If you are a University retiree enrolled in UC-sponsored medical coverage and you or your enrolled family member become eligible for premium-free Medicare Part A (hospital insurance), then you must enroll in Medicare Part B (medical insurance) and return the required documentation to transfer to UC-sponsored medical coverage for Medicare enrollees. UC Retirement Administration will send you information on Medicare enrollment a few months before you and/or any enrolled family members turn 65.

In most cases, once you complete the required forms, you will transfer to the Medicare version of your current plan. For example, if you are enrolled in Health Net, you would transfer to Health Net Seniority Plus. In some cases, the Medicare version of your plan may have a different service area from the non-Medicare version. If your plan requires you to live within the service area and the Medicare version of the plan is not available where you live, then you and your family will be allowed to transfer to any UC-sponsored plan available in your area. There could be other differences between your current non-Medicare plan and your new Medicare plan — your doctor, specialists, behavioral health provider, prescription drug formulary and how you pay for these drugs may change.

To receive benefits under a UC-sponsored Medicare plan, you must use a provider who accepts Medicare. If your doctor does not take Medicare patients or will only render services under a "private contract" directly with you, neither Medicare nor your UC-sponsored medical plan will cover the services. Please check with your doctor and your major specialists to see if they take Medicare patients; otherwise you may need to select a new doctor or medical plan during the Open Enrollment before you turn 65. Becoming eligible for Medicare alone does not allow you to change medical plans.

See the Medicare Factsheet for more information including becoming eligible for Medicare through your spouse, ex-spouse or as a widower.

Required Forms
To enroll in a UC-sponsored Medicare plan and be eligible for a University Part B reimbursement (if any), you must return all required forms in a timely manner.

• UC Medicare Declaration form (UBEN 126)—all UC-sponsored Medicare plan enrollees must complete and return this form.
• Medicare Advantage Universal Enrollment/Election form (UBEN 127)—If you enroll in Kaiser Senior Advantage, Health Net Seniority Plus, Coordination of Benefits or Private Fee For Service, or WHA Care+(Medicare Advantage Prescription Drug plans), you must complete this form to ensure proper coordination of your UC plan benefits with Medicare.
• Anthem Blue Cross Part D Enrollment form—If you are enrolled in an Anthem Blue Cross Medicare plan (except the Anthem Blue Cross Plan without Prescription Drug coverage), you must complete this form to assign your prescription drug coverage to Medicare.

If you are not eligible for Medicare Part A

Prescription Drug Coverage (Part D)

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