Seniors

Medicare is a federal health insurance program for people 65 years of age or older. It pays for much of your health care, but not all of it, such costs could be, prescription drugs, deductibles, coinsurance.

Medicare Supplements are a health insurance policy sold by private heath insurance companies to fill the "gaps" in Medicare coverage. For more information or to get a quote, fill out our online

Click Here Medicare Quote Form

Q) What is Medicare?

A) Medicare is a Federal health insurance program for retirees age 65 or older and certain disabled people. Medicare Part A covers inpatient hospital care, some skilled nursing facility care and hospice care. Medicare Part B covers physician care, diagnostic x-rays and lab tests and durable medical equipment. Medicare Part D is a federal prescription drug program.

Q) I'm turning age 65; what do I need to do? Should I enroll in Medicare A and/or B if I am eligible?

A) If you are age 65 or over, call or visit your local Social Security Office for confirmation of Social Security and Medicare benefit eligibility. If eligible and if you are retired, you must enroll in Medicare Parts A and B to continue coverage with the GIC. See the Retiree/Survivor Benefit Decision Guide for your health plan options.

If eligible and if you continue working after age 65, you should enroll in Medicare Part A. You should NOT enroll in Medicare Part B until you (the insured) retire.

The spouse of an active employee who is 65 or over should sign up for Medicare Part A when he or she (the spouse) reaches age 65 and enroll in Part B when the insured retires. Due to federal law, different rules apply for same sex spouses. See below for details.

Most enrollees should not sign up for Medicare Part D.

Q) I'm retired, but not age 65. My spouse is turning age 65; what should my spouse do?

A) Your spouse should call or visit your local Social Security Office for confirmation of Social Security and Medicare benefit eligibility. If eligible, he/she must enroll in Medicare Parts A and B to continue coverage with the GIC. See the under/over age 65 section of the Benefit Decision Guide for health plan combination options.

Q) How to I find out whether I am eligible for Medicare A and/or B benefits?

A) When you or your spouse is age 65 or over, visit your local Social Security Administration office to find out if you are eligible for Medicare Part A for free. If you or your spouse is disabled, contact Social Security about Medicare eligibility. If eligible, contact the Group Insurance Administrator for your health plan options.

Q) I have been a state employee for my entire career and have never contributed to Social Security. Why do I need to know about Medicare?

A) You may still be eligible for Medicare benefits. When you turn age 65, visit your local Social Security office for eligibility information. If you are not eligible for Medicare, the Group Insurance Administrator will require proof from the Social Security Administration that you are not eligible.

Q) What is the cost of Medicare Part B?

A) The premium is set by the Centers for Medicare and Medicaid Services (CMS). Contact them or your local Social Security office for the current premium cost.

Q) How do I pay for Medicare Part B?

A) In most cases, the federal government will deduct the Medicare Part B premium from your monthly Social Security check. If you or your spouse are not eligible for a Social Security check, but are eligible for Medicare Part A for free, the federal government will bill you for the Medicare Part B premium.

Q) When must I enroll in Medicare Part A and B?

A) When you or your spouse turns 65, and if you (the enrollee) are retired, you must enroll in Medicare Parts A and B. If you (the enrollee) continue working after age 65, you and/or your spouse must enroll in Medicare Part A. (Different rules apply to same sex spouses; see below for details.) When you retire, you and/or your spouse must enroll in Medicare Part B and join a Medicare plan sponsored by the Group Insurance Administrator.

If you do not enroll in Medicare Part B within the required time, you will be required to pay federal government penalties. Also, you may be ineligible for health coverage through the Group Insurance Administrator if you do not enroll in Part B within the required time.

Q) Should I choose only Medicare for health care coverage?

A) "Medicare only" coverage is not recommended as it has coverage limitations. To ensure comprehensive coverage, Medicare retirees should enroll in a Medicare health plan sponsored by the Group Insurance Administrator as a supplement to their Medicare coverage.

Q) What are the consequences if I cancel or do not pay Medicare Part B?

A) If you cancel or do not pay Medicare Part B, the Group Insurance Administrator is required to terminate your Group Insurance health coverage. This would mean that you would only have Medicare Part A coverage for inpatient hospital care. You would no longer have coverage for:

Physician office visits
Prescription drugs
Outpatient mental health/substance abuse care
Outpatient surgery
X-rays and diagnostic tests
Hearing aids
And more

Q) If I enroll in a Croup Insurance Medicare supplemental plan, what happens to my spouse's coverage?

A) Your spouse will continue to be covered under your existing non-Medicare plan until he or she becomes eligible for Medicare. You and your spouse must join the same health plan. See the Retiree/Survivor Benefit Decision Guide for under and over age 65 health plan combination options.

Q) I'm turning age 65 and have a same sex spouse; what do I need to do? Should I enroll in Medicare A and/or B if I am eligible?

A) If you are age 65 or over, call or visit your local Social Security Office for confirmation of Social Security and Medicare benefit eligibility. If eligible and if you are retired, you must enroll in Medicare Parts A and B to continue coverage with the Group Insurance Administrator. See the Retiree/Survivor Benefit Decision Guide for your health plan options.

If eligible and if you continue working after age 65, you should enroll in Medicare Part A. You should NOT enroll in Medicare Part B until you retire.

The same sex spouse of an active employee should sign up for Medicare Part A and Part B when he or she (the spouse) reaches age 65. Keep in mind that the same sex spouse is subject to federal imputed income taxes. See the imputed income table for more information.

Most enrollees should not sign up for Medicare Part D.

Q) I am an ACTIVE state employee age 65 or over; which health plan card should I present at a doctor's office or hospital?

A) When visiting a hospital or doctor, present your Group Insurance Administrator health plan card (not your Medicare card) to ensure your Group Insurance plan is charged for the visit. If you are still working and are age 65 or over, your Group Insurance health plan is your primary health insurance provider; Medicare (if you have it) is secondary. You may need to expain this to your provider is he/she asks for your Medicare card.

Q) How do I find out about Medicare Plan options?

A) When you retire at age 65 or over or if you are retired and turn age 65, the Group Insurance Administrator will contact you about your health plan options. The Group Insurance Administrator's Retiree/Survivor Benefit Decision Guide provides an overview of your Medicare health plan choices.

Q) When can I change Group Insurance Coverage to a Medicare Plan?

A) You may change your Group Insurance Medicare Plan during annual enrollment or if you move out of a Group Insurance HMO Medicare Plan's service area.

Q) At age 65 my spouse or I were not eligible for Medicare Part A for free. I or my spouse have subsequently become eligible for Medicare Part A. What do we need to do?

A) You or your spouse must notify the Group Insurance Administrator in writing when you become eligible for Medicare Part A. The Group Insurance Administrator will notify you of your coverage options. Failure to do this may result in loss of Group Insurance coverage.

Q) I am an active employee who is age 65 or over. Should I enroll in Medicare Part D?

A) No.

Q) I am a retiree. Should I enroll in Medicare Part D?

A) For most Group Insurance Medicare enrollees, the drug coverage you currently have through your Group Insurance health plan is a better value than the Medicare drug plans being offered. Therefore, you should not enroll in a Medicare drug plan. (If you are a member of one of the Group Insurance Medicare Advantage plans.

If you have limited income and assets, the Social Security Administration offers help paying for Medicare prescription drug coverage and this may be the one case where signing up for a Medicare Part D plan may work for you. Contact the Social Security Administration for details.

When considering medicare supplement insurance or a medicare advantage plan. You should research the company's ratings and the plans they are offering. You can do that by calling the Texas Department of Insurance for Texas Health Insurance Plans. For Las Vegas Health Insurance Plans you should call the Nevada Department of Insurance.

Whether you need more health insurance in addition to Medicare is a decision that only you can make. If you decide to buy more insurance, shop carefully and buy a policy that you can afford and offers the benefits you think you need most. Here are some helpful tips for you to keep in mind when shopping for health insurance.
Shop Carefully Before You Buy. Policies differ as to coverage and cost, and companies differ as to service. Contact different companies and compare the premiums before you buy.

Don't Buy More Policies Than You Need. Duplicate coverage can be expensive and generally is unnecessary. A single comprehensive policy is better than several policies with overlapping or duplicate coverage. Federal law prohibits an insurer from selling you a second Medigap policy unless you state in writing that you intend to cancel the first policy after the replacement policy goes into effect. Recent changes in the law affect beneficiaries who get help from the state through its Medicaid program in paying their health care costs. Anyone who sells you a policy in violation of the various anti-duplication provisions is subject to criminal and/or civil penalties under federal law. Call 1-800-638-6833 to report suspected violations.

Consider Your Alternatives. Depending on your health care needs and finances, you may want to consider continuing the group coverage you have at work, joining a managed care plan, buying a Medigap policy, or buying a long-term care insurance policy.

Check For Pre-existing Condition Exclusions. In evaluating a policy, you should determine whether it limits or excludes coverage for existing health conditions. Many policies do not cover health problems that you have at the time of purchase. Pre-existing conditions are generally health problems you saw a doctor about within the 6 months before the date the policy went into effect.

If you have had a health problem, the insurer might not cover you for expenses connected with that problem. Medigap policies, however, are required to cover pre-existing conditions after the policy has been in effect for 6 months. Some companies have shorter waiting periods before covering a pre-existing condition.

Beware of Replacing Existing Coverage. Be careful when buying a replacement Medigap policy. Make sure you have a good reason for switching from one policy to anotherýyou should only switch for different benefits, better service, or a more affordable price. On the other hand, don't keep inadequate policies simply because you have had them for a long time. If you decide to replace your Medigap policy, you must be given credit for the time spent under the old policy in determining whether and to what extent any pre-existing conditions restrictions apply under the new policy. You must also sign a statement that you intend to terminate the policy to be replaced. Do not cancel the first policy until you are sure that you want to keep the new policy. You have 30 days to decide.

Policy Delivery or Refunds Should be Prompt. The insurance company should deliver a policy within 30 days. If it does not, contact the company and obtain in writing the reason for the delay. If 60 days go by without a response, contact your state insurance department.

Prohibited Marketing Practices. It is unlawful for a company or agent to use high pressure tactics to force or frighten you into buying a Medigap policy, or to make fraudulent or misleading comparisons to get you to switch from one company or policy to another. Deceptive "cold lead" advertising also is prohibited. This tactic involves mailings to identify individuals who might be interested in buying insurance. If you fill in and return the card enclosed in the mailing, the card may be sold to an insurance agent who will try to sell you a policy.

Be Aware of Maximum Benefits. Most policies have some type of limit on benefits. They may restrict either the dollar amount that will be paid for treatment of a condition or the number of days of care for which payment will be made. Some insurance policies (but not Medigap policies) pay less than the Medicare-approved amounts for hospital outpatient medical services and for services provided in a doctor's office. Others do not pay anything toward the cost of those services.

Policies to Supplement Medicare Are Neither Sold Nor Serviced by the State or Federal Governments. State insurance departments approve policies sold by private insurance companies but approval only means the company and policy meets requirements of state law. Do not believe statements that insurance to supplement Medicare is a government-sponsored program. If anyone tells you that they are from the government and later tries to sell you an insurance policy, report that person to your state insurance department or federal authorities.

This type of misrepresentation is a violation of federal and state law. It is also unlawful for a company or agent to claim that a policy has been approved for sale in any state in which it has not received state approval or to use fraudulent means to gain approval.

Know With Whom You're Dealing. A company must meet certain qualifications to do business in your state. You should check with your state insurance department to make sure that any company you are considering is licensed in your state. This is for your protection. Agents also must be licensed by your state and may be required by the state to carry proof of licensure showing their name and the company they represent. If the agent cannot verify that he or she is licensed, do not buy from that person. A business card is not a license.

Keep Agents' and/or Companies' Names, Addresses and Telephone Numbers. Write down the agents' and/or companies' names, addresses and telephone numbers or ask for a business card that provides all that information.

Take Your Time. Do not be pressured into buying a policy. Principled sales people will not rush you. If you are not certain whether a policy is what you need, ask the salesperson to explain it to a friend. Keep in mind, however, that there is a limited time period in which new Medicare Part B enrollees can buy the Medigap policy of their choice without special conditions being imposed. Once this open enrollment period ends, you may be limited as to the Medigap policies available to you, especially if you have a pre-existing health condition.

If You Decide To Buy, Complete the Application Carefully. Do not believe an insurance agent who says your medical history on an application is not important. Some companies ask for detailed medical information. If you leave out any of the medical information requested, coverage could be refused for a period of time for any medical condition you neglected to mention. The company also could deny a claim for treatment of an undisclosed condition and/or cancel your policy.

Look For an Outline of Coverage. You must be given a clearly worded summary of the policy . . . READ IT CAREFULLY.

Do Not Pay Cash. Pay by check, money order or bank draft made payable to the insurance company, not to the agent or anyone else. Get a receipt with the insurance company's name, address and telephone number for your records.

For Your Protection

As previously noted, federal criminal and civil penalties can be imposed against anyone who sells a Medigap or other health insurance policy in violation of the anti-duplication and other insurance laws. Penalties may also be imposed for claiming that a Medigap policy meets legal standards for federal certification when it does not, or for using the mail for the delivery of advertisements offering for sale a Medigap policy in a state in which it has not received approval.

Additionally, it is illegal under federal law for an individual or company to misuse the names, letters, symbols or emblems of the U.S. Department of Health and Human Services (DHHS), the Social Security Administration, or the Health Care Financing Administration. It also is illegal to use the names, letters, symbols or emblems of their various programs.

This law is aimed primarily at mass marketers that use this information on mail solicitations to imply that the product is either endorsed or is being sold by the U.S. government. The advertising literature is often designed to look like it came from a government agency. If you believe that you have been the victim of any unlawful insurance sales practices, contact your state insurance department immediately. Texas Department of Insurance Telephone number is 1-800-252-3439.

1-800-479-8075 Office 866-572-6137 Fax


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