Health Benefits

How Medicare Works With Your CalPERS Health Plan

Elderly woman getting her blood pressure checked.

It’s important to understand how your CalPERS health plan and Medicare work together to ensure you’re receiving the best possible care.

What Is Medicare?

Medicare is a federal health insurance program regulated by the Centers for Medicare and Medicaid Services (CMS).

Medicare is for individuals:

  • Age 65 and older
  • Under age 65 with certain disabilities
  • With End-Stage Renal Disease (ESRD)
  • With Amyotrophic Lateral Sclerosis (ALS, or Lou Gehrig’s Disease)

Medicare consists of four parts, each covering specific services:

  • Medicare Part A (Hospital)
  • Medicare Part B (Medical)
  • Medicare Part C (Medicare Advantage plans)
  • Medicare Part D (Prescription drugs)

Make sure to understand Medicare Parts A through D and what Medicare covers to ensure you choose the right plan for you.

Although CMS runs the Medicare program, most coverage is provided on a local level through various providers. As a CalPERS member, you can continue your health coverage through the CalPERS Health Program once you retire and enroll in Medicare. If you want to continue your health coverage with CalPERS once you retire, then here’s what you need to know.

How to Continue Your Health Coverage With CalPERS

A few months before you turn 65, we’ll send you a letter with the steps and requirements you need to continue your health coverage with CalPERS. If you want to plan ahead, check out Medicare where we break down the entire process and provide more information.

Once you’re ready to retire, or are eligible for Medicare, you’ll need to apply with the Social Security Administration. If you’re eligible for Medicare Part A or Part B, we’ll work with CMS to obtain your Medicare information so we can automatically transfer you from a Basic health plan to a CalPERS Medicare health plan. Throughout this process, you can choose to change your health plan. To view what plans are available to you, log in to your myCalPERS account.

If you don’t choose a Medicare health plan when you’re eligible for Medicare, we’ll automatically enroll you into a Medicare health plan.

Even if you’re ineligible for Medicare, you can continue your health coverage through a CalPERS Basic health plan. You must complete the Ineligibility of Medicare Certification (PDF) form and submit it with copies of any supporting documentation to us prior to your 65th birth month.

Learn More

The transition to Medicare might sound confusing, but we’re here to help! Don’t hesitate to contact us if you have questions. We also have various resources to guide you, like this Medicare and Your CalPERS Health Benefits video and our comprehensive Medicare Enrollment Guide (PDF).