Medical & Rx Coverage For Retirees Age 65 And Over

Overview

Non-disabled retirees and spouses must enroll in Basic Medicare (Part A and Part B) when first eligible to continue participating in the State-sponsored retiree health coverage program. (Disabled retirees please see here.) Enrollment in Basic Medicare is completed through the Social Security Administration.

Retirees may purchase additional coverage through the State's Medicare exchange program administered by Via Benefits (formerly One Exchange). Via Benefits offers Medicare supplement plans (Medigap), Medicare Advantage plans, Part D prescription drug plans, and dental and vision plans.

State retirees entitled to a subsidy will receive that subsidy via a health reimbursement arrangement (HRA) administered by Via Benefits. The retiree MUST purchase a Medigap or a Medicare Advantage plan through Via Benefits to receive an HRA. Purchasing a Medigap plan outside of Via Benefits will result in a loss of HRA funding.

Alert!

You must IMMEDIATELY start collecting your State pension upon retirement in order to qualify for State-sponsored medical and prescription coverage as well as any State subsidy.

Coverage Details

Coverage Information

Basic Medicare (Part A & Part B)

Part A
- Covers inpatient care. See Medicare.gov for more information on Part A
Part B
- Covers outpatient care. See Medicare.gov for more information on Part B

Medicare Supplement Plans (Medigap)

Helps pay some of the healthcare costs that basic Medicare Part B doesn't cover—e.g., copayments, coinsurance, and deductibles
Does not cover prescription drugs
There are many kinds of Medigap plans. See Medicare.gov for more information on Medigap plans, including how to compare Medigap plans

Medicare Part D Prescription Drug Plans

Covers prescription drugs
See Medicare.gov for more information on Part D

Medicare Advantage Plans

A type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits
Most plans include prescription coverage
See Medicare.gov for more information on Medicare Advantage Plans

Eligibility

Generally, you are eligible for Medicare when you turn 65 and have contributed to Social Security for 40 quarters. However, Medicare is a federal program, and eligibility is determined by the Social Security Administration. For example, disbled individuals may be eligible for Medicare sooner than age 65. Please use the Medicare eligibility tool to see if you are eligible. You may also call the Social Security Administration at (800) 772-1213 regarding your eligibility.

Judges, legislators and State police troopers: click here for post-65 retiree health coverage information.

Enrollment

Enrollment Periods

There are two primary periods of Medicare enrollment:

Initial enrollment period (IEP)

A 7-month period that begins 3 months before and ends 3 months after you turn age 65. If you are covered by group health plan coverage* at or beyond age 65, you do not need to enroll in Medicare during your initial enrollment period.
Special enrollment period (SEP)

If you did not enroll in Medicare during your IEP because you were covered under a group health plan*, you may enroll at any time while covered under the group health plan, or during the 8-month period that begins the month the employment ends or the group health plan coverage ends, whichever comes first.

Group health plan coverage is coverage based on your employment or your spouse's employment. The State's pre-65 retiree health coverage and COBRA do NOT count as group health plan coverage.

Penalties may be applied to your Part B premium if you do not enroll with Medicare Part B as soon as you are eligible, and to your Part D premium if you go 63 days or more after your IEP is over without prescription drug coverage. (If you are post-65 and still working at the State, you are NOT required to purchase a Part D prescription drug plan. When you do retire, Medicare will require proof of creditable prescription drug coverage for your post-65 months/years.)

How to Enroll

Step 1: Medicare Exchange Eligibility Form

Submit the Medicare Exchange Eligibility Form to the Office of Employee Benefits at least two months before your retirement date.

Step 2: Medicare Part A & Part B

Contact the Social Security Administration to enroll in Medicare Part A and Part B:

Call (401) 528-4501 or (800) 772-1213
Visit www.ssa.gov/medicare

Step 3: Medigap, Part D, and Medicare Advantage

Once you have your Part B effective date and Medicare ID number, contact Via Benefits in order to enroll in Medigap, Part D, and Medicare Advantage plans:

Call 1-844-448-7298
Visit my.viabenefits.com/ri

Note: In most cases, Via Benefits will not have your Health Reimbursement Arrangement (HRA) funding information at the time of your initial call. Please refer to the HRA page for additional details on the amount you can expect to receive.

Premium Rates

Monthly Premiums

Medicare Part A

Part A is generally premium-free. See Medicare.gov for more information on Part A costs.

Medicare Part B

Part B monthly premium is generally under $200. See Medicare.gov for more information on Part B costs.

Medigap

Medigap premiums can vary widely. Each insurance company chooses its own way to price policies, so there can be big differences in the premiums that different insurance companies charge. See Medicare.gov for more information on Medigap costs.*

Medicare Part D

See Medicare.gov for more information on Part D costs.

Medicare Advantage

Medicare Advantage premiums can vary widely. Each insurance company chooses its own way to price policies, so there can be big differences in the premiums that different insurance companies charge. See Medicare.gov for more information on Medicare Advantage costs.