State Retiree Health and Medicare (Age 65 and Over)

Medicare-Eligible Retirees

This category applies if you and covered family members are all eligible for Medicare.

Medicare benefits are an important part of your coverage. Make sure you are enrolled in Medicare Hospital Insurance (Part A) and Medical Insurance (Part B). You may apply by contacting any Social Security Administration office.

Medicare Part A helps pay for care in a hospital and skilled nursing facility, and for home health and hospice care. Medicare requires patients to pay a hospital benefit period deductible and co-insurance.

Medicare Part B covers 80% of Medicare-approved participating physician charges and other health services, after you pay your calendar year deductible.

Medicare Part D is an outpatient prescription drug benefit. When electing Medicare-coordinating coverage under the Retiree Health Benefits Program, participants must decide whether they wish to get outpatient prescription drug coverage through the program or through a separate, non-program-sponsored Medicare Part D plan. For more information about non-program-sponsored Medicare Part D plans, contact Medicare using the resources at the bottom of this page.

If you enroll in one of the non-program-sponsored Medicare Part D prescription drug plans, you may be asked for a copy of the Part D Certificate of Creditable Coverage (see resources at the bottom of the page).This certificate notifies a Medicare Part D plan that you had creditable drug coverage when you were enrolled in the UVA Health Plan and are not required to pay a late enrollment penalty.

Supplemental Plan Choices

There are two supplemental plan choices for enrollment under the Retiree Health Benefits Program for retirees who are Medicare eligible: Advantage 65 and Advantage 65 – Medical Only. The Dental/Vision Plan is also available as an option with Advantage 65 and Advantage 65 – Medical Only. For those retirees who enroll in Advantage 65 or Advantage 65 – Medical Only, Medicare will be the primary payer and Advantage 65 or Advantage 65 – Medical Only will serve as a supplement to Medicare’s coverage.

  • Advantage 65 is a Medicare supplemental plan that pays secondary to Medicare and covers much of the cost of medical services for which Medicare does not pay 100%. Generally, with the exception of out-of-country major medical services specifically described in the member handbook, Advantage 65 will not pay for services that are denied by Medicare. Advantage 65 also includes an enhanced Medicare Part D benefit for outpatient prescription drug coverage. New Medicare-eligible participants who elect Advantage 65 will be submitted for enrollment in the program’s Part D coverage as part of this plan.

  • Advantage 65 with Dental/Vision adds coverage for certain basic dental and routine vision services to the Advantage 65 coverage described above. There is no coverage for prosthetic and complex restorative dental services.

  • Advantage 65 – Medical Only provides the same medical benefits as the Advantage 65 plan described above but does not include outpatient prescription drug coverage. If this plan is elected, outpatient prescription drug coverage should be obtained through a non-state-sponsored Medicare Part D Plan or other creditable coverage such as Tricare, Veterans Benefits, or coverage through a spouse’s active employment in order to avoid a higher Part D premium at a later date. If a Medicare-eligible participant elects medical-only coverage upon initial enrollment in the Retiree Health Benefits Program or upon initial eligibility for Medicare, or that person drops or is unenrolled from prescription drug coverage at any time, the Medicare-eligible participant will not be able to elect Medicare-coordinating prescription drug coverage through the Retiree Health Benefits Program at a later date.

  • Advantage 65 – Medical Only with Dental/Vision adds coverage for certain basic dental and routine vision services to the Advantage 65 – Medical Only coverage described above. There is no coverage for prosthetic and complex restorative dental services.

To cover both Medicare-eligible and non-Medicare-eligible family members, see information regarding coverage for a combination of non-Medicare eligible and Medicare eligible retirees.


Combination of Non-Medicare Eligible and Medicare Eligible

This category applies if one or more covered family members are not eligible for Medicare, and one or more covered family members are eligible for Medicare.

The insurance plans available for Medicare eligible retirees are Advantage 65 and Advantage 65 – Medical Only. The Dental/Vision Plan is also available as an option with Advantage 65 and Advantage 65 – Medical Only. All non-Medicare eligible family members must enroll in the UVA Health Plan.

When you or your family member who was not Medicare-eligible becomes eligible for Medicare, eligibility for enrollment in the UVA Health Plan ends. Make sure that person

  • is enrolled in Medicare Part A and Part B
  • terminates coverage in the UVA Health Plan
  • enrolls in Advantage 65 or Advantage 65 – Medical Only

The Dental/Vision Plan is also available as an option with Advantage 65 or Advantage 65 – Medical Only. These changes do not occur automatically. You must take action by contacting the University Benefits Division at least two months before you or a family member becomes Medicare eligible. This allows plenty of time for the enrollment process and helps ensure that you or your family member has appropriate health insurance coverage beginning the first day of Medicare coverage. Applications must be received at the Benefits Division prior to the date of Medicare eligibility. Those not yet eligible for Medicare are eligible for enrollment in the UVA Health Plan.


Payment of Retiree Health Insurance Premium

VRS Annuities

Retirees who receive a monthly annuity from VRS will have their health insurance premium deducted from their monthly annuity check if it is large enough to cover the premium. If the check is too small to pay the health premium, retirees will be billed directly. They will pay premiums by check each month or authorize a monthly bank draft from their checking or savings accounts to pay the premium if this option is available by the carrier.

Other Retirement Annuities

Retirees who receive a monthly annuity from an organization other than VRS will be billed directly. They will pay premiums by check each month or authorize a monthly bank draft from their checking or savings account to pay the premium if this is available by the carrier.


Health Insurance Credit

The health insurance credit program is designed to assist retirees with the cost of their benefits. To be eligible, you must be enrolled in one of the following:

  • an employer-sponsored health insurance plan
  • a personal health insurance plan
  • Medicare Part B

Retirees with 15 or more years of creditable state service who enroll in the State Health Benefits Program are eligible for a health insurance credit of $4 per month for each year of creditable service. Disability retirees usually receive a health credit of $120 per month.

If you are receiving a monthly annuity from VRS and are enrolled in the State Retiree Health Benefits Program, the credit will be included in your monthly annuity check. If you are paying premiums directly to the plan and are enrolled in the State Retiree Health Benefits Program, the credit will be mailed to your home address the month after it is earned.

Alternate Health Insurance Credit Program

If you enroll in other health insurance instead of the State Retiree Health Benefits Program, you will be eligible for the Alternate Health Insurance Credit if you have at least 15 years of service credit with a State agency when you retire. You receive $4 per month for each year of creditable service. Disability retirees usually receive a health credit of $120 per month.

To receive the alternate health insurance credit, you must submit a Retiree Health Insurance Credit form (VRS-45) to VRS. If you are receiving a monthly annuity from VRS, the credit will be included in your monthly annuity check. Otherwise, your credit will be mailed to your home address the month after it is earned.

Contact VRS for more information on the Health Insurance Credit or the Alternate Health Insurance Credit.


Making Changes to Your Coverage

You can reduce membership or cancel coverage going forward at any time, but if you cancel coverage you may not re-enroll in the future. Changes are effective on the first day of the month following receipt of the form at the University Human Resources Benefits Division. If a dependent is being dropped because of eligibility loss, the change will be effective on the first day of the month following loss of eligibility.

Both Medicare and Non-Medicare Retirees can make membership-level changes due to qualifying mid-year events.

  • To make a change in your health benefits plan membership, submit a completed enrollment form and confirming documentation within 31 days of a mid-year qualifying event to the University Human Resources Benefits Division
  • If approved, the change in your health benefits coverage will be effective on the first day of the month following receipt of the enrollment form with verifying documentation
  • If the change is being made because a dependent has lost eligibility, it will be effective on the first day of the month following loss of eligibility

Non-Medicare Retirees may also make membership changes for non-Medicare spouses or dependents at open enrollment. Medicare Retirees must experience a mid-year qualifying event to add dependents.

Spouses who are covered by the plan at the time of a retiree’s death can continue coverage for the rest of their lives unless they remarry. See the Survivor Benefits page in the left menu for more information.


Beneficiary Designation

To update beneficiaries, contact the benefits vendor. Visit the Retiree benefits page for contact information.


Resources