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Human Resources

Medicare - How Does It Work?

Medicare and Active Employees Enrolled in a Pace University Sponsored Health Plan

What is Medicare and How Does It Work?

Medicare is a national health insurance program that covers individuals age 65 and older. Medicare can also cover younger people who qualify due to disability or permanent kidney failure.

Active Pace University Employees who are covered by medical insurance through their Pace University employment are not required to enroll in Medicare; nor are their covered dependents.

However, it is likely that Medicare will play an important role in your health insurance coverage now and/or when you retire. It is strongly recommended that all employees approaching age 65; or those who otherwise become eligible for Medicare prior to retirement, speak with a Medicare Specialist at the Social Security Administration for information about enrollment and limitations on Medicare payments for specific services. Everyone’s situation is unique based on their age, employment status and spousal eligibility. Speaking with a representative about your unique profile can help insure your future coverage.

How Does Medicare Interact with Pace’s Cigna Plan?

As an active employee, the Pace Cigna Plan pays primary with any Medicare Plans paying secondary. This also applies if you have a spouse who is over 65. As a result of the Medicare payer rules many individuals defer their Medicare enrollment in plans that require a premium until they are no longer covered as an active employee or the spouse of an active employee.

Note: If you cover a Domestic Partner that is over 65, the Medicare payer rules do not apply and Medicare is primary with the CIGNA plan paying secondary.

What are the different parts of Medicare?

Medicare includes: (click on links for more information)

  • Part A – Helps pay for inpatient care in hospitals and skilled nursing facilities, home health care, hospice care and blood. There is no cost for Part A for employees who have worked and paid taxes for at least 10 years in Social Security and/or Medicare covered employment. See Section Medicare Part A for more details.
  • Part B – Helps pay for outpatient medical services such as: doctor visits, outpatient hospital services, certain home health services. Part B requires a premium and is based on your modified adjusted gross income as reported by your IRS tax return for the past two years. In 2013, the standard Part B premium is $104.90 (per person). See Section Medicare Part B for more details.
  • Part C – Also known as “Medicare Advantage Plan” - is a hybrid of Part A and Part B Benefits. Run by Medicare-approved private insurance companies.
  • Part D – Helps pay for prescription drug coverage insurance.