Quick answers
- What happens to my PEBB coverage when I turn 65?
- PEBB retiree coverage ends the last day of the month before the month you become eligible for Medicare. If your 65th birthday is May 15, Medicare eligibility starts May 1 and PEBB retiree coverage ends April 30.
- Do I need Medicare Part B if I'm a PEBB retiree?
- Yes, in practice. Retiree coverage isn't coverage from current work, so delaying Part B can mean a lifelong penalty, and PERS PHIP Medicare plans require both Part A and Part B.
- What is PERS PHIP?
- The PERS Health Insurance Program offers Medicare retirees a choice of Medicare supplement and Medicare Advantage plans, all with prescription drug coverage. It is run by Oregon PERS, not PEBB.
- How does the PERS RHIA subsidy work?
- Tier One and Tier Two PERS retirees with eight or more years of qualifying service who are enrolled in Parts A and B and a PHIP Medicare plan get a monthly premium subsidy set by OAR 459-035-0060.
- When do I enroll in PHIP for Medicare?
- PHIP rules allow enrollment within 90 days of your initial Medicare eligibility if you are enrolled in Parts A and B, as well as within 90 days of retirement and at other set times.
The Public Employees' Benefit Board (PEBB), part of the Oregon Health Authority, provides health benefits for employees of Oregon state agencies and universities and for eligible retirees. If you are a PEBB retiree approaching Medicare, the key fact is that PEBB retiree medical coverage doesn't continue once you are eligible for Medicare. What you choose next decides your premiums, network and drug coverage.
Who PEBB retiree coverage is for
PEBB retiree plans are for eligible retirees who are not yet eligible for Medicare, typically people who retire under PERS before 65. Retirees from state service who aren't yet on Medicare may also get the PERS Retiree Health Insurance Premium Account (RHIPA) subsidy based on years of state service. This page explains what happens at the move to Medicare. Active employees still working at 65 should see working past 65 in Oregon.
When PEBB retiree coverage ends
Under OAR 101-050-0010, retirees and their covered family members leave PEBB retiree plans when they become eligible for Medicare. Coverage ends the last day of the month before the month of Medicare eligibility. The rule's example: someone whose 65th birthday is May 15 becomes eligible for Medicare on May 1, so PEBB retiree coverage ends April 30.
- Medicare eligibility can come from age 65 or from disability; either one ends PEBB retiree medical coverage for that person.
- A spouse or dependent who isn't eligible for Medicare is treated separately; check PEBB's retiree rules for how long they can stay.
- PEBB's retiree fact sheet tells members who become eligible for Medicare to contact the PERS Health Insurance Program or Medicare.
Don't miss your Part B start date. Retiree coverage isn't coverage from current employment, so it doesn't give you a Part B special enrollment period. Sign up during your Initial Enrollment Period, the seven months around your 65th birthday month, so Medicare starts when PEBB ends. A late Part B penalty adds 10% to your premium for each full 12 months you could have had Part B but didn't, for as long as you have Part B.
Your Medicare options after PEBB
- PERS Health Insurance Program (PHIP): for PERS retirees and eligible spouses and dependents. PERS offers Medicare supplement and Medicare Advantage plan choices; all PHIP health plans include prescription drug coverage. PHIP requires every Medicare-eligible member to have both Part A and Part B. Details are at pershealth.com.
- Individual Medicare coverage: Original Medicare with a Medigap policy and a Part D plan, or a Medicare Advantage plan. When you first have Part B at 65, Oregon gives you a six-month Medigap open enrollment period with no health questions. See Medigap in Oregon.
- A spouse's employer plan from current work, if you have one: see spouse's employer plan and Medicare.
PHIP plans have their own rules, networks and premiums, which are not the same as standardized Medigap plans bought on your own. Read the plan materials PERS sends and compare before you decide.
How PHIP enrollment works
Under OAR 459-035-0070, a PERS retiree can enroll in PHIP:
- within 90 days of the effective date of retirement;
- within 90 days of first becoming eligible for Medicare, if enrolled in Parts A and B;
- within 90 days of a Social Security Notice of Award letter;
- at any time after 24 months in a row of other group health coverage, applying within 30 days after that coverage ends; or
- during an open enrollment period the PERS Board sets.
Miss these windows and you may not get another chance to join PHIP. Call PERS Health at 1-800-768-7377 to confirm your dates before PEBB coverage ends.
Part B, IRMAA and the RHIA subsidy
You pay the Part B premium to Medicare ($202.90 a month standard in 2026), usually deducted from your Social Security benefit. If your income two years earlier was above $109,000 (single) or $218,000 (married filing jointly), you also pay an income-related surcharge (IRMAA). A PERS pension counts toward that income. PEBB doesn't pay your Part B premium.
The PERS Retirement Health Insurance Account (RHIA) pays a monthly premium subsidy toward a PHIP Medicare plan for eligible retirees. Under OAR 459-035-0030, you must:
- be a Tier One or Tier Two PERS member receiving a service or disability retirement benefit;
- have eight or more years of qualifying service; and
- be enrolled in Medicare Parts A and B and in a PHIP Medicare plan.
The subsidy amount is set in OAR 459-035-0060. Surviving spouses and dependents may also qualify if they have Parts A and B. Ask PERS Health about your eligibility.
Part D and drug coverage
PERS says all PHIP health plans include prescription drug coverage, so you shouldn't need a separate Part D plan, and joining one could conflict with your PHIP plan. If you choose individual coverage instead, join a Part D plan (or a Medicare Advantage plan with drug coverage) within 63 days after your other creditable drug coverage ends to avoid a late-enrollment penalty. In 2026 Part D caps your out-of-pocket drug costs at $2,100.
Transition timeline
- Four to six months before your Medicare month. Confirm with PEBB when your retiree coverage ends and ask PERS Health for PHIP Medicare plan materials.
- Sign up for Parts A and B. Use your Initial Enrollment Period, which runs three months before through three months after your 65th birthday month. Apply at ssa.gov or call Social Security at 1-800-772-1213.
- Choose your Medicare coverage. Enroll in a PHIP Medicare plan within 90 days of first Medicare eligibility, or pick individual Medigap, Part D or Medicare Advantage coverage.
- Line up the dates. Make Medicare and your new plan start the first day of your Medicare month, the day after PEBB retiree coverage ends.
- Review every fall. Read your plan's Annual Notice of Change and compare options during Open Enrollment, October 15 to December 7.
Resources and contacts
- PEBB: oregon.gov/oha/pebb
- PERS Health Insurance Program: 1-800-768-7377; pershealth.com
- PERS Member Services: 1-888-320-7377 (TTY 503-603-7766)
- Social Security: 1-800-772-1213 (TTY 1-800-325-0778), for Medicare enrollment and IRMAA
- 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) and Medicare.gov
- Licensed insurance agents: to compare individual Medicare plans from the companies they work with, you can request a call from a licensed insurance agent.
Related guides
OEBB and Medicare
Educator retirees and Medicare.
Retiring after 65 in Oregon
Timing Medicare when work coverage ends.
Medicare enrollment in Oregon
Every enrollment period.
Sources
- OAR 101-050-0010 — PEBB retiree plan enrollment and termination (Cornell LII)
- Oregon Health Authority — PEBB Retiree Member Information (PDF)
- Oregon Health Authority — Public Employees' Benefit Board (PEBB)
- Oregon PERS — PERS Health Insurance Program (PHIP)
- Oregon PERS — PERS Health Insurance Plan (PHIP), employer information
- OAR 459-035-0070 — PHIP enrollment (Cornell LII)
- OAR 459-035-0030 — RHIA eligibility
- Medicare.gov — When can I sign up for Medicare?
Every question in this guide
Frequently asked questions
Do PEBB retirees have to enroll in Medicare at 65?
PEBB retiree coverage ends when you become eligible for Medicare, so most retirees enroll in Parts A and B then. If you are still working with PEBB active-employee coverage, you can delay Part B without penalty until that coverage or job ends.
Does PEBB or PERS pay the Part B premium?
PEBB doesn't. You pay your Part B premium to Medicare, usually from your Social Security check. Eligible PERS retirees in a PHIP Medicare plan may get the RHIA subsidy toward their plan premium, and people with lower incomes may qualify for a Medicare Savings Program.
Is PERS PHIP drug coverage creditable for Medicare Part D?
PERS says all PHIP health plans include prescription drug coverage, so you shouldn't need a separate Part D plan. Keep the yearly creditable coverage notice your plan sends in case you ever change coverage.
Should I stay with a PHIP plan or buy individual Medicare coverage?
It depends on the plans, your doctors and your drugs. Individual Medigap, Medicare Advantage and Part D plans are another option. To compare plans from the companies they work with, you can ask a licensed insurance agent; for PHIP details, call PERS Health at 1-800-768-7377.
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