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Medicare Supplement Plan

If you are eligible, you may enroll in the Medicare Supplement Plan, which provides coverage for hospitalization and physician services in addition to the coverage provided by Medicare Part A and Part B. To enroll in the Medicare Supplement Plan, you must first enroll in Medicare Part A and Part B.

The Medicare Supplement Plan also provides Medicare Part D prescription drug benefits, in addition to supplemental prescription drug benefits that cover the coverage gap (donut hole) typical of most Part D plans.

For an introduction to Medicare, see Medicare & You, available on medicare.gov. For details on the Medicare Supplement Plan, including prescription drug coverage and covered services, see Guide to the Medicare Supplement Plan.

Eligibility

As a retiring member of the Benefits Plan, you may enroll in the Medicare Supplement Plan if you

  • are Medicare-eligible;
  • are retiring from active service or have had continuous coverage; 
  • are enrolled in Original Medicare (Medicare Part A and Part B); and
  • meet the Rule of 70.
Rule of 70

You must be age 55 or older when you terminate eligible service with the Presbyterian Church (U.S.A.).

You must have at least five years of Medical Plan participation.

The sum of your age and years of Medical Plan participation at termination must equal 70 or more.

Continuous Coverage Requirement

To enroll in the Medicare Supplement Plan, you must have continuous coverage until you are eligible for Medicare. Generally, you must be covered continuously by the Medical Plan, medical continuation, or other acceptable coverage as defined by the plan until you are eligible for Medicare Supplement.

If you have other eligible coverage and otherwise qualify for Medicare Supplement, you may waive coverage in Medicare Supplement to postpone your enrollment. If you do not waive coverage, you will not be eligible to enroll in the Medicare Supplement Plan later.

Family Members Who May Enroll

These family members also may enroll in the Medicare Supplement Plan, regardless of whether you choose to enroll when you are eligible:

  • your spouse or eligible child(ren) who has maintained continuous coverage and is enrolled in Medicare Part A and Part B
  • your surviving or former spouse who has maintained continuous coverage and is enrolled in Medicare Part A and Part B

Hospital and Medical Benefits

After Medicare pays its share and you meet your annual deductible, the plan pays 80 percent of your eligible expenses (based on Medicare’s allowance) up to an annual copayment maximum. When your out-of-pocket costs for eligible expenses (including the deductible) reach an annual maximum, the Medicare Supplement Plan pays 100 percent of eligible expenses for the rest of the calendar year. Any Medicare-approved service is considered to be an eligible expense. Deductible and maximum out-of-pocket amounts are set each year.

In addition, the Medicare Supplement Plan provides an annual preventive care benefit of up to $125. This benefit can be applied to any routine tests associated with your well visit that are not fully covered by Medicare and/or to an annual vision exam.

Coverage Basics

The Medicare Supplement Plan covers a wide range of medically necessary services and supplies beyond what Original Medicare pays, and some costs that Medicare does not cover at all.

Generally, Medicare Supplement covers

  • prolonged hospitalization, skilled nursing facility care, and inpatient and outpatient psychiatric treatment;
  • medical supplies and services;
  • your Medicare Part A and Part B deductibles;
  • ambulance services;
  • outpatient prescription drugs;
  • required medical care when traveling outside the United States.

The Medicare Supplement Plan does not cover

  • routine dental or hearing care;
  • custodial care;
  • services for you if you reside outside the United States.

Travel Outside the United States

Original Medicare doesn’t cover medical services and supplies when you travel outside the United States. However, the Medicare Supplement Plan provides primary coverage when you and your eligible family members travel internationally. The plan pays 80 percent of medically necessary costs, and you pay 20 percent, up to the copayment maximum.

For more information, see the Medical Assistance during International Travel Benefits Overview, which contains emergency contact numbers.

Enrolling and Re-enrolling in the Medicare Supplement Plan

If you are eligible when you retire, you may enroll in the Medicare Supplement Plan or postpone coverage until a later time. If you enroll, you will pay a subscription rate, or premium, for each person covered, up to two premiums. For complete eligibility rules, see Guide to the Medicare Supplement Plan.

If you enroll in the Medicare Supplement Plan, you should not enroll in a separate Part D plan, as the Medicare Supplement coverage offered by the Board of Pensions includes qualified Part D and supplemental prescription drug coverage.

To enroll when you are first eligible, complete, sign, and return the Medicare Supplement Subscription, Waiver, or Withdrawal form to the Board, along with a copy of your Medicare card, within 30 days of your last day of coverage under the Medical Plan as an active member.

To waive coverage when you retire, because you have other qualified health coverage, complete, sign, and return the Medicare Supplement Subscription, Waiver, or Withdrawal form to the Board within 30 days of your last day of coverage under the Medical Plan as an active member. You will be able to enroll in the plan at a later time if you

  • have met the Rule of 70;
  • were covered by other qualified health coverage when you retired; and
  • complete, sign, and return the Medicare Supplement Subscription, Waiver, or Withdrawal form to the Board at least 30 days in advance of your last day of other coverage.

To cancel your coverage, complete, sign, and return the Medicare Supplement Subscription, Waiver, or Withdrawal form to the Board. You may cancel your coverage at any time. Your coverage will be canceled as soon as administratively possible. However, if you choose to cancel your coverage, you cannot re-enroll at a later date unless you qualify under the eligibility guidelines. In addition, you can choose to withdraw from and re-enroll in Medicare Supplement only once.

To re-enroll for coverage after you have waived or canceled coverage, complete, sign, and return the Medicare Supplement Subscription, Waiver, or Withdrawal form to the Board at least 30 days in advance of your last day of other coverage.

You will be able to enroll in the plan one time after you have waived or canceled coverage if you

  • have met the Rule of 70; and
  • were covered by other qualified health coverage when you retired.

If you have waived or canceled coverage in the Medicare Supplement Plan to join a Medicare Advantage plan (a Part C plan under Medicare), you may be eligible to re-enroll

  • during the first 12 months of your participation in a Medicare Advantage plan;
  • if you make a permanent move out of the Medicare Advantage plan service area;
  • if your Medicare Advantage plan significantly modifies premiums or benefits, or discontinues its coverage to Medicare-eligible participants.