If you (or your spouse) are covered on the state sponsored retiree group health plan, coverage will terminate at the end of the month prior to the affected individual’s eligibility for Medicare. Entitlement to Medicare is typically effective the first of the month of your 65th birthday. For example, if John Doe was born on 4/24/1952, he would become Medicare eligible by virtue of age 4/1/2017. If the affected individual was born on the first day of a month, Medicare entitlement becomes effective on the first day of the previous month of their 65th birthday. In this scenario, if John Doe was born on 4/1/1952, he would become eligible for Medicare effective 3/1/2017.
If you have single coverage in the retiree group health plan, then group health coverage and retiree vision coverage (if the retiree was enrolled in vision) will automatically terminate when you become eligible for Medicare due to turning 65.
If you have retiree plus dependent(s) in group health coverage, (and retiree vision if enrolled) the policy is automatically adjusted to the correct coverage and premium level when the Medicare eligible member is removed and group health coverage(and retiree vision if applicable) is continued for your remaining eligible dependents. For example, a retiree has family coverage in the group health plan and the retiree turns 65 on 5/15. The retiree has a covered spouse who is still under age 65 and a covered child who is still under age 26. The policy will automatically change to spouse plus child only effective 5/1.
If you or your covered dependent becomes entitled to Medicare prior to the age of 65, coverage will be terminated for the Medicare-eligible member if you retired from a local government agency.
If you are a state, higher education, or local education retiree, then if you or your covered dependent becomes entitled to Medicare prior to the age of 65, Medicare parts A and B must be obtained to keep group health coverage until you or your affected dependent would have become Medicare eligible by virtue of age. Medicare will become primary and the state group health plan will pay secondary. If parts A and B are not taken when first eligible as a retiree, coverage will be terminated.