My Retiree
Virtual Education Center™

Medicare 101

When you’re new to Medicare, it may be a bit of a puzzle, so here’s an overview of the pieces:

What is Medicare?

Medicare is a federal program that offers health insurance to American citizens and other eligible individuals.

Who can get Medicare?

U.S. citizens and legal residents who have lived in the U.S. for at least 5 years in a row, including the 5 years just before you apply for Medicare. You must also be 65 or older, younger than 65 with a qualifying disability, or any age with a diagnosis of end-stage renal disease or ALS.

What do I need to know about Medicare?

There are 4 basic parts of Medicare: A, B, C and D.

Parts A and B together make up what’s known as Original Medicare. You get this from the federal government.

Part C (Medicare Advantage) and Part D (prescription drug coverage) are private Medicare plan options offered by Medicare-approved private insurance companies.

What are my Medicare coverage choices under SHBP?

We offer 2 Group Medicare Advantage (PPO) options for your retiree medical coverage: a standard plan and a premium plan.

The Medicare Advantage (PPO) plans are also referred to as Part C plans. SHBP’s Medicare Advantage plans include Medicare Part A (inpatient care), Part B (provider visits and outpatient care) and Part D (prescription drug plan). The plans have all the benefits of Original Medicare (Part A and Part B), plus prescription drug coverage (Part D) and extra programs that go beyond Original Medicare.

How do the SHBP Medicare Advantage (PPO) plans work?

As Preferred Provider Organization (PPO) plans, they give you access to nationwide coverage. You can see any provider — in-network or out-of-network — at the same cost share, as long as they accept the plan and have not opted out of, or been excluded or precluded from, the Medicare Program. Explore your summary plan benefits here

Knowledge is power

Timing matters when you first enroll, so make note:

1. 4 months before you turn 65

   SHBP will contact you by mail, at the address we have on file, about your requirement to enroll in Medicare Part B (or your spouse/dependent’s requirement to enroll, 4 months before their 65th birthday).

2. 3 months before you turn 65

   You will be able to choose the SHBP MA plan if:

   1. You are retired.
   2. Your dependent is age 65 or older.

   You (or your spouse/dependent) should contact Social Security (SSA) 3 months before your 65th birth month — you’ll see that applying for Medicare Part B is easy. After applying, share your Medicare Beneficiary Identifier (MBI) number with SHBP. At that point, you’ll be able to choose one of the SHBP MA plan options.

   • There’s a monthly fee for Medicare Part B that’s deducted from your Social Security payment. If you don’t qualify for Social Security, or haven’t yet claimed it, you’ll have to pay Medicare directly for Part B coverage.
   • Note that you are automatically enrolled in Parts A and B if you are receiving Social Security or Railroad Retirement Board benefits when you become eligible for Medicare. Otherwise you must enroll yourself.
   • Medicare Part A, Part B and Part D may charge penalties if you sign up after your IEP ends, unless you qualify for a Special Enrollment Period.

3. 2 months before you turn 65

   SHBP will send you a final courtesy reminder to enroll in Medicare Part B and share your number with us. Once you share your MBI number, you’ll be able to choose one of the SHBP MA plan options.

   • If you (or your spouse/dependent) have not shared your (or their) MBI information at least 1 month before your (or their) 65th birthday, you/they will remain in the SHBP Commercial (non-Medicare Advantage) plan option. Your premium will not be subsidized by SHBP, and you will be responsible for the entire cost of the coverage, which is substantially higher than your current premium. You may reduce your premiums in the future if you provide your Medicare Part B information to SHBP.
   • If you continue to work past 65, you must share your MBI information at least 1 month before your retirement date, or you will also will remain in the SHBP Commercial (non-Medicare Advantage) plan option, and incur higher costs as noted above.
   • Contact SHBP Member Services toll-free at 1-800-610-1863 or visit the SHBP enrollment portal at myshbpga.adp.com to enroll in the SHBP MA plan of your choice.

4. 1 month before you turn 65

   Keep an eye out for your new ID card, along with a Quick Start Guide from UnitedHealthcare, in the mail.

5. Happy birthday!

   You’re enrolled in the SHBP UnitedHealthcare Group Medicare Advantage plan.