Are you an NEA retiree, approaching Medicare age and confused about how Medicare and your NEA-provided health insurance will coordinate? NEA Human Resources staff met with you prior to your exit from active employment and outlined (both orally and in writing) your post-retirement health benefit and coordination with Medicare. But if you retired early, when being eligible for Medicare seemed years away, you may not have paid much attention.
If you’ve attended quarterly NEARO meetings of late, you’ve probably heard the explanation below more than once from HR’s Luis Vall-Lloveras. But for those who’ve missed those sessions, here’s a recap. (If you retired from an NEA affiliate, you may have coverage similar to that explained below, but to be sure, it would be best to contact the person handling staff retiree benefits for the association from which you retired.)
When NEA employees retire, they may be eligible to take with them a post-retirement medical plan; most of the time it’s the same plan they had as active employees. Retirees under age 65 continue to have primary coverage from their post-retirement medical plan. Retirees 65 and over become Medicare eligible and receive their primary benefits from Medicare. Their post-retirement health plan becomes secondary and pays a smaller portion of any medical costs than it would if they were still working.
Upon becoming Medicare eligible, NEA retirees must enroll in Part A (hospital coverage) and, with some rare exceptions, Part B (outpatient coverage), but not Part C (Medicare Advantage) or Part D (drug benefit).
Medicare Part A covers care if you’re admitted to a hospital overnight, including not only the cost of the room but also related tests, doctors’ care, and medications. Part B covers outpatient services and any items not covered in Part A, such as visits to a doctor’s office, outpatient treatment, tests, and other medical treatment such as dialysis or chemotherapy not administered in a hospital.
Part C—called Medicare Advantage — provides benefits somewhat beyond those in Parts A & B, but is run by insurance companies that charge a premium for services most of which are covered by the NEA medical plan for retired employees, with no additional premium. NEA does not advise signing up for Part C.
NEA retirees do not have to enroll in Part D, the drug benefit established in 2002-03, because their secondary plan already provides a pharmacy benefit that is at least equal to, if not better than, what Part D would provide. Each year NEA Human Resources mails notices to all NEA retirees reminding them of the "creditable coverage" of the pharmacy benefit contained in the NEA medical plan(s) and outlining the potential consequences of enrolling in Medicare Part D, which may cost them premiums with little return not already available from NEA.
If you have questions about health care coverage as an NEA retiree, please contact the Human Resources Service Center, 202/822-SELF(7353). If you have other questions about the coordination of benefits with Medicare, please call 800-633-4227.