Medicare is a federal health insurance program regulated by the Centers for Medicare and Medicaid Services (CMS).
ELIGIBILITY AND ENROLLMENT
Medicare is for individuals:
- Age 65 and older
- Under age 65 with certain disabilities
- With End-Stage Renal Disease (ESRD)
Medicare consists of four parts, each covering specific services:
- Medicare Part A (Hospital)
- Medicare Part B (Medical)
- Medicare Part C (Medicare Advantage plans)
- Medicare Part D (Prescription drugs)
The Social Security Administration (SSA) oversees Medicare eligibility and enrollment.
CONTINUING CSJ HEALTH COVERAGE AFTER AGE 65
A few months before you turn 65, the Office of Retirement Services will send you notifications of the requirements to continue your health coverage. The notifications request information about your eligibility or ineligibility to enroll in Medicare.
This Medicare Transition Presentation is intended for members who are approaching Medicare eligibility and who may have questions regarding the Medicare transition process and enrollment requirements. VIEW MEDICARE TRANSITION PRESENTATION
Office of Retirement Services DOES NOT pay for Medicare Part B Premiums.
Eligible retirees have three (3) Medicare Plans available to choose from. Please click here to find out more information or contact the Office of Retirement Services at (408) 794-1000 or toll free at (800) 732-6477.
MEDICARE PART B REIMBURSEMENT
SAN JOSE MUNICIPAL CODE §3.36.1925 was implemented in 2001 to establish the Medicare Part-B Reimbursement benefit. The purpose of the Medicare Part-B Reimbursement benefit was to ensure that all P&F members get the same amount of subsidy paid towards their medical coverage.
- Must be eligible for medical coverage under the provision of the Plan and must be enrolled in a medical plan.
- Must submit proof of Medicare Part-B payment by April 1st for the prior year.
- Reimbursement shall not exceed the amount of the Medicare Part-B payment.
- The medical premium shall not exceed the premium of the lowest cost plan.
HOW IS THE POLICE & FIRE MEDICARE PART B REIMBURSEMENT CALCULATED?
The Police & Fire Retirement Fund will pay the cost of the lowest cost plan for health coverage. If the Member chooses a plan other than the lowest cost plan, they pay the difference.
The same goes for the reimbursement of Medicare Part B. If there is a subsidy balance, that balance may be used toward the reimbursement of the Medicare Part B premium paid to Social Security. Therefore, a Member may get a full reimbursement or they may only get a partial reimbursement depending on the subsidy balance.