Medicare Eligibility and your LAUSD District-Sponsored Medical Coverage

LAUSD Medicare #Enrollment Requirements

 

LAUSD District-sponsored retiree medical coverage requires that after you and/or your spouse/domestic partner become eligible for Medicare for any reason, you must enroll and remain enrolled in Medicare Parts A and B. It is recommended that you apply for Medicare 90 days prior to your 65th birthday;

Learn how to enroll ONLINE and get the official Enrollment link 

Eligibility for Medicare is considered a major – qualifying  life event, therefore you are eligible to change plans.  However, you must send a written request to Benefits Administration for your plan change 30 days before you become eligible for Medicare. Lack of Medicare coverage will not affect your dental or vision benefits.

 

The  main parts of Medicare

Medicare Part A
Hospital

All retirees/spouses/domestic partners must enroll and remain enrolled in Medicare Part A premium free, if eligible.

***I’m having trouble confirming if LAUSD employment counts.  Please provide a citation.

To be eligible for Part A premium free, an individual must have 40 quarters of Medicare-covered employment. That is, earnings where you and/or the employer paid into Social Security – Medicare other than LAUSD which apparently doesn’t.  These earnings can be based on your  own earnings or the earnings of a spouse or former spouse.  Set up an ONLINE account with Social Security & Medicare.

If you are not eligible for Medicare Part A Hospital premium free, to continue your District benefits you must provide to LAUSD Benefits Administration a confirmation letter of ineligibility from the Centers of Medicare and Medicaid Services (CMS).   If you are not eligible for Free Part A, you will only be eligible to enroll in Kaiser Senior Advantage or Anthem Blue Cross EPO plan.

Learn how to enroll ONLINE and get the official Enrollment link 

It’s my understanding, you can simply enroll using the above link.  If you are not eligible for FREE Part A, Medicare will let you know.

Health Net Seniority Plus and UnitedHealthcare® Group Medicare Advantage (HMO) plans require eligibility and enrollment in Medicare Parts A and B.

 

Medicare Part B
Doctor Visits

All retirees/spouses/domestic partners must enroll and remain enrolled in Medicare Part B $144/month premium and remit the applicable premium to Social Security in order to maintain District-sponsored medical benefits. If you don’t enroll or you stop paying for your Medicare Part B premium at any time for yourself and/or your spouse/domestic partner, your District sponsored medical benefits will terminate.

 

Medicare Part D
Prescriptions

The Medicare Prescription Drug Plan (PDP), also known as Medicare Part D, became available January 1, 2006. Although you have the option of enrolling in a Medicare PDP, in most cases these plans will not provide you with any additional advantages. The LAUSD prescription drug plan is at least as good as the standard Medicare Part D benefit for most Medicare-eligible participants. LAUSD will continue to provide your current prescription drug coverage through Kaiser Senior Advantage, UnitedHealthcare® Group Medicare Advantage (HMO), Health Net Seniority Plus, or SilverScript® , a CVS/Caremark company the prescription drug provider for the Anthem Blue Cross EPO and HMO plans.

If you elect to enroll in a PDP outside your current District-sponsored plan, the District will cancel your medical and prescription coverage.  LAUSD *

Additional Info

Retirees not eligible for premium-free Part A may be eligible for the CalSTRS Medicare Premium Payment Plan (MPPP).  Contact CalSTRS at 800-228-5453 for eligibility requirements.  LAUSD *

Please mail/fax copies of Medicare cards and letters to LAUSD Benefits Administration at the address listed on page 24 and include retiree’s name, employee ID, or Social Security number on all correspondence.

All retirees/spouses/domestic partners age 75 and older as of January 1, 2010 (retirees born prior to January 1, 1935), were grandfathered-in at their current Medicare Parts A and B enrollment levels. All other retirees/spouses/domestic partners must comply with all District Medicare Parts A, B, & D requirements as listed below.

How does #Divorce affect the CalSTRS Retirement Plan?

 

Divorce – #Community Property – Information

Cal STRS Community Property Guide

 

If you ever worked for a company or put money into a plan, but do not remember where it is, etc. try these ideas to locate your missing retirement funds.

Tax Issues?

You  and a nonmember spouse are responsible for your own tax liabilities incurred as a result of community property payments received from CalSTRS, unless your court order states otherwise.

Because of this rule, CalSTRS must have the nonmember spouse’s Social Security number before any community property payment can be made. Each party can submit an Income Tax Withholding reference Certificate form W 4 to indicate a tax withholding reference.

To obtain information regarding taxation of CalSTRS benefits, see the Member Handbook above.  For more specific information, visit irs.gov or ftb.ca.gov or consult a tax professional.   

18 comments on “LAUSD Medicare Qualification

  1. I will be applying for Medicare within a few weeks.

    I worked for LAUSD for 33 and a half years. However, I have moved out of the Los Angeles area to Texas and have been here for 4 years.

    Are there tricks to applying?

    I do not have any credits with Social Security.

    I am somewhat confused.

    Is there an ineligibility letter I need to receive?

    Thank you!

    • IMHO Medicare has tried real hard to make it simple… A good portion of the information on our site, is simply Medicare’s Brochures.

      So, go to our Medicare Sign Up page and see Medicare’s Video’s and instructions.

      See above where we copied LAUSD’s rules about either getting Medicare A & B or getting a letter that you don’t qualify for Premium Free Part A. If you don’t have Part A Hospital, then your choices are limited. I would presume your choices are also limited as you are out of state and the HMO’s might not cover there.

      You can buy into Part A. Here’s our page on that.

  2. As a retired LAUSD employee, do I have to pay for Medicare Part D and is it also based on income levels?

    I know I have to pay for part B based on income levels.

    • Blue Shield Vital has $50 Part B Premium Reduction

      If you compare Vital to say Inspire on our Blue Shield MAPD Page

      Vital has a Maximum Out of Pocket for $3,400 vs $999
      $20 Co Pay vs 0 for 1st 20 days of Skilled Nursing
      $120 Emergency Room vs $0
      Higher Rx Co Pays

      There is no free lunch. MLR Medical Loss Ratio

      United Health Care has the Patriot Plan, but it doesn’t include Part D Rx. It’s designed for those who have Rx through the Veterans Administration.

      Page 5 of the LAUSD Retirement Benefits Guide shows what plans are available to you. Please check the website of those respective companies for Part B Premium Reduction. I doubt it. Are you over 65 or under? Do you have Medicare A & B or just B?

      If you are very low income, check out Medicare Savings Programs to pay your entire Part B premium.

  3. Does LAUSD require that an employee notify them when the employee or the spouse turn 65, and what if they qualify for Medicare A premium free, if the employee is still working?

  4. I’m going to be out for a surgery for a couple of months. Does LAUSD give me SDI State Disability Insurance or an Equivalent?

    • LAUSD teachers don’t pay into SDI so they won’t get those benefits. Lausd.net

      I suggest you check out illness leave.

      A formal ILLNESS LEAVE is a leave granted to an employee for absence covering a period of more than 20 consecutive working days because the employee is unable to work due to personal illness, injury, quarantine occasioned by the employee’s own or another’s illness, or a temporary disability caused or contributed to by pregnancy, miscarriage, childbirth or recovery therefrom.

      These are paid leaves. LAUSD.net

  5. I’m not a happy camper with the Anthem Medicare Advantage Plan. I only found out about this change last week. How can I get back onto Medicare A & B? Can I get a Medi Gap plan?

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