Medicare
The original Medicare Plan is a fee for service plan that is managed by the Federal Government (Hospital Part A and Medical Part B). It coordinates with your state Medicare plan in the following manner:
- You may go to any physician or supplier who accepts Medicare and who is accepting patients, or to any hospital or other facility.
- You present your Medicare card (red, white and blue) and your Anthem Blue Cross Blue Shield (BCBS) card when you receive health care.
- You pay a set amount (a deductible) towards your health before Medicare pays. Once the deductible is met, Medicare pays its share first as your primary insurer and your state-sponsored insurance pays its negotiated share as your secondary insurer for covered services and supplies. (Read your state Medicare plan handbook to understand what your plan covers.)
No. As a plan participant of the State Retiree Health Benefits Program, once you become eligible for Medicare, regardless of age, you are required to secure both Medicare Part A and Part B and select one of the state Medicare-coordinating plans. If you do not secure both parts of Medicare, you will not receive the full level of benefits from your plan and may have a gap in your coverage.
Yes. You will be required to secure both Part A and Part B and select one of the Medicare-coordinating plans. For membership types in combination with Non-Medicare participant(s) your monthly premium will never exceed the monthly COVA family health insurance premium. You will receive a new plan identification card from Anthem Blue Cross Blue Shield and MEDCO, if applicable.
Note: The MEDCO card is for participants that select a Medicare-coordinating plan that covers prescription drugs. (Plan includes Medicare Part D)
You may want to contact the Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627 to confirm your employment status is accurate with Medicare.
- If you do not notify Medicare of your change from active employment to retirement or long-term disability status, you may be denied enrollment in Medicare Part D.
- If you are Medicare eligible immediately prior to retirement or the start of long-term disability, be sure to contact Medicare prior to your change in status and make them aware your status is changing.
- If you are Medicare eligible and enrolled in the state plan as an active employee immediately prior to retiring or start of long-term disability, advise Medicare you will be losing creditable coverage as an active employee and will be enrolling in Medicare Part D due to your change in status.
- Under both circumstances: Access to your prescription drug coverage is not available until Express Scripts has received approval from Medicare. Only Medicare can approve your prescription drug coverage. Be sure Medicare is aware of your change in employment status.
Note: Prescription drug enrollment (Medicare Part D) can be a lengthy process. We encourage you to fill prescriptions prior to your date of Medicare eligibility.
When you enroll in a Medicare Plan normally, your monthly health insurance premium will reduce. For rates, see the Department of Human Resource Management's Health Coverage-Medicare Retiree page
You can obtain further information on your state health benefits from the State Administrator's office at the Department of Human Resource Management Retiree Health Insurance page.
The Advantage 65 plans provide an out of country major medical benefit. (See your plan handbook for details.) However, if you live abroad you are not eligible for Medicare Part D. Therefore, the only available plans would be the Advantage 65 Medical only plans.
When at least one of you becomes eligible for Medicare and has to elect a Medicare-coordinating plan, the benefit of the dual contract no longer applies since you will both have single contracts. When one of you moves to a Medicare-coordinating plan, the other (with the waived retiree election) will be automatically changed to a retiree group participant with single membership under his or her own eligibility rights.
The separation of records will ensure that your information reflects a continuous record of individual eligibility for both of you. Each of you will have the premium deducted or billed based on your own monthly Virginia Retirement System (VRS) benefit.
If, at the time of Medicare eligibility, you would like to continue to have both your spouse’s premium and your premium deducted from one monthly VRS benefit, YOU MUST inform VRS of your intent 30 days prior to your Medicare eligibility effective date by submitting a State Health Benefits Program Enrollment Form to:
Virginia Retirement System
P.O. Box 2500
Richmond, VA
23218-2500
Attn: Health Benefits Unit.
When you become eligible for Medicare you will have a choice of the following plans:
- Advantage 65 - State plan that supplements the benefits of Medicare. This plan includes medical coverage administered by Anthem Blue Cross Blue Shield (BCBS) and prescription drug coverage administered by MEDCO.
- Advantage 65 with Dental/Vision – State plan that supplements the benefits of Medicare. Adds dental and vision benefits to Advantage 65. This plan includes medical, dental and vision coverage administered by Anthem BCBS and prescription drug coverage administered by MEDCO.
- Advantage 65 Medical Only - State plans that supplements the benefits of Medicare. Medical coverage is administered by Anthem BCBS. This plan does not include prescription drugs.
- Advantage 65 Medical Only with Dental/Vision - Adds dental and vision benefits to Advantage 65 Medical Only. The medical, dental and vision coverage is administered by Anthem BCBS. This plan does not include prescription drugs.
You will receive a courtesy notification from VRS 45-60 days prior to becoming eligible for Medicare. This notice will explain the Medicare-coordinating plans available through the State Retiree Health Benefits Program.
You can choose one of the Medicare Plans available by completing and submitting the Retiree Enrollment/Waiver form that is enclosed with your notification to VRS with your plan selection or using Employee Direct.
You will be automatically enrolled in the Advantage 65 with dental/vision Medicare-coordinating plan the first day of the month your Medicare is effective, if you do not choose another Medicare plan. You will receive a new membership card from Anthem BCBS within 5-7 days from your enrollment. You will only receive a new MEDCO card, if you were enrolled in dual (retiree +one) or family membership.
You should send a copy of your Medicare ID card to VRS. Without this information, the state will use your Social Security number followed by the letter A for processing. It is important that VRS have the correct Medicare ID number on file, because Medicare verifies it for coverage. If your Medicare ID number is incorrect when you go through the verification process, your state prescription drug benefit will be denied. You will not be able to access your state prescription drug coverage.
Note: Automatic enrollment is based on a participant turning age 65. Participants that are Medicare eligible other than at age 65 will be responsible for changing to a Medicare-coordinating plan at the time of Medicare eligibility. For example: disability retirees may be eligible for Medicare prior to their 65th birthday and therefore, would need to report the Medicare eligibility to VRS.
No. Your prescription drug premium is included with your state-sponsored health insurance coverage if you are enrolled in: Advantage 65 or Advantage 65 with dental/vision. (Option I, Option II and Option II with dental/vision are not available to new plan participants.)
If you want to remain in one of the state Medicare plans and enroll in an alternative Medicare Part D plan, you must change your plan to one of the Advantage 65 Medical Only plans. You cannot be enrolled in more that one Medicare Part D program at the same time.
You cannot be enrolled in multiple Medicare Part D plans at the same time, therefore; the State Administrator’s office will terminate your state prescription drug coverage and automatically enroll you in one of the Advantage 65 Medical Only plans.
No, if you enroll in one of the state Advantage 65 medical-only plans when you become eligible for Medicare, you will not have another opportunity to enroll.
- A deductible will apply to all covered drugs except generics.
- The cost of the drug is based on the tier (category) of the drug. (Refer to your Formulary, Summary of Benefits and Evidence of Coverage from Express Scripts) or the Express Scripts website.
- Access to your prescription drug coverage is not available until Express Scripts has received an approval from Medicare. Only Medicare can approve your prescription drug coverage. The state plan cannot make any exceptions for participants who have not been approved by Medicare to cover their prescription drugs.
Note: Prescription drug enrollment (Medicare Part D) can be a lengthy process. Consider filling prescriptions prior to your date of Medicare eligibility.