Medicare Basics

Medicare is a health insurance program for individuals who meet one of the following criteria:

• Age 65 or older
• Under age 65 with certain qualifying disabilities
• Any age with end-stage renal disease requiring dialysis or a kidney transplant

Understanding when and how to enroll is important, as late enrollment can result in permanent penalties.

Medicare Initial Enrollment Period

Medicare charges a lifetime late enrollment penalty of 10% for each 12-month period you were eligible for Medicare Part B but did not enroll. This penalty does not apply if you are covered by an employer health plan. See Working Past Age 65 below.

If you are receiving Social Security benefits:

• Social Security will automatically enroll you in Medicare Parts A and B
• Your Medicare ID card will be mailed to you

If you are NOT yet receiving Social Security benefits:

• You must enroll in Medicare through a Social Security office or online at ssa.gov/medicare/sign-up
• To have coverage start the month you turn 65, enroll as soon as you are eligible

Signing Up for Medicare

Medicare Part A

• Part A is premium-free for most people, based on your work record or that of a spouse or former spouse
• If Social Security determines you are not eligible for premium-free Part A and you plan to enroll in SERS’ Medicare coverage, do not enroll in Part A
• The SERS Medicare Advantage plan covers Part A services

Medicare Part B

• Everyone must enroll in Part B and pay a monthly premium
• Premiums are deducted from your Social Security benefit or paid directly to Medicare
• The 2026 standard Part B premium for most new enrollees is $202.90 per month

If you or your spouse are covered by an employer health plan, you may delay enrolling in Medicare Parts A and B.

When employer coverage ends, you have a one-time Special Enrollment Period of up to eight months to enroll in Medicare without penalty. Contact your local Social Security office to schedule an appointment or enroll online at www.ssa.gov/medicare/sign-up.

Enrollment Based on Medicare Status

If you already have Medicare Part A:

You must enroll in Medicare Part B and submit the following to Social Security:

• Application for Enrollment in Medicare Part B (CMS-40B)
• Request for Employment Information (CMS-L564), completed by your employer

This form confirms you delayed Part B enrollment due to employer coverage and prevents a late enrollment penalty.

If you have Part A only or receive a Social Security benefit, you generally cannot file your Medicare application any earlier than 30 days before the month you want your coverage to begin.

Contact your local Social Security office for these forms or download them at www.ssa.gov/forms.

If you do not have Medicare:

You must enroll in both Medicare Part A and Part B and submit:

• Request for Employment Information (CMS-L564), completed by your employer. This form confirms you delayed Part B enrollment due to employer coverage and prevents a late enrollment penalty.

If you are not yet receiving Social Security benefits, you may apply up to three months before coverage begins.

Forms are available at ssa.gov/forms or through your local Social Security office.

Medicare Part A (Hospital Insurance)

Helps cover:

• Inpatient care in hospitals
• Skilled nursing facility care (not custodial or long-term care)
• Hospice care
• Home health care

Part A is premium-free for most people, based upon either their own work history or their spouse’s work history in Social Security.

Medicare Part B (Medical Insurance)

Helps cover:

• Services from doctors and other health care providers
• Outpatient care
• Home health care
• Durable medical equipment
• Some preventive services

Everyone is eligible for Part B and pays a monthly Part B premium. In 2026, the premium for most new enrollees is $202.90 per month.

Medicare Part C (Medicare Advantage)

• Includes Part A and Part B benefits
• Offered by Medicare-approved private insurers
• Often includes prescription drug coverage and additional benefits

Medicare Part D (Prescription Drug Coverage)

• Helps cover prescription drug costs
• Offered by private insurers

Purchased separately, unless you enroll in a Medicare Advantage plan that includes Part D.

Medicare Coverage Choices

When you become eligible for Medicare, you must choose how to receive coverage:

• Original Medicare, or
• A Medicare Advantage Plan

Members eligible for SERS’ health care coverage will receive an “Approaching 65” packet approximately three months before turning 65. This packet includes information about Medicare enrollment and the SERS Medicare Advantage Plan.

• Members enrolled in SERS’ non-Medicare coverage will transition to the SERS Medicare plan once Medicare proof is received
• Members who previously waived SERS’ coverage may enroll during this period; Medicare proof must be provided

Enrollment opportunities are limited. If you decline SERS’ Medicare coverage or enroll in another individual Medicare plan, future enrollment may not be allowed.

Eligible SERS retirees enrolled in both Medicare Part B and SERS’ health care coverage may receive a $45.50 monthly reimbursement toward their Part B premium.

You are not eligible if:

• Your Part B premium is paid by another source, including Medicaid or the Medicare Premium Assistance Program
• Your Part B coverage is cancelled

Reimbursement begins after proof of Part B enrollment is received and is not retroactive. Spouses and dependents are not eligible for this reimbursement.

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