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Medicare Information

Medicare is health insurance through the Social Security Administration. Qualification for Social Security benefits requires either 40 quarters of covered employment or coverage under a spouse's or ex-spouse if the marriage lasted at least 10 years. University employees hired after 4/1/86 are required by law to contribute to Medicare.

Medicare Parts
Medicare consists of three parts:

  1. Part A Medicare: Inpatient hospital charges
  2. Part B Medicare: Outpatient and medical services
  3. Part D Medicare: Prescription services

Medicare Part A is a premium-free program for participants with enough earned work quarters as determined by the Social Security Administration (SSA).

Medicare Part B is not free and requires a monthly premium contribution.

Medicare Part D is not required for plan participants in the State Employees Group Insurance Program.

Eligibility
If you qualify for Social Security benefits

  1. You qualify for Part A Medicare at NO COST when you turn 65
  2. You qualify for Part B Medicare when you turn 65
  3. If you have State of Illinois Group Insurance coverage, your coverage is on average as good as or better than the standard Medicare Part D Prescription drug coverage. You can keep your current group coverage and choose not to enroll in Medicare Part D unless you qualify for low-income/extra-help assistance. Please see Notice of Creditable Coverage below.

Notice of Creditable Coverage
The Notice of Creditable Coverage is a document that is intended to advise Medicare beneficiaries whether Prescription Drug coverage through the Program is creditable, meaning that coverage is the same or better than the Medicare Part D benefit. This Notice of Creditable Coverage prevents a Member from being penalized if enrolling in Medicare Part D at a later date. The Notice of Creditable Coverage will be provided to you prior to the enrollment period for Medicare Part D by the Social Security Administration.

NOTE: Each participant who becomes eligible for Medicare is required to submit a copy of their Medicare card to the Benefits department in the Office of Human Resources. Failure to notify may result in substantial financial liabilities.

When should you and your spouse enroll in Medicare?
If you turn age 65, are not yet retired, and you qualify for Medicare:

  1. You should enroll for Part A at no cost
  2. Wait until you retire to enroll in Part B

If you are not yet retired, you carry your spouse on your health insurance, your spouse is retired, and/or your spouse turns 65:

  1. Spouse should enroll in Part A
  2. Wait until you retire for spouse to enroll in Part B

Reduced health insurance premiums for spouse
If you are retired and carry your Medicare-covered spouse on your health insurance coverage, your premiums for health insurance will decrease.

If you are actively working for the State and are eligible for Medicare (due to a disability or being age 65 or older), then…
Medicare Part A is required. Since you are still working and have state health insurance coverage you may delay purchasing Medicare Part B until you terminate current employment and health coverage. The State will remain your primary insurance coverage until you terminate. Once you terminate, Medicare Part B must be in effect.

If you are age 65 or older and ineligible for premium-free Medicare Part A, then…
You are required by the State to provide proof of your Medicare ineligibility. (This could happen in cases in which a person does not have 40 quarters of SSA covered employment or are not covered by a spouse.) Medicare-ineligible individuals should contact their local Social Security Administration and request written verification of their ineligibility for premium-free Medicare Part A benefits based on their work record. The verification letter must be forwarded to the Medicare COB Unit at the Department of Central Management Services.

Medicare-ineligible plan participants who have a Medicare-eligible spouse must complete an SSA application for Medicare benefits based on the eligible spouse's work record. If the individual is eligible for Medicare based on the spouse's work record, they must accept the coverage.

NOTE: Individuals that are eligible for Medicare benefits based on End Stage Renal Disease (ESRD) must contact the Medicare COB Unit at the Department of Central Management Services for information regarding Medicare requirements.
For Further Information
Visit the Medicare website to:

  1. View Medicare plans are in your area
  2. Find doctors who participate in Medicare
  3. View Medicare service coverage, including preventive services
  4. Obtain Medicare appeals information and forms
  5. Access information on the quality of care provided by nursing homes, hospitals, home health agencies, plans and dialysis facilities
  6. View Medicare publications

For questions about :
Medicare - call 1-800-MEDICARE (1-800-633-4227) or TTY 1-877-486-2048.

Eligibility and how to enroll in Medicare, Social Security retirement benefits, or disability benefits - call Social Security Administration (SSA) at 1-800-772-1213 or TTY 1-800-325-0778.

The Notice of Creditable Coverage - call CMS Medicare Coordination of Benefits (COB) Unit at 1-800-442-1300 or 1-217-782-7007.

The information presented regarding state benefits and Medicare - call CMS Medicare Coordination of Benefits (COB) Unit within the Department of Central Management Services at 1-800-442-1300 or 1-217-782-7007.

*Should any discrepancies arise between this publication and information issued by the Social Security Administration (SSA), the SSA information governs. This publication is provided as a source of information and does not constitute legal, tax, or other professional advice. If you require legal advice or other professional assistance, consult the services of a professional advisor.

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