Getting & Managing Health Coverage
ACERA offers a range of health plan options to ACERA retirees, dependents, and survivors who are receiving a monthly retirement benefit from ACERA.
Medicare and ACERA
Medicare is health insurance for people 65 or older. You may be eligible to get Medicare earlier if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also called Lou Gehrig’s disease).
Some people get Medicare automatically, others have to actively sign up. Follow these steps to enroll in Medicare:
Step 1: Determine if You Are Eligible to Enroll in Medicare
Who is eligible for Medicare?
People under age 65 who are disabled
If you’re getting Social Security disability benefits, you’ll get Medicare automatically after getting disability benefits for 24 months, or at age 65, whichever is sooner. If you have ALS (also called Lou Gehrig’s disease) you’ll get Medicare automatically as soon as you start getting disability benefits.
People age 65 and older
At age 65, you can enroll in Medicare. But you may want to wait if you’re still working when you turn 65.
Step 2: Understand What Medicare Is and How it Works
What are the parts of Medicare?
Part A (Hospital Insurance): Helps cover inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care.
Part B (Medical Insurance): Helps cover:
- Services from doctors and other health care providers
- Outpatient care
- Home health care
- Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
- Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits)
Part C (Medicare Advantage): Medicare Advantage is a Medicare-approved plan from a private company that offers an alternative to Original Medicare for your health and drug coverage. These “bundled” plans include Part A, Part B, and usually Part D. In most cases, you’ll need to use doctors who are in the plan’s network. Plans may have lower out-of-pocket costs than Original Medicare. Plans may offer some extra benefits that Original Medicare doesn’t cover — like vision, hearing, and dental services.
Part D (Drug coverage): Helps cover the cost of prescription drugs (including many recommended shots or vaccines). You join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare.
Also, Supplemental Insurance (Medigap): Extra insurance you can buy from a private company that helps pay your share of costs in Original Medicare. Policies are standardized, and in most states named by letters, like Plan G or Plan K. The benefits in each lettered plan are the same, no matter which insurance company sells it.
When do I sign up for Medicare?
People Under Age 65 Who Are Disabled
If you’re getting Social Security disability benefits, you’ll get Medicare automatically after getting disability benefits for 24 months, or at age 65, whichever is sooner. If you have ALS (also called Lou Gehrig’s disease) you’ll get Medicare automatically as soon as you start getting disability benefits.
retired People 65 and Older (and not covered under working spouse’s insurance)
Most people who are retired (and not covered under a working spouse’s insurance) sign up for both Part A (Hospital Insurance) and Part B (Medical Insurance) when they’re first eligible (usually when they turn 65). You have a 7-month enrollment period associated with your 65th birthday:
| 7-Month Medicare Enrollment Period | ||
|---|---|---|
| 3 Months Before 65th Birthday | 65th Birthday Month | 3 Months After 65th Birthday Month |
| Coverage Effective 1st Day of 65th Birthday Month | Coverage Effective 1st Day of Month After 65th Birthday Month | Coverage Effective 1st Day of Month After Enrollment Month |
Required Enrollment Timing for Kaiser Permanente Senior Advantage Plan: ACERA requires signing up 2 or 3 months before your 65th birthday month to ensure your Kaiser Permanente Senior Advantage Plan enrollment is effective on the 1st day of your 65th birthday month.
Enrollment Period if You Miss the Initial 7-Month Period: January – March of each year. Coverage becomes effective the 1st day of the month after you sign up.
Medicare Part B Late Enrollment Penalty: If you are not still working and you do not enroll in Medicare during this period and sign up later, you will have to pay a lifetime 10% penalty for each 12-month period you did not enroll in Medicare Part B after you were eligible.
Learn more about other special situations (special enrollment periods).
People 65 and Older Still Working or retired and covered under working spouse’s insurance
If you (or your spouse) are still working at a job that has 20 or more employees and have health insurance from that job, you can wait until you (or your spouse) stop working (or lose your health insurance, if that happens first) to sign up for Part B (Medical Insurance), and you won’t pay a late enrollment penalty.
If you don’t have to pay a premium for Part A (Hospital Insurance), you can choose to sign up when you turn 65 (or anytime later). Your job-based insurance pays first, and Medicare pays second.
Learn more about other situations.
What does Medicare cost?
Part A (Hospital Insurance)
$0 for most people because they paid Medicare taxes long enough while working—generally at least 10 years. You get “Premium-Free Part A” if you:
- Qualify to get (or are already getting) retirement or disability benefits from Social Security (or the Railroad Retirement Board).
- Get Medicare earlier than age 65.
If you’re not sure, you can log into (or create) your secure my Social Security account to find out if you paid Medicare taxes long enough.
Part B (Medical Insurance)
You’ll pay a monthly premium to Medicare for Part B. The amount can change each year. Some people pay higher premiums because they have higher incomes.
- The additional higher premium due to having a higher income is called the Income-Related Monthly Adjustment Amount (IRMAA). If you sign up for an individual Via Benefits Medicare Medical Plan through ACERA, and you’re eligible for the Monthly Medical Allowance subsidy to offset the cost of the plan, you can you can use the Monthly Medical Allowance to get reimbursed for the IRMAA. Simply log in to your account at Via Benefits and submit a reimbursement claim to Via Benefits for the additional amount IRMAA amount that is above the $174.70 base amount for 2024.
Usually, the Part B premium is deducted from your monthly benefits from Social Security. If you don’t get Social Security benefits or if your monthly benefit is too low, you’ll get a bill from Medicare to pay your Part B premium.
Part C (Medicare Advantage Plan)
Varies by plan. If you choose a Medicare Advantage Plan like the Kaiser Permanente Senior Advantage Plan, you’ll usually pay an additional premium to the insurance carrier on top of the premiums you pay directly to Medicare.
Part D (Drug Coverage)
Varies by plan. You pay the premium directly to the insurance carrier.
What is the difference between Original Medicare and Medicare Advantage (Part C)?
There are 2 main ways to get your Medicare coverage:
| 1. Original Medicare | 2. Medicare Advantage Plan (Part C) |
|---|---|
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Includes:
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Includes:
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You can add:
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Most plans include:
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More comparisons at Medicare.gov
Step 3: Preview Your Coverage Options
You can stick with Original Medicare, but you will probably want to consider seeking a higher level of coverage by either adding a Part D Plan and a Medigap Supplemental Plan to Original Medicare, or selecting a Medicare Advantage Plan. ACERA has plan options for both.
If you’re 65 or older, you must choose a Medicare plan for medical coverage through ACERA: If you’re age 65 or older and want to enroll in medical coverage through ACERA, ACERA mandates that you enroll in Medicare Part B through the federal government and choose among our Medicare plan options. You can not enroll in or maintain enrollment in a non-Medicare plan if you are age 65 or older. If you are enrolled in a non-Medicare plan and don’t enroll in a Medicare plan upon reaching aged 65, your medical coverage through ACERA will be cancelled.
Your ACERA plan options depend on where you live in the U.S.
| Where You Live | Your ACERA Plan Options |
|---|---|
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In the Kaiser Permanente Senior Advantage Plan (CA) service area (based on zip code):
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In the Kaiser Permanente service areas (based on zip code) outside of California including:
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| Anywhere in the U.S. not in a Kaiser Permanente Service area |
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Kaiser Permanente Senior Advantage Plan
The Kaiser Permanente Senior Advantage Plan is a group Medicare Advantage Plan option for ACERA retirees living in metro California in the service areas above. You’ll pay a monthly premium to Kaiser Permanente that ACERA will deduct from your retirement check and send to Kaiser. Premiums are listed below.
Benefits
- $10.00 co-pays for office visits, allergy treatments, hearing and vision exams, and immunizations
- Silver&Fit free gym membership program
- Much more
2025 Kaiser Permanente Senior Advantage Plan Monthly Premiums
| Plan | Self Premium |
Self + 1 2 w/ Medicare |
Self + 1 1 w/ Medicare |
Family 2 w/ Medicare |
Family 1 w/ Medicare |
|---|---|---|---|---|---|
| Kaiser Permanente HMO | $375.22 | $750.44 | $1,473.10 | $1,661.72 | $2,384.38 |
Via Benefits Individual Medigap and Medicare Advantage Options
ACERA contracts with Via Benefits, a private health insurance exchange, to provide you access to 1000+ healthcare plans across 80+ insurance carriers. You’ll typically pay a monthly premium for these plan in addition to what you pay to Medicare, but not always.
- You must enroll in both Medicare Parts A & B
- Prescription drug coverage
- If you enroll in a Medicare Advantage plan, prescription drug coverage wil come with the plan, so you don’t need to enroll in a separate plan.
- If you enroll in a Medigap plan, you’ll need to enroll in a separate Part D plan for prescription coverage. Via Benefits will help you choose a Part D plan.
- Plans are nationwide in the U.S. There are no plans outside of the U.S., but most plans will provide emergency coverage while you travel.
- Enrollment is done via phone 1-(888) 427-8730 or online.
- A licensed benefits advisor will go over plans available in your area
- You tell them how much coverage you’re looking for, how much you want to pay, what doctors you want to visit, and/or what prescriptions you need.
- If you’re eligible for the Monthly Medical Allowance, reimbursement is available for retiree’s out of pocket medical expenses e.g., Medical & prescription drug plan premiums, prescription co-pays and deductibles and medical necessary costs
- Auto-pay and direct deposit are available
- Online health reimbursement account tracking and status updates
Explore Via Benefits Plan Options
Step 4: Sign up for Medicare Parts A & B when you’re ready
When do I sign up for Medicare?
People Under Age 65 Who Are Disabled
If you’re getting Social Security disability benefits, you’ll get Medicare automatically after getting disability benefits for 24 months, or at age 65, whichever is sooner. If you have ALS (also called Lou Gehrig’s disease) you’ll get Medicare automatically as soon as you start getting disability benefits.
retired People 65 and Older (and not covered under working spouse’s insurance)
Most people who are retired (and not covered under a working spouse’s insurance) sign up for both Part A (Hospital Insurance) and Part B (Medical Insurance) when they’re first eligible (usually when they turn 65). You have a 7-month enrollment period associated with your 65th birthday:
| 7-Month Medicare Enrollment Period | ||
|---|---|---|
| 3 Months Before 65th Birthday | 65th Birthday Month | 3 Months After 65th Birthday Month |
| Coverage Effective 1st Day of 65th Birthday Month | Coverage Effective 1st Day of Month After 65th Birthday Month | Coverage Effective 1st Day of Month After Enrollment Month |
Required Enrollment Timing for Kaiser Permanente Senior Advantage Plan: ACERA requires signing up 2 or 3 months before your 65th birthday month to ensure your Kaiser Permanente Senior Advantage Plan enrollment is effective on the 1st day of your 65th birthday month.
Enrollment Period if You Miss the Initial 7-Month Period: January – March of each year. Coverage becomes effective the 1st day of the month after you sign up.
Medicare Part B Late Enrollment Penalty: If you are not still working and you do not enroll in Medicare during this period and sign up later, you will have to pay a lifetime 10% penalty for each 12-month period you did not enroll in Medicare Part B after you were eligible.
Learn more about other special situations (special enrollment periods).
People 65 and Older Still Working or retired and covered under working spouse’s insurance
If you (or your spouse) are still working at a job that has 20 or more employees and have health insurance from that job, you can wait until you (or your spouse) stop working (or lose your health insurance, if that happens first) to sign up for Part B (Medical Insurance), and you won’t pay a late enrollment penalty.
If you don’t have to pay a premium for Part A (Hospital Insurance), you can choose to sign up when you turn 65 (or anytime later). Your job-based insurance pays first, and Medicare pays second.
Learn more about other situations.
How do I sign up for Medicare?
Follow the instructions at Medicare.gov by answering the questions where it says “Answer a few questions to find out.”
When will my Medicare coverage start?
| Enrollment Time | Coverage Effective |
|---|---|
| 3 months before 65th birthday month | 1st day of birthday month |
| 65th birthday month | 1st day of month after birthday month |
| 3 months after 65th birthday month | 1st day of the month after enrollment |
| Between January 1-March 31 each year (after initial enrollment period) | 1st day of the month after you sign up |
| Special situations | See the chart at Medicare.gov |
Step 5: Enroll in Your ACERA Medicare Plan
How do I enroll in the Kaiser Permanente Senior Advantage Plan?
After you enroll in Medicare, complete the appropriate forms below. Avoid paper, ink, scanning, and hassle with DocuSign E-Forms. PDF forms require Adobe Acrobat Reader (free).
| Form | DocuSign E-Form | Manual PDF Form | Notes | |
|---|---|---|---|---|
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Medical Plan Enrollment Form |
DocuSign | Mandatory. If you’d like to enroll in the ACERA Kaiser Permanente Senior Advantage Plan | ||
| Kaiser Permanente Senior Advantage Enrollment Form | DocuSign | Mandatory. If you’re enrolling in the Kaiser Permanente Senior Advantage Plan, you must fill this out in addition to the Medical Plan Enrollment Form. | ||
| Medicare Part B Reimbursement Plan (MBRP) Application Form | DocuSign |
Recommended. With 10+ years of ACERA service credit or a service-connected disability retirement, get reimbursed for the federal cost of Medicare Part B. More info on the MBRP page. Before you start, have a scan or photo of your Medicare card available showing your Medicare Part B effective date to upload with the form. |
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| Affidavit of Dependent Eligibility | DocuSign | Optional. Mandatory if you are electing coverage for your children (or other non-spouse dependents) age 19 through 25 or children age 26 and older if incapable of supporting themselves due to a mental or physical disability incurred prior to age 26 | ||
| Affidavit of Domestic Partnership | Optional. Mandatory if you are electing healthcare coverage for a domestic partner. Since this requires notarization, you can’t submit it through DocuSign. Follow the instructions below to submit your form. | |||
How do I enroll in a Via Benefits Individual Plan?
Sign Up For Via Benefits Online
Or call 1-888-427-8730
Helpful Hints To Make Your Via Benefits Experience Efficient
- Before you call Via Benefits for your enrollment appointment, have a list of all of your prescription medications in front of you so the Benefit Advisor you speak with can help you choose a Medicare Part D plan and inform you about the copay required for each medication.
- When you call Via Benefits for your enrollment appointment, to help you choose between Via Benefits plans, ask these questions and any others you have:
- What’s the monthly premium cost for the plan?
- What extras does the plan cover above the standard?
- What does the Via Benefits Benefit Advisor recommend?
- You are not obligated to choose a plan during the first call. In fact, once the Benefit Advisor narrows down the plan choices for you, you may ask them to mail you documentation on a small group of plans. You may want to ask your doctor some questions about these plans:
- Does my doctor accept the plan?
- What does my doctor recommend?
- After you sign up for a plan, you will receive a packet about your plan in the mail. Look over the plan documents within the 30-day grace period after your enrollment date to make sure the plan has the benefits you believe you signed up for. If the plan is different than you believe you signed up for, you may call Via Benefits again during the grace period to enroll in the correct plan.
When will my ACERA Medicare plan coverage start?
[Info coming soon]
Step 6: Use Your Medicare Plan
What’s my Medicare card?
How do I get services?
What are some tips for using Medicare?
What helpful tools are available?