Still working with PEBB or OEBB coverage at 65
Active PEBB or OEBB coverage through a current job with the state, a university, a school district, an education service district or a community college is health coverage from current work. Because these employers have 20 or more employees, the PEBB or OEBB plan pays first, and you can usually delay Part B without a penalty. You get 8 months to sign up after the job or the coverage ends. Many people take Part A at 65 anyway, since most people pay no Part A premium; if you contribute to a health savings account, stop 6 months before Medicare starts. See working past 65 in Oregon and the Part B special enrollment period.
When does each kind of coverage end?
| Coverage | What happens at Medicare | Rule |
|---|---|---|
| Active PEBB or OEBB (you're still working) | Continues while you work. Pays first; Medicare pays second if you have it. | Medicare Secondary Payer rules |
| PEBB retiree coverage | Ends the last day of the month before the month you become eligible for Medicare. | OAR 101-050-0010 |
| OEBB retiree medical and vision | Ends the last day of the month before your Medicare effective date, unless you're eligible because of end-stage renal disease. Report Medicare within 31 days or OEBB may take back coverage to that date. Dental may continue if your employer allows it. | OAR 111-050-0015 |
| Your spouse or dependents on PEBB or OEBB | A spouse or dependent who isn't eligible for Medicare may be able to keep coverage until they lose eligibility; ask PEBB or OEBB. | OAR 111-050-0015 (OEBB) |
| COBRA | Doesn't count as coverage from current work, so it doesn't let you delay Part B. | Medicare.gov |
Line up Medicare before your PEBB or OEBB retiree coverage ends. Sign up for Part A and Part B in the 3 months before your birthday month so Medicare starts the same day your retiree coverage stops.
PERS Health Insurance Program vs. individual Medicare plans
The PERS Health Insurance Program (PHIP) offers PERS retirees and eligible spouses and dependents a choice of Medicare medical plans with a Part D prescription drug plan. Individual Medicare plans are the Medigap, Medicare Advantage and Part D plans anyone with Medicare in Oregon can buy.
| Question | PERS Health Insurance Program (PHIP) | Individual Medicare plans |
|---|---|---|
| Who can join | PERS retirees and their eligible spouses, domestic partners and dependents | Anyone with Medicare who lives in the plan's service area (Medigap: Part A and Part B) |
| Part A and Part B | Required to enroll at Medicare eligibility (OAR 459-035-0070) | Part A and Part B required for Medigap and Medicare Advantage |
| When you can enroll | Within 90 days of retirement; within 90 days of first becoming eligible for Medicare (with Parts A and B); after losing other group coverage you had for 24 months in a row, if you apply quickly; or during an open enrollment PERS sets | Medigap: best in your 6-month open enrollment when Part B starts, plus Oregon's birthday rule for current policyholders. Medicare Advantage and Part D: your Initial Enrollment Period, October 15 to December 7, or a special enrollment period such as losing employer or retiree coverage |
| Drug coverage | Includes a Part D plan, so don't buy a separate one | A standalone Part D plan with Medigap, or drug coverage inside most Medicare Advantage plans |
| Spouse rules | A spouse or dependent with Parts A and B must be in the Medicare plan from the same carrier as the retiree | Each person picks their own plan |
| Premium help | RHIA subsidy for eligible Tier One and Tier Two retirees in a PERS-sponsored Medicare plan | No RHIA. Medicare Savings Programs and Extra Help can help if your income is limited |
| Getting back in later | Limited to the enrollment windows above | Medigap may require health questions outside open enrollment or a guaranteed-issue right |
The RHIA subsidy
The Retirement Health Insurance Account (RHIA) helps pay the premium for a PERS-sponsored Medicare plan. Under OAR 459-035-0030, you qualify if you are a Tier One or Tier Two member who:
- is enrolled in Medicare Part A and Part B,
- receives a PERS service or disability retirement benefit and had 8 or more years of qualifying service at retirement (or a disability benefit figured as if you had 8 years), and
- is enrolled in a PERS-sponsored Medicare plan.
Surviving spouses and dependents must also have Parts A and B. The rule doesn't include OPSRP members. If you choose an individual Medigap or Medicare Advantage plan instead of a PERS plan, you don't get the RHIA subsidy. State retirees who aren't yet eligible for Medicare may qualify for a different subsidy, RHIPA, based on state service.
Your Medigap rights when you leave public employee coverage
- Medigap open enrollment starts with Part B. If you delayed Part B while on active PEBB or OEBB coverage, your 6-month Medigap open enrollment starts when you finally enroll in Part B, not at 65 (OAR 836-052-0138).
- Guaranteed issue when group coverage ends. If employer or union group coverage that pays after Medicare ends, Oregon's rule gives you a guaranteed right to buy certain Medigap policies, generally within 63 days after it ends (OAR 836-052-0142). Keep the letter that shows the end date.
- Birthday rule. Once you have Medigap, you can switch to a policy with the same or lesser benefits each year, from 30 days before to 30 days after your birthday, without health questions (OAR 836-052-0143).
See Medigap in Oregon and Medigap vs. Medicare Advantage in Oregon.
How to decide
- Find your coverage end date. Ask PEBB or OEBB when your coverage ends, and plan for Medicare to start the next day.
- Enroll in Part A and Part B. You'll need both for a PERS plan, the RHIA subsidy, Medigap or Medicare Advantage.
- Check whether you get RHIA. Ask PERS Health (1-800-768-7377) whether you qualify and how it applies to its plans.
- Compare PHIP plans with individual plans. Check your doctors, drugs, total yearly cost and how each covers care away from home.
- Mind the windows. PHIP's 90-day window after Medicare eligibility and your 6-month Medigap open enrollment are your easiest chances.
To compare individual plans from the companies they work with, you can request a call from a licensed insurance agent, at no cost to you, or see plans for your ZIP code. See also PEBB and Medicare, OEBB and Medicare and retiring after 65 in Oregon.
Sources
- Or. Admin. Code § 101-050-0010, PEBB retiree coverage termination (via Cornell LII)
- Or. Admin. Code § 111-050-0015, OEBB early retiree coverage and Medicare (via Cornell LII)
- Or. Admin. Code § 459-035-0070, PERS Health Insurance Program enrollment (via Cornell LII)
- Or. Admin. Code § 459-035-0030, RHIA eligibility (via oregon.public.law)
- Oregon PERS — PERS Health Insurance Program (PHIP)
- Or. Admin. Code § 836-052-0138, Medigap open enrollment (via Cornell LII)
- Or. Admin. Code § 836-052-0142, guaranteed issue for eligible persons (via Cornell LII)
- Or. Admin. Code § 836-052-0143, birthday rule (via Cornell LII)
- Medicare.gov — Working past 65
- Medicare.gov — Which insurance pays first
Frequently asked questions
Does PEBB retiree coverage continue after I get Medicare?
No. Oregon's PEBB rules end retiree coverage when you become eligible for Medicare, on the last day of the month before the month of eligibility (OAR 101-050-0010). For example, if you turn 65 on May 15 and are eligible for Medicare May 1, PEBB retiree coverage ends April 30.
What happens to OEBB coverage when I get Medicare?
An early retiree who becomes eligible for Medicare can't continue OEBB medical or vision coverage unless eligible because of end-stage renal disease. Coverage ends the last day of the month before your Medicare effective date, and you must report Medicare to OEBB within 31 days. Dental may continue if your employer allows it (OAR 111-050-0015).
Do I need Part B to join the PERS Health Insurance Program?
To enroll when you first become eligible for Medicare, PERS rules require that you be enrolled in Medicare Part A and Part B, and you must apply within 90 days (OAR 459-035-0070). The RHIA premium subsidy also requires Parts A and B.
Who gets the PERS RHIA subsidy?
Under OAR 459-035-0030, Tier One and Tier Two retirees who receive a PERS retirement or disability benefit, had 8 or more years of qualifying service, are enrolled in Medicare Parts A and B, and are in a PERS-sponsored Medicare plan. The rule doesn't include OPSRP members. The amount is set by PERS rule.
Should I choose a PERS plan or an individual Medicare plan?
It depends on your doctors, drugs, budget and whether you get the RHIA subsidy, which only applies to a PERS-sponsored plan. Leaving PHIP can be hard to undo, because PERS allows enrollment only at set times. Compare both before you decide, and call PERS Health at 1-800-768-7377 with questions.
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