If you think you should be getting the credit, call the PG&E Benefits Service Center at 1-866-271-8144.

Disabled and under 65? You’ll get a higher credit.

If you and your dependents are under 65 and eligible for Medicare due to a disability, PG&E will reimburse you the full amount you pay for the standard Medicare part B premium instead of the $15 credit.

In other words, PG&E will reimburse the standard Part B premium, excluding any income-based surcharges that Social Security may assess you. Your Medicare Part B credit will be based on the year you were first approved for Medicare Part B. When you or your dependents turn 65, the credit will change to $15 per month.

You and up to two dependents can get this credit as long as each of you is:

  • Disabled and under 65,
  • Enrolled in Medicare Parts A and B, and
  • Enrolled in a PG&E-sponsored medical plan.

Think you qualify for Social Security disability benefits? Call Allsup, Inc., at 1-888-339-0743. PG&E has contracted with Allsup, Inc., to provide help with the Social Security disability application process at no cost to potentially eligible disabled retirees and dependents.

WHEN DO YOU NEED TO ENROLL IN MEDICARE?
Turning 65 soon? Age 65 or older? Under 65 and disabled?
You or your spouse must apply for Medicare Parts A and B three months BEFORE turning 65. You or your spouse must be enrolled in Medicare Parts A and B by the date you retire.

If you’ve been getting Social Security disability benefits for at least two years, you should be automatically enrolled in Medicare Parts A and B unless you declined or canceled Part B after becoming eligible.

If you declined or canceled Medicare Part B after becoming eligible, you'll need to be re-enrolled in Medicare Part B by the date you retire. Contact the Social Security Administration immediately.

IMPORTANT: Enrollment in Medicare Part B is not always automatic. Contact the Social Security Administration to enroll in Medicare Part B.

Did you decline or cancel Medicare Part B when first eligible? Contact Social Security right away to sign up for Part B.

What if your Medicare enrollment is late?

If you don’t enroll in Medicare Part B when you’re first eligible, you will have to pay a Medicare Part B late enrollment penalty for the rest of your life. You’ll also need to pay back any PG&E-sponsored retiree medical benefits you received when you should have received Medicare benefits instead. The amounts you have to repay may be substantial.

How can you enroll in Medicare?

There are three ways you can enroll in Medicare Parts A and B:

  1. Call the Social Security Administration at 1-800-772-1213.
  2. Visit your local Social Security office.
  3. Enroll online.
DID YOU WAIVE MEDICARE COVERAGE BECAUSE YOU HAD EMPLOYEE COVERAGE?

Did you or your spouse waive Medicare coverage because you were still working and had employee coverage?

You’ll need to enroll in Medicare Parts A and B BEFORE you retire—and your Medicare coverage must be effective by the date you retire.

Otherwise, you won’t have full coverage. This means you’ll have to the pay the charges Medicare would have covered. You’ll start getting full coverage when you finally enroll in Medicare Parts A and B and your Medicare coverage becomes effective.

If you’re late enrolling in Medicare, you may have to wait for the next Open Enrollment period in the fall before you can enroll in Medicare. This means you could be without primary medical coverage until the following January 1.

Social Security may require you or your spouse to have PG&E complete a Request for Employment Information form as part of your Medicare Part B application. This may help you avoid being charged a late enrollment penalty.

Submit the form to PG&E:

Fax Email Mail
1-925-459-7329
Attention: Retirements
HRPensionQuestions@pge.com PG&E Benefits Department
Attention: Retirements
1850 Gateway Blvd., 7th Floor
Concord, CA 94520

DON'T BE LATE
Submit the form to PG&E at least three weeks before your Social Security Administration deadline. PG&E will complete and return the form to you within two weeks of receiving it from you. The Social Security Administration will not be flexible if you submit a late form.

WHEN MEDICARE COVERAGE STARTS

If you enroll at least three months before turning 65, your Medicare coverage will be effective the first day of the month you reach age 65. If your birthday is on the first day of the month, your Medicare coverage will be effective the first day of the prior month.

Under 65 and disabled? Your Medicare coverage should automatically start after you’ve been getting Social Security disability benefits for two years. DO NOT decline Part B when you become eligible for it.

Did you or a disabled family member decline or cancel Medicare Part B when initially eligible because you were still working? You or the Medicare-eligible dependent will need to be enrolled in Part B by the date you retire.

HOW MEDICARE WORKS

There are two important points to understanding how Medicare works:

  1. Allowable amount. Medicare determines an allowable amount for a particular service. Doctors and hospitals that accept Medicare assignment have agreed to accept Medicare’s allowable amount as payment in full—even though the allowable amount is usually less than what the doctor or hospital would charge.
  2. Partial payment. Medicare typically pays 80% of the allowable amount. In some cases, Medicare will pay 100% of its allowable amount for some preventive services—like annual flu shots.

Medicare Coordination of Benefits (COB) HMOs and Medicare Advantage HMOs

Medicare Coordination of Benefits (COB) HMOs and Medicare Advantage HMOs work differently:

Medicare COB HMO. If you use network providers, you’ll pay a copayment at the time of service, and your HMO will coordinate all payments with Medicare. Usually, you’ll have no additional payments beyond your copayment.

You also can use licensed providers outside your HMO’s network. However, you'll get traditional Medicare coverage at the standard level of Medicare benefits.

Medicare Advantage HMO. A Medicare Advantage HMO works like a Medicare COB HMO, except there is no out-of-network coverage. Instead, you assign or give away control of your Medicare benefits to the HMO when you enroll.

You can’t use your Medicare benefits outside of your HMO’s network.

WHAT MEDICARE COVERS

Medicare Part A is called hospital insurance. Medicare Part A generally covers a portion of your hospital and some skilled nursing services when you’re classified as an inpatient.

Medicare Part B is called medical insurance. Medicare Part B generally covers a portion of your medically necessary and preventive services when you’re classified as an outpatient—even if you’re hospitalized.

Medicare Part D is Medicare’s prescription drug plan. All PG&E-sponsored plans have better prescription drug benefits than the basic Medicare Part D prescription drug benefit.

DO NOT ENROLL in any Medicare Part D prescription drug plan, Medicare COB plan or Medicare Advantage plan that is not sponsored by PG&E.

If you do, you and your enrolled dependents will be disenrolled from your PG&E-sponsored plan, and you will lose all of your prescription drug and medical coverage through PG&E.

That’s because if you enroll in an external plan, your Medicare benefits will be paid to that plan—not to your PG&E-sponsored plan.