Medicare Eligibility and your LAUSD District-Sponsored Medical Coverage

While your retiree health care coverage is available after you become eligible for Medicare, you should understand how Medicare affects health care coverage. Medicare is the national health care program for individuals who are age 65 and older (and certain other individuals).

There are three main parts:

  • Part A, which provides coverage for hospitalization,
  • Part B, which provides coverage for outpatient care, and
  • Part D, which provides prescription drug coverage (all LAUSD plans include prescription drug coverage).

To retain your District-sponsored retiree medical coverage after you and/or your spouse/domestic partner become eligible for Medicare for any reason, you must enroll and remain enrolled in Medicare Parts A and B. It is recommended that you apply for Medicare 90 days prior to your 65th birthday; contact your local Social Security office for information. or click here 

Eligibility for Medicare is considered a major life event, therefore you are eligible to change plans. However, you must send a written request to Benefits Administration for your plan change 30 days before you become eligible for Medicare. Lack of Medicare coverage will not affect your dental or vision benefits.

LAUSD Medicare Requirements

All retirees/spouses/domestic partners age 75 and older as of January 1, 2010 (retirees born prior to January 1, 1935), were grandfathered-in at their current Medicare Parts A and B enrollment levels. All other retirees/spouses/domestic partners must comply with all District Medicare Parts A, B, & D requirements as listed below.

Please mail/fax copies of Medicare cards and letters to LAUSD Benefits Administration at the address listed on page 24 and include retiree’s name, employee ID, or Social Security number on all correspondence.

Medicare Part A
Hospital

All retirees/spouses/domestic partners must enroll and remain enrolled in Medicare Part A premium free, if eligible.

***I’m having trouble confirming if LAUSD employment counts.  Please provide a citation.

To be eligible for Part A premium free, an individual must have 40 quarters of Medicare-covered employment. These earnings can be based on his/her own earnings or the earnings of a spouse or former spouse. Contact your local Social Security office for eligibility information.

If you are not eligible for Medicare Part A premium free, to continue your District benefits you must provide to LAUSD Benefits Administration a confirmation letter of ineligibility from the Centers of Medicare and Medicaid Services (CMS). By submitting the ineligibility letter, you will only be eligible to enroll in Kaiser Senior Advantage or Anthem Blue Cross EPO plan.

Health Net Seniority Plus and UnitedHealthcare® Group Medicare Advantage (HMO) plans require eligibility and enrollment in Medicare Parts A and B.

Medicare Part B
Doctor Visits

All retirees/spouses/domestic partners must enroll and remain enrolled in Medicare Part B and remit the applicable premium to Social Security in order to maintain District-sponsored medical benefits. If you don’t enroll or you stop paying for your Medicare Part B premium at any time for yourself and/or your spouse/domestic partner, your District sponsored medical benefits will terminate. For Medicare Part B premium, contact your local Social Security office.

Medicare Part D
Prescriptions

The Medicare Prescription Drug Plan (PDP), also known as Medicare Part D, became available January 1, 2006. Although you have the option of enrolling in a Medicare PDP, in most cases these plans will not provide you with any additional advantages. The LAUSD prescription drug plan is at least as good as the standard Medicare Part D benefit for most Medicare-eligible participants. LAUSD will continue to provide your current prescription drug coverage through Kaiser Senior Advantage, UnitedHealthcare® Group Medicare Advantage (HMO), Health Net Seniority Plus, or SilverScript® , a CVS/Caremark company the prescription drug provider for the Anthem Blue Cross EPO and HMO plans.

If you elect to enroll in a PDP outside your current District-sponsored plan, the District will cancel your medical and prescription coverage.  LAUSD *

 

Retirees not eligible for premium-free Part A may be eligible for the CalSTRS Medicare Premium Payment Plan (MPPP).  Contact CalSTRS at 800-228-5453 for eligibility requirements.  LAUSD *

Travel Policies

4 comments on “LAUSD Medicare Qualification

  1. I’m going to be out for a surgery for a couple of months. Does LAUSD give me SDI State Disability Insurance or an Equivalent?

    • LAUSD teachers don’t pay into SDI so they won’t get those benefits. Lausd.net

      I suggest you check out illness leave.

      A formal ILLNESS LEAVE is a leave granted to an employee for absence covering a period of more than 20 consecutive working days because the employee is unable to work due to personal illness, injury, quarantine occasioned by the employee’s own or another’s illness, or a temporary disability caused or contributed to by pregnancy, miscarriage, childbirth or recovery therefrom.

      These are paid leaves. LAUSD.net

  2. I’m not a happy camper with the Anthem Medicare Advantage Plan. I only found out about this change last week. How can I get back onto Medicare A & B? Can I get a Medi Gap plan?

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