Medicare is a federal health insurance program for the following:
- Participants age 65 or older
- Participants under age 65 with certain disabilities
- Participants of any age with End-Stage Renal Disease (ESRD)
Medicare has the following parts to help cover specific services:
- Medicare Part A (Hospital Insurance): Part A coverage is required for plan participants eligible for the coverage at a premium-free rate. The Social Security Administration (SSA) determines eligibility for participants who have earned enough credits based on their own work history or that of a spouse who is at least 62 years of age (when applicable).
- Medicare Part B (Outpatient and Medical Insurance): Part B is not required. Medicare Part B requires a monthly premium contribution (amount determined by the SSA).
- Medicare Part D (Prescription Drug Insurance): Part D coverage is not required. Medicare Part D coverage requires a monthly premium contribution, unless the participant qualifies for extra-help assistance. In order to apply for Medicare benefits, plan participants are instructed to contact their local SSA office or call 1-800-772-1213. Plan participants may also contact the SSA via the internet at www.socialsecurity.gov to sign up for Medicare Part A benefits.
To ensure that healthcare benefits are coordinated appropriately and the correct premium is charged, plan participants must notify TRS when they become eligible for Medicare and send TRS a copy of their Medicare identification card. Plan participants should contact the State of Illinois CMS Medicare COB Unit for any questions via phone at 1-800-442-1300 or 217-782-7007.
Teachers’ Retirement Insurance Program (TRIP) Medicare Requirements
Each plan participant must contact the SSA and apply for Medicare benefits upon turning the age of 65. If the SSA determines that a plan participant is eligible for Medicare Part A at a premium-free rate, TRIP requires that the plan participant accept the Medicare Part A coverage. If the SSA determines that a plan participant is not eligible for premium-free Medicare Part A based on his/her own work history or the work history of a spouse at least 62 years of age (when applicable), the plan participant must request a written statement of the Medicare ineligibility from the SSA. Upon receipt, the written statement must be forwarded to TRS. Plan participants who are ineligible for premium-free Medicare Part A, as determined by the SSA, are not required to enroll in Medicare.
Retirees, Survivors and Disabled Participants without Current Employment Status (and their applicable Dependents)
Plan participants (including dependents) who are retired, a survivor or a disability recipient without Current Employment Status (such as no longer working due to a disability) who are eligible for premium-free Medicare Part A must enroll in Medicare Part A, but may decline enrollment in Medicare Part B. However, even though TRIP does not require plan participants to enroll in Medicare Part B, participants who receive the lower Medicare primary TRIP premium (due to having both Medicare Parts A and B) are required to maintain their enrollment in Medicare A and B. Participants receiving the Medicare primary premium will be subject to the higher non-Medicare primary premium if disenrollment from Medicare Part B occurs. Furthermore, the participant will be charged the higher premium rate retroactively to the date Medicare Part B was dropped. Plan participants who drop Medicare Part B coverage must notify TRS immediately and provide the date the coverage termed.
Plan Participants Eligible for Medicare on the Basis of End Stage Renal Disease (ESRD):
Plan participants at any age who are eligible for Medicare benefits based on End Stage Renal Disease (ESRD) must contact the State of Illinois CMS Medicare COB Unit for information regarding the Medicare requirements and to ensure the proper calculation of the 30-month Coordination of Benefit Period.
Each plan participant who becomes eligible for Medicare is required to submit a copy of his/her Medicare card to his/her Group Insurance Representative (GIR) at the Teachers’ Retirement System (TRS). You may contact TRS at 1-800-877-7896.