LAFCO

The retiree medical insurance plans through Kaiser, Western Health Advantage and Anthem Blue Cross are the same plans offered by LAFCO for active employees. Also, the UnitedHealthcare plan is available for Medicare-enrolled retirees. Premiums for all of these plans are eligible to be covered by the Benefit Plan Subsidy you may receive.

At retirement you are eligible to enroll in the plan and level of coverage you have as an active employee. For example, if you (and your dependents) have the Kaiser Low plan as an active employee, you are eligible to continue the Kaiser Low coverage as a retiree.

If you would like a different medical insurance plan in retirement than what you have as an active employee, you must change plans during open enrollment and wait until your new coverage is effective January 1 prior to retiring. However, keep in mind that if you entered MCERA membership on or after January 1, 2008, Benefit Plan 4 requires 5 years of continuous coverage in the same medical plan. Changing plans, even from Kaiser Low to Kaiser Silver, immediately before retirement would make you ineligible to receive the Benefit Plan 4 subsidy.

There is no open enrollment after retirement. If you drop your medical plan you may not reenroll.

The retiree dental insurance plan through Delta Dental is the same plan offered by LAFCO for active employees and the premiums are eligible to be covered by the Benefit Plan Subsidy you may receive.

To be eligible for retiree dental insurance you must have dental coverage in place as an active employee prior to retirement.

There is no open enrollment after retirement. If you drop your dental plan you may not reenroll.

The State Association of County Retirement Systems (SACRS), of which MCERA is a member, sponsors a voluntary vision insurance plan for all retirees and beneficiaries through VSP Vision Care.

The VSP Vision Care plan is separate from any plans that may be offered by your former employer. If you elect vision coverage through VSP as a retiree, you are responsible for all VSP Vision Care premiums as they are not covered by the Benefit Plan subsidy you may receive.

Open enrollment is available for VSP after you retire.

If you are already enrolled in the VSP plan and wish to cancel your coverage, please call MCERA Retiree Benefits at (415) 473-4149 or send an email to MCERARetirees@marincounty.org.

Contact VSP

For more information on the benefits available through VSP visit marincera.vspforme.com or call VSP at (800) 400-4569.

Continuous health coverage is required for you to be eligible to remain on your medical plan in retirement. Depending on your termination date, you may need to apply for COBRA insurance to fill a coverage gap in order to enroll in the retiree medical plans. Contact Human Resources regarding COBRA.

If you entered MCERA membership on or after January 1, 2008, you must meet additional continuous coverage requirements in order to receive a retiree medical subsidy through Benefit Plan 4.

The effective date of your retiree medical coverage is determined by your plan provider and the date your active coverage ends. Your active coverage is generally effective for 2 weeks following your last pay date, assuming you have paid the full premiums for that pay period. Please contact us if you need help determining when your active health coverage will end based on your termination and retirement dates.

Kaiser Plans

If Your Active Coverage Ends After the 15th of the Month
Your retiree coverage is effective the day after your active coverage ends. You do not need to take any additional action to ensure continuous coverage.

If Your Active Coverage Ends Before the 15th of the Month
Your retiree coverage is effective the first day of the following month, and you must sign up for COBRA for the remainder of the current month to avoid a coverage gap.

Anthem Blue Cross, Western Health Advantage and UnitedHealthcare Plans

Your retiree coverage is effective on the first day of the month following your retirement date. No additional action is necessary if your active coverage continues through the end of the month. You must sign up for COBRA only if your active coverage will end prior to the last day of the month.

Premiums will be deducted from your monthly retirement benefit payments beginning with the first payment you receive after you retire. If you receive a subsidy through a Benefit Plan, this will appear on your monthly deposit confirmation as "Employer Subsidy." Any amount you owe in addition to the subsidy will appear as "Net Medical Care Cost."

You are eligible to maintain insurance coverage for dependents enrolled on your active employee insurance plans at the time of retirement. After retirement you may only add dependents with a qualifying life event such as loss of other coverage, marriage, birth or adoption. Generally, children may remain on your insurance plans until age 26. Please contact us about dependent coverage if you have a disabled adult child. If you drop any dependent from your insurance plan you may not reenroll them at a later date.

Most Benefit Plan subsidies apply only to retiree premiums and the retiree is responsible for 100% of the cost of dependent insurance. However, if you have 30 or more years of LAFCO service and are eligible for a subsidy through Benefit Plan 3, you may receive a second subsidy to help pay for your spouse's/partner's medical and dental premiums.

In some cases, you and your dependents may be on different medical plans. For example, if you are on Anthem Blue Cross and cover your younger spouse, at age 65 with Medicare enrollment you will transition to the UnitedHealthcare Group Medicare Advantage plan and your spouse will remain on Anthem until they also turn 65.

Kaiser Plans

Kaiser's service areas are based on zip code within the following regions: Northern California, Southern California, Colorado, Hawaii and Northwest (Oregon & Washington).

Coverage and premiums in non-California plans may be different, and coverage areas may be different for pre-age 65 and post-age 65 Senior Advantage plans. We recommend checking with the plan provider before relocating to determine if there will be changes to your healthcare coverage. See MCERA's Kaiser Premiums and Coverage Areas booklet for more information.

Western Health Advantage Plan

Western Health’s service areas are based on zip code within the following California counties: Colusa, El Dorado, Humboldt, Marin, Napa, Placer, Sacramento, Solano, Sonoma, and Yolo.

Anthem Blue Cross Plan

The Anthem Blue Cross plan offers coverage within the United States.

UnitedHealthcare Group Medicare Advantage Plan

This plan offers coverage within the United States.

If you move outside of your primary Kaiser or Western Health coverage area you may need to enroll in another plan to continue to receive your Benefit Plan Subsidy. If you subsequently move back into your original Kaiser or Western Health coverage area you are allowed to return to your original plan.

Coverage and premiums in non-California plans may be different, and coverage areas may be different for pre-age 65 and post-age 65 Senior Advantage plans. We recommend checking with the plan provider before relocating to determine if there will be changes to your healthcare coverage. See MCERA's Kaiser Premiums and Coverage Areas booklet for more information.

You must keep MCERA informed of your address. However, updating your address with MCERA does not update your address with your healthcare providers. You must file address change requests with your healthcare providers separately.

If You Are Over 65 at the Time of Retirement

If you are over age 65 at retirement your Medicare benefits must be effective on or prior to your retirement date. There are premium penalties if your benefits are effective after retirement, so we recommend beginning the enrollment process no later than three months before you plan to retire.

MCERA must receive one of the following with your retirement application:

• Medicare enrollment card
• Letter from Medicare confirming enrollment

If You Turn 65 After Retirement

If you are already retired when you turn 65 your Medicare benefits must be effective on your 65th birthday. We recommend beginning the enrollment process no later than three months before you turn 65.

If You Do Not Enroll when Eligible

The consequences for lack of Medicare enrollment when eligible could be loss of coverage and Benefit Plan subsidy. If your retiree medical coverage is terminated there is no opportunity to reenroll at a later date.

Contact Medicare to apply for Medicare Parts A and B. When you apply for Parts A and B you automatically receive Part D, the prescription drug program. You should assign your Part D benefits to your insurance carrier (either Kaiser, Western Health or UnitedHealthcare). You may only assign Medicare benefits to one insurance plan at a time, and your LAFCO retiree coverage will be cancelled if you opt to assign benefits a non-LAFCO insurance provider..

If you are on Kaiser or Western Health you will also need to enroll in the insurance provider's Medicare Advantage plan. If you are on Anthem Blue Cross you will transfer to the UnitedHealthcare Group Medicare Advantage plan. If you are over 65 at the time of retirement MCERA will provide the enrollment forms with your retirement application. If you turn 65 after retirement MCERA will mail you the enrollment forms prior to your 65th birthday.

Your Medicare coverage will combine with your current coverage for a single comprehensive health plan and in most cases your monthly premium will decrease. Medicare will become your primary payor with Kaiser, Western Health or UnitedHealthcare becoming the secondary payor. You are responsible for any payments owed after what Medicare and your health plan pay.

Coverage summaries for all plans are available from MCERA upon request. You may also contact MCERA or your health plan provider for more information specific to your individual situation.

Individuals with a modified adjusted gross income (MAGI) of $103,000 or more, and married couples with a MAGI of $206,000 or more pay higher premiums for Part B. Medicare calls the additional amount the income-related monthly adjustment amount, or IRMAA.

Information on how the IRMAA is determined, what to do if your income has gone down, and charts outlining the income levels and premiums for single and married tax filers is in the Social Security website: Medicare Premiums: Rules for Higher-Income Beneficiaries.