Applies only if you are covered for Medicare Part A, but not enrolled in Medicare Part B, and have a medical plan:
- If you decide not to purchase Medicare Part B when you become eligible, your plan will not coordinate coverage for Medicare Part B services. That means you’ll continue to pay for those services and equipment as you did before you become eligible for Medicare. For example, under the Anthem Blue Cross Plan II, a doctor’s office visit will be covered at 80 percent after your deductible. You would be responsible for the remaining 20 percent.
- Without Medicare Part B, you would continue to incur these costs until you hit your out-of-pocket maximum on Anthem Blue Cross Plan II ($2,500 per calendar year, including deductible). If you have Anthem Blue Cross Plan I or Prudent Buyer Plan, you will continue to incur the costs into the future because there is no out-of-pocket maximum.
- You are subject to the one (1) million dollar Lifetime Maximum coverage for the Anthem Blue Cross Plans I, II, and Prudent Buyer Plan, alone or combined. “Combined” means any benefits paid under a prior LACERA-administered Anthem Blue Cross plan will reduce any maximum amounts eligible for the current Anthem Blue Cross plan.
- Without Medicare Part B, you are ineligible to enroll in a LACERA-administered Medicare plan. Thus, you are disqualified from participating in the County’s Medicare Part B Premium Reimbursement Program.
- If you are eligible, but are not enrolled in Medicare Part B and have a HMO plan, you may pay a higher premium.
- Finally, if you decide not to enroll in Medicare Part B when you become eligible at age 65, and later decide to enroll, you will be charged a penalty of 10 percent for each year you were eligible and chose to decline coverage. If you are a late enrollee in Medicare Part B and pick one of the plans eligible for reimbursement, the County will not reimburse the penalty portion of the Part B premium.
Ultimately, the decision is yours. It is worth considering enrolling in Medicare Part B as soon as you are eligible to avoid penalties for late enrollment. Additionally, enrolling in Medicare Parts A and B and a Medicare plan will qualify you for the County’s Medicare Part B Premium Reimbursement Program and coordination of benefits with Medicare, providing the following conditions are met:
- You are paying for your Medicare Part B premium yourself.
- You are not being reimbursed for your Medicare Part B Premium by another agency, for example: other employer, State.
NOTE: Some benefit information mentioned above may be subject to future changes.