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Medical Coverage

If you are age 65 or older when you retire, or if you have certain disabilities, Medicare will provide your primary coverage for medical expenses in retirement. Medicare provides important healthcare coverage, but it has gaps, including no limit to your out-of-pocket costs if you are injured or become extremely ill. To fill these gaps, you may supplement your Medicare coverage through one of several means, including, if you qualify, the Medicare Supplement Plan, available through the Board of Pensions.

If you retired between ages 55 and 65, your primary coverage is likely medical continuation (a self-paid form of the coverage available to active members). It’s important that you either maintain this coverage or file a waiver when you terminate employment with the PC(USA) so that you may qualify for the Board’s Medicare Supplement coverage, if otherwise eligible, when you turn 65.

For an overview of coverage options and information on comparing various supplemental plans, read Choosing Healthcare Coverage at Retirement.

Medicare

Medicare is a federal health insurance program for people age 65 or older, or younger if they have certain disabilities. It provides the foundation for your healthcare coverage in retirement.

You get Medicare coverage in one of two ways:

  • through providers you choose (Original Medicare)
  • using a managed care plan (Medicare Advantage)

Original Medicare

Original Medicare consists of two parts, Part A and Part B:

  • Part A helps pay for hospital stays; some follow-up costs after hospitalization; and skilled nursing facility, hospice, and home healthcare expenses.
  • Part B pays some doctors’ services and outpatient medical care costs and some preventive care services.

You can add stand-alone Part D prescription drug coverage to your Original Medicare coverage. However, this is a component of the Medicare Supplement Plan available through the Board of Pensions.

You can select among the many providers that accept Original Medicare, but be aware that some providers do not participate. Before you use a provider, be sure to ask if your doctor or medical equipment supplier is a Medicare participating provider.

Medicare Advantage

These plans typically provide all-in-one coverage for hospitalization and physician services through private, Medicare-approved companies. They must provide Part A and Part B benefits, and may also include Part D coverage as well as additional benefits like vision and dental.

These plans are usually set up as HMOs, PPOs, or private fee-for-service plans.

For overview information about Medicare, including eligibility, enrollment, and coverage guidelines, see Medicare & You, available on medicare.gov.

Medigap Plans

The Medicare Program does not cover all healthcare costs in retirement. There are significant gaps in coverage. For this reason, many private insurers sell Medicare Supplement Insurance — Medigap, for short — to help pay some of those uncovered costs.

In most states, Medigap policies are standardized. They must provide the same basic benefits so consumers can compare plans easily. All Medigap plans fully cover certain basic benefits, such as Part A coinsurance costs for up to an additional 365 days of hospital care.

New Medigap plans no longer cover outpatient prescription drugs. For that, you must add stand-alone Part D coverage.

Medicare Supplement Plan of the PC(USA)

If you meet the eligibility requirements and you are enrolled in Medicare Part A and Part B, you may enroll in the Medicare Supplement Plan. The Medicare Supplement Plan is similar to a Medigap plan; it provides additional coverage for hospitalization and physician services.

Unlike a new Medigap plan, however, the Medicare Supplement Plan also provides primary prescription drug coverage. This coverage consists of Part D and supplemental benefits to fill the coverage gap (donut hole) typical of most Part D plans.

For information about enrolling and coverage, see the Medicare Supplement Plan page.