Medicare

Information provided here regarding potential Medicare benefits is general in nature. Any decisions regarding these benefits should be made only after contacting the Social Security Administration.

If you are a U.S. citizen or a lawfully admitted alien who has lived in the U.S. for at least five years, you can receive Medicare benefits at age 65. The real question for PSRS members is whether or not you will have to pay a premium for Medicare coverage.

If you were hired by a PSRS-covered employer before April 1986 and have not changed employers since that time, you do not pay into Medicare on your PSRS-covered wages. If you were hired or have changed employers since March 1986, Medicare contributions are withheld from your pay. If you pay into Medicare, your employer matches your contributions. When you are paying into Medicare, you receive "units" based on your earnings. You can receive a maximum of four units in one calendar year.

Medicare benefits may be payable under special circumstances that are not explained here, such as with the occurrence of a disability. We recommend you contact the Social Security Administration at 1-800-MEDICARE (633-4227) for specific information about your entitlement to Medicare benefits.

Medicare Components Explained

There are four components to Medicare - Part A, Hospital Insurance; Part B, Medical Insurance; Part C, Medicare Advantage Plans; and Part D, Prescription Drug Coverage. You may choose to participate in any or all parts.

Part A - Hospital Insurance

Medicare Part A, Hospital Insurance, pays for inpatient hospital expenses, hospice care and skilled home health services for homebound patients, and helps with short-term in-patient care in skilled nursing facilities if the patient is there for rehabilitation.

You can receive Part A free, if:

  • You have 40 Medicare units from your own employment
  • You qualify through an eligible spouse or ex-spouse

If you do not qualify to receive Part A free, you can pay a monthly premium.

Part B - Medical Insurance

Medicare Part B helps pay for doctors' services, outpatient hospital care and some medical equipment and supplies. Everyone must pay a premium to receive Part B coverage regardless of the number of Social Security units they have. Premiums for Part B are deducted from your monthly Social Security benefit. If you are not eligible to receive Social Security benefits, you will be billed quarterly for Part B coverage.

Part C - Medicare Advantage Plans

Medicare Advantage Plans are health plan options approved by Medicare and run by private companies. Medicare Advantage Plans provide all of your Part A (hospital) and Part B (medical) coverage and must cover medically-necessary services. They generally offer extra benefits, and many include Part D coverage.

Part D - Prescription Drug Coverage

Beginning January 1, 2006, new Medicare prescription drug plans are available to people with Medicare. Insurance companies and other private companies work with Medicare to offer these drug plans. They will negotiate discounts on drug prices.

Medicare prescription drug plans provide insurance coverage for prescription drugs. Like other insurance, if you join you will pay a monthly premium (generally around $35 in 2006) and pay a share of the cost of your prescriptions. Costs vary depending on the drug plan you choose.

Drug plans may vary in what prescription drugs are covered, how much you have to pay, and which pharmacies you can use. When you join a drug plan, it is important for you to choose one that meets your prescription drug needs.