Retired or Preparing for Retirement
This page is designed to assist members as they prepare for retirement and for members who are already retired, but becoming Medicare eligible. The sections below contain important information categorized by age and by Medicare eligibility.
Please note that all new retirees who are eligible for State Health Plan coverage will be automatically enrolled into a plan at the time of retirement even if a member did not have Plan coverage as an active employee. Retirees that cancel their coverage for any reason will not be allowed to enroll unless they experience a qualifying life event or enroll during the next scheduled Open Enrollment.
Employees with a hire date on or after 1/1/2021 are not eligible for retiree health benefits at retirement.
For your convenience, you can find a downloadable presentation and recorded webinar from our "Understanding Your Medical Plan Options When You Become Medicare-Eligible" series our our Presentation Archive page. If you still have questions about your health plan options, eligibility or premium rates, you may contact the Eligibility and Enrollment Support Center at 855-859-0966.
When You Plan to Retire and Are Not Yet 65
You are encouraged to talk with your Health Benefits Representative (HBR) or Human Resources department ahead of time to plan the proper steps. Retiring members who are eligible for coverage under 65 will be automatically enrolled in the health plan they were enrolled in as an active employee along with any covered dependents, regardless of contribution status.
When You Approach 65 and Plan to Continue Working
Many State Health Plan members continue working after the age of 65. The State Health Plan mails you a Medicare eligibility letter prior to your 65th birthday. The letter asks that you confirm your eligibility for Medicare benefits.
If you are actively working for the state after 65, the Plan will continue to be your primary coverage and Medicare will be secondary. This means you can choose to enroll in Medicare Part A but you can delay enrollment into Medicare Part B until you actually retire from state employment. However, it will be important to remember to enroll in Medicare Part B to become effective as of your retirement date.
When You Plan to Retire and Are 65 or Older
It is recommended to talk with your HBR or Human Resources Department ahead of your retirement to plan your steps and submit your retirement paperwork at least 120 days prior to your planned retirement date.
Medicare Primary members have several options for health plan coverage. These options include the following plans:
- Humana Group Medicare Advantage (PPO) Base Plan
- Humana Group Medicare Advantage (PPO) Enhanced Plan
- Base PPO Plan (70/30)
In order for a retiree to be eligible for the Humana Group Medicare Advantage (PPO) Plans, the retiree must be enrolled in Medicare Parts A and B.
Important reminder: Your retiree health plan benefit effective date is the first of the month following your retirement effective date. For example: If your retirement date is January 1, your retiree health plan benefit effective date is February 1. Please note that for active members who will be Medicare eligible at the time of retirement, Medicare becomes primary the last month that a retiring active member is covered by his or her agency and the Medicare reduced rate applies. Members should be aware of the Medicare primary change and the need to elect Medicare Part B to be effective as of the date of their retirement. If active member is planning to retire within a few months of turning 65, remember Medicare effective date will be delayed if member enrolls the month they turn 65 or during the three (3) months after their birthday month. Member could be left without Medicare coverage being effective as of their retirement date thus increasing their out-of-pocket cost for medical services in addition to limiting member’s plan selection to the Base PPO Plan (70/30) administered by Blue Cross, NC for the remainder of the plan year.
If you are eligible for State Health Plan benefits under the State Retirement Systems, then you will be auto-enrolled into either the Humana Group Medicare Advantage (PPO) Base Plan or the Base PPO Plan (70/30). The plan will be dependent upon when your retirement paperwork is processed and approved by the State Retirement Systems. Please see the table below.
Medicare Eligibility and Automatic Enrollment
|Member Eligibility||Paperwork Status||Auto-Enrollment||Decision Timeline|
|Retiring members and/or dependents who are Medicare-eligible AND||Retirement paperwork (6E Form and any other required documents) is processed and approved 60 days or greater from their retiree health plan benefit effective date, THEN THEY WILL BE||Automatically enrolled into the Humana Group Medicare Advantage (PPO) Base Plan. For qualified retirees, the plan is premium-free for retiree-only coverage.||Retirees will have up to 30 days PRIOR to their benefit effective date to change plans if they desire.|
|Retiring members who are Medicare-eligible AND||Retirement paperwork (6E Form and any other required documents) is processed and approved less than 60 days prior to their retiree health plan benefit effective date, THEN THEY WILL BE||Automatically enrolled in the Base PPO Plan (70/30). For qualified retirees, this plan is also premium-free for retiree-only coverage.||Retirees will have up until the day before the health plan effective date to elect a Medicare Advantage option.|
Note: If no action is taken, retirees will remain in the Humana Group Medicare Advantage (PPO) Base Plan or Base PPO Plan (70/30) for the remaining portion of the plan year. Changes to plan elections for the following plan year can then be made during the next Open Enrollment period. If the retiree has dependents that are non-Medicare Primary, they will be automatically enrolled into the health plan they were enrolled in as an active dependent.
When You Are Already Retired and Turning 65
If you are already retired and about to turn 65, you will become eligible for Medicare and your options under the State Health Plan will change. The State Health Plan will automatically enroll you into the Humana Group Medicare Advantage (PPO) Base Plan to become effective when you become Medicare-eligible/Medicare Primary. You will receive written notification of this auto-enrollment from the State Health Plan approximately 80 to 90 days before your Medicare becomes effective and be given an opportunity to make a change. However, if you want to make a change, you will need to notify us no later than 30 days before your Medicare coverage is to become effective. This plan is premium-free for qualified retiree-only coverage.
NOTE: You become Medicare eligible the first of the month you turn 65 (e.g., 65th birthday is 3/15, you become Medicare eligible 3/1). However, if your 65th birthday is on the first day of a month, you become Medicare eligible the first day of the prior month (e.g., 65th birthday is 5/1, you become Medicare eligible 4/1). It will be very important for you to enroll in Medicare Part A and Medicare Part B as soon as you are permitted. The earliest you may enroll in Medicare is any time during the three months prior to your 65th birthday month. To enroll in Medicare, contact the Social Security Administration at 800-772-1213 or by visiting their website at www.socialsecurity.gov.
|State Health Plan Eligibility and Enrollment Support Center||For questions regarding enrollment or eligibility, to make address changes or for assistance with the eBenefits enrollment system.||855-859-0966|
|Blue Cross and Blue Shield of North Carolina||For questions regarding the Base PPO Plan (70/30).||888-234-2416|
|Humana||For questions regarding the Medicare Advantage Base and Enhanced plans.||888-700-2263|
|Social Security Administration||For questions regarding Social Security. The U.S. Social Security Administration administers Social Security, a social insurance program consisting of retirement, disability and survivors' benefits.||(800) 772-1213|
|Seniors' Health Insurance Information Program (SHIIP)||For questions regarding Medicare enrollment.||855-408-1212|
Remember: It is essential for the State Health Plan to have your most up-to-date contact information (i.e., both physical and mailing addresses, phone numbers, email address) to ensure you receive important benefit details and other information. To report any changes, contact the Eligibility and Enrollment Support Center at 855-859-0966.