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State of Delaware Office of Pensions

Medicare FAQ's

These are Frequently Asked Questions regarding: Medicare, Medicare Supplement & Express Scripts Medicare (Qualified Part D) Prescription Drug Plan (PDP)


Please click on the question below to expand and see the answer.

In accordance with the Group Health Insurance Plan (GHIP) Eligibility and Enrollment Rules 4.09 and 4.12, you must enroll in Medicare Part A (Hospital) and Part B (Medical), “Original Medicare”, insurance when eligible due to either turning age 65 or receiving Social Security Disability benefits for a period of 24 months. Employees receiving Long-Term Disability (LTD) and enrolled in insurance through the GHIP must enroll in Medicare Parts A and B upon becoming eligible. You can delay Part B enrollment only if you will qualify for a special enrollment period with the Social Security Administration. (See Question 2).
If you or your spouse are currently working and have medical benefit coverage with an active employer group plan, you can delay Part B enrollment until the active employer’s group medical coverage ends. When the coverage ends, you must contact the Social Security Administration (SSA) and enroll in Medicare Part B under a special enrollment period with the SSA. You must then contact the Office of Pensions with your Medicare Part B enrollment information in order to continue enrollment under the State of Delaware (SOD) Pension Group.

  • The health insurance plan through the SOD Pension Group is not active employer group health insurance coverage and cannot be used to obtain a special enrollment period with the SSA. If you will be delaying Part B enrollment, you must contact our office to coordinate your coverage. The insurance through you or your spouse’s current employer must be your primary insurance coverage.
If you are currently collecting Social Security retirement or disability benefits, your Medicare Parts A & B should be automatically enrolled and you should receive a Medicare card by mail. If you are not collecting Social Security benefits, you must contact the SSA to enroll in Medicare Part A and Part B.

  • You can enroll online at www.ssa.gov or by visiting any SSA branch office in person beginning three months prior to your birth month. For additional information on when and how to sign up for Part A & Part B refer to www.medicare.gov/sign-up-change-plans.

  • When completing the enrollment application, you will be asked if you are currently covered under a current employer group health plan. The insurance plans provided by the Office of Pensions are not active employer group health insurance plans.
In order to meet the enrollment deadline for the Special Medicfill Plan, the Office of Pensions must receive a copy of your Medicare card at least 30 days prior to your Medicare eligibility start date (either due to obtaining the age or 65 or after 24 months of receiving Social Security Disability benefits).
If you have not received a Medicare card, please contact a SSA branch office and request a benefit verification letter confirming your Part B enrollment. The benefit verification letter should state the dates that your Part A and Part B insurance will become effective. You can also print enrollment verification from your online SSA account.

  • Unfortunately, the Office of Pensions does not have direct access to Medicare records and we must receive a benefit verification letter or a copy of your Medicare card in order to enroll you in the Special Medicfill Plan. A copy of your Medicare card is required for your pension file.
Typically, you will be enrolled in Part A (hospital) insurance at no charge with working credits. Please contact the Office of Pensions if you do not qualify for free Part A insurance.

There is a monthly premium cost for Part B (medical) insurance. In order to remain under the State of Delaware Pension Group insurance you are responsible to maintain Part B enrollment and pay Part B monthly premiums to the SSA. The Office of Pensions is not responsible for your Part B enrollment and/or payment of your monthly Part B premiums. Failure to maintain Medicare Part A and B enrollment with the SSA will result in termination of medical and prescription drug coverage.

  • The monthly cost and payment arrangement for Part B monthly premiums is determined by and paid directly to the SSA. Part B premiums are not deducted from your pension payment. If the SSA determines that you are a high-income earner, a higher Part B premium and an additional premium for enrollment in a qualified Part D prescription plan is charged. This an Income-Related Monthly Adjustment Amount (IRMAA). You are responsible to pay all required amounts directly to the SSA. Failure to pay will result in the termination of coverage of medical and prescription drug coverage.
If the medical provider accepts Medicare and the service(s) are covered by Medicare, Medicare will typically pay 80% of the allowable charges of the claim. The Official U.S. Government Site for Medicare (www.medicare.gov) is user friendly and provides a wealth of information on this topic. You may also contact Medicare by telephone at 1-800-MEDICARE (1-800-633-4227).
The State of Delaware provides a Medicare Supplement Plan called Special Medicfill. This is a Medigap plan administered through Highmark of Delaware. The Special Medicfill plan is offered with or without Part D prescription drug coverage that is administered through Express Scripts.
Once Medicare becomes your primary insurance Medicare Supplement plans will only cover if Medicare pays as the primary payer. Special Medicfill is designed to coordinate and typically covers 20% of allowable charges of the claim balance after Medicare pays as primary and also covers the Medicare deductible. There is no deductible for the Special Medicfill Plan. Please be sure to present both your Medicare and Highmark Medicare Supplement cards when using medical/hospital services.

For more information on the Highmark Medicare Supplement plan, Special Medicfill, please visit: http://ben.omb.delaware.gov/medical/bcbs/index.shtml
This is an enhanced Medicare Part D prescription plan. The plan does not have a deductible and has a wrap in place during the coverage gap (“donut hole”) period: Copays will not increase during the coverage gap period.

Prescription Coverage 30-Day Supply 90-Day Supply
Tier 1 Generic $8.00 $16.00
Tier 2 Preferred (Formulary) $28.00 $56.00
Tier 3 Non-Preferred Brand/Generic Drugs $50.00 $100.00

For more information please visit: https://dhr.delaware.gov/benefits/medicare/highmark.shtml
The premium is based on retirement date and how many years of creditable service were earned while working for the State of Delaware. Please refer to the health rate tables under your specific retirement plan. Contact the Benefits Section of the Office of Pensions if you have questions.
Special Medicfill monthly premium cost or plan changes including prescription co-pays are communicated each year at the end of September. Open enrollment for the Special Medicfill Plan is held annually in the month of October and any elected changes are effective the following January 1st.
Vision and dental insurance plans are separate plans from your medical coverage. Enrollment in Medicare will not affect your enrollment in these plans. If you wish to make changes to these plans, you must do so during the open enrollment period held annually in May or within 30 days of a qualifying event (enrollment in Medicare is not a qualifying event).
Once a copy of your Medicare card is received, you will be enrolled in the Special Medicfill Plan with prescription coverage. Your spouse and any dependents currently enrolled in coverage will continue to be enrolled in their current elected plan under a separate contract. You will receive new cards for all members enrolled in coverage from the carrier(s).

  • Your medical deduction will change to reflect the plan adjustments. You will be charged the current monthly rate for Special Medicfill and also the current monthly rate for the plan(s) in which your non-Medicare family member(s) remain enrolled.
The Centers for Medicare & Medicaid Services (CMS) only allows for enrollment in one qualified Part D prescription drug plan. Enrollment in another Part D plan will terminate prescription coverage with the State of Delaware (SOD) Express Scripts prescription drug plan.

  • The SOD offers enrollment in the Special Medicfill Plan with OR without the qualified Part D prescription drug coverage. When you submit a copy of your Medicare card, you are automatically enrolled in Special Medicfill with the qualified Part D prescription plan. Please contact the Office of Pensions for assistance if you are enrolled in another qualified Part D plan and to enroll in the Special Medicfill Plan without prescription drug coverage.

Enrollment in a Medicare Advantage plan is not compatible with the Special Medicfill Plan. Medicare does not allow for coordination of benefits between the two plans. The Special Medicfill Plan is considered a Medigap plan and requires enrollment in original (traditional) Medicare.

  • Medicare does not permit a Medigap plan to pay for a Medicare Advantage plan’s co-pays, deductibles, or premiums. Please refer to www.medicare.gov for additional information on Medigap and Medicare Advantage Plans.

  • If your spouse is only offered a Medicare Advantage plan through their former employer/retirement benefits and they are paying 50% or less of the monthly premium, then your spouse must enroll in the Medicare Advantage plan.
Yes, if your spouse is provided health coverage through either active employment or retirement; your spouse must enroll in that coverage unless your spouse is responsible to pay more than 50% of the total monthly premium, for the lowest active or retiree health benefit plan available, even if the coverage is provided through a third party. This includes Medicare supplement plans or cash benefits in lieu of enrollment in a health plan (also known as stipends).

Yes, Medicare is considered a change in insurance. A new electronic Spousal Coordination of Benefits form is required to be completed within 30 days of a spouse’s employment or insurance status change.

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State of Delaware Office of Pensions
McArdle Building, 860 Silver Lake Blvd., Suite #1
Dover, DE 19904-2402
Toll Free: (800) 722-7300, Local: (302) 739-4208

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