Navigating insurance is never easy. Here at MUST, we strive to be a resource for Montana’s public schools, and their employees. Retirement is an exciting time, and we know a lot of consideration goes into planning – especially around insurance.
Here are reputable resources for information regarding health insurance:
As a current, or soon-to-be retiree, below is a high-level overview of options you can evaluate to determine what may be best for you and your needs.
MUST Retiree Health Coverage Under Your Group
As a retiree, you can maintain your MUST coverage through the group’s plan, given that: you held coverage before retirement, the group retains MUST coverage, and you meet the eligibility requirements. Options include those benefits your group annually elects for its active population (plans vary by group). To see if you are eligible reach out to us at (406) 457-4400 or email us at [email protected]. PLEASE NOTE – MUST does not offer premium reduction due to Medicare eligibility and retirees are not eligible for Basic Life or LTD.
If your coverage terminated under your MUST health plan, you may be eligible under COBRA to continue the same coverage you had when coverage ended, on a temporary self-pay basis. COBRA requires this continuation of coverage to be made available to covered Members – called qualified beneficiaries under COBRA – on the occurrence of a qualifying event. Retirement is a qualifying event.
Original Medicare + Medicare Supplement + Part D Prescription Drug
If a retiree is already enrolled or eligible to enroll into Medicare Part A and/or Medicare Part B (generally age 65 or older), enrolling in Medicare Supplement with a Prescription Drug Plan (Part D) is likely a huge savings to enrollees. Retirees covered under a MUST medical plan do not receive a premium discount. Medicare automatically becomes Primary for a MUST retiree member who is 65. This is generally a more expensive option.
Medicare Advantage Plans
If you have Part A and Part B, you can join a Medicare Advantage Plan, sometimes called “Part C” or an “MA Plan”. This type of Medicare health plan is offered by Medicare-approved private companies that must follow rules set by Medicare. Most Medicare Advantage Plans include drug coverage (Part D) and some extras like vision, hearing and dental services. Each plan can have different rules for how you get services. Costs for monthly premiums and services you get vary depending on which plan you join. These plans must cover all emergency and urgent care, and almost all medically necessary services Original Medicare covers. Some plans tailor their benefit package to offer additional benefits to treat certain conditions. To understand more about Medicare Advantage Plans click here.
Resource: Understanding Medicare Advantage Plans
Individual Marketplace – HealthCare.gov
This program was made for those individuals/married couples who qualify based on annual income level thresholds set by the federal government. A positive trait of this program is assets, including property or bank accounts/investment balances, do NOT factor into the calculation. Rather, the program is solely based off of the household’s “Adjusted Gross Income” (AGI) from the 1040 tax filing each year. The AGI is what determines the cost and benefits for insurance. Retirees with a pension and fixed income generally qualify for this program that makes health insurance more affordable than available retiree coverage. For example, the current income thresholds for households of 1 and 2 tax filers are:
Household of 1 = $14,580 – $58,320
Household of 2 = $19,720 – $78,880
If you are not yet age 65, and your AGI income would put you in these income brackets, shopping the Marketplace coverage may help to save money while still receiving comprehensive coverage.
Private Individual Coverage
For those households that do not qualify for Marketplace coverage based on income, buying individual coverage directly from a private insurance company is available. This is generally the most expensive option in the private market, but comparing the costs of this insurance versus the retiree coverage is a worthwhile exercise.
Yes, for the purpose of exploring coverage on the Marketplace coverage options. There is a distinction between “terminating” or “renewing”; your Qualifying Event date is your last day of coverage. You will receive notice of creditable coverage from BCBSMT.
Yes, you can explore your options before and during your district’s open enrollment period. Depending on your situation, you may also qualify for a premium tax credit. You have a Special Enrollment Period of 60 Days before or after the Qualifying Event, which is your last day of coverage. Explore your options early.
Yes, you can explore your options before and during your group’s open enrollment period. Depending on your situation, you may also qualify for a premium tax credit. You have a Special Enrollment Period of 60 Days before or after the Qualifying Event, which is your last day of coverage. Explore your options early. REMEMBER – outside of open enrollment or a special enrollment period, you may not voluntarily drop your retiree coverage and replace it with other Marketplace coverage. Consult with a licensed insurance agent specialized in Marketplace coverage.
No, upon retirement, if you were a district eligible covered employee, you needed to notify MUST within 60 days of your last day of employment of your decision to continue coverage as a retiree.
There are no voluntary drops of MUST coverage outside of open enrollment. The following events allow you and/or your dependent(s) to drop medical coverage:
- Medicare Eligible – you have 30 days from becoming Medicare eligible to drop coverage. Please notify MUST at [email protected] to process the request. If you are outside of the 30 days from becoming Medicare eligible you must provide proof of coverage.
- Gain of Coverage – you have 30 days from the effective date of gain of other medical coverage. You must provide proof of other coverage that shows the effective date your new coverage takes effect.
Coverage will end on the last day of month of receipt or requested effective date whichever is later. Drops of dental/vision are not allowed until open enrollment.
You have 30 days from becoming Medicare eligible to drop coverage. Please complete a change request in Benelogic to process the request. If you are outside of the 30 days from becoming Medicare eligible you must provide proof of coverage. Your current coverage with MUST will end on the last day of month of receipt or requested effective date whichever is later. COBRA will be offered to spouse/dependent(s) if applicable.
Retirees are offered both MUST retiree coverage and COBRA coverage upon notification of becoming eligible for retirement for yourself and your eligible dependent(s). If they did not elect COBRA coverage at that time, they would have waived their right to COBRA continuation coverage.