Health Benefits (PERACare) FAQs
PERA benefit recipients (retiree, cobeneficiary, qualified child, or dependent parent receiving a monthly retirement, disability or survivor benefit from PERA) and their eligible dependents may enroll in PERACare.
No. PERACare plans are completely separate from coverage offered by your employer.
Yes, there are other options for coverage in retirement. You are not required to enroll in PERACare and we encourage you to review all of your options.
For retirees under age 65 and not yet eligible for Medicare:
- Connect for Health Colorado or your State’s insurance marketplace
- Employer coverage through a spouse who is still working
- COBRA coverage – available as a continuation of employer coverage after termination of employment
- For retirees age 65+, or under 65 and eligible for Medicare due to disability
- Individual Medicare plans sold directly by insurance carriers
- Employer coverage through you or a spouse who is still working
Note: Coverage that is not based on current employment, such as COBRA, is not considered creditable coverage by Medicare past age 65 and could result in Medicare enrollment delays or penalties in the future.
You can enroll in PERACare within 30 days of your first retirement benefit payment, or within 30 days of certain Enrollment Eligibility Events as described in the PERACare Health Benefits Program booklets. You may also enroll, change plans, or add dependents during the annual open enrollment period each fall.
You can submit a PERACare Enrollment/Change Form online by logging into PERA’s secure website, or download the appropriate form for you below.
Monthly PERACare premiums vary depending on the plan. Premium information can be found in the PERACare Health Benefits Program booklets or you can use the PERACare Premium Calculator to get a personalized estimate.
For PERA members under the age of 65 (Pre-Medicare), PERACare offers two PPO plan options with UMR, a UnitedHealthcare company, and an HMO and High Deductible Health Plan (HDHP) with Kaiser Permanente of Colorado (Kaiser).
For PERA members 65 and older, PERACare offers three Medicare Advantage plans that combine the benefits of Medicare Parts A and B with Part D prescription coverage into one comprehensive plan. Currently the Medicare plan options are two national PPO plans with UnitedHealthcare and one regional HMO plan with Kaiser Permanente of Colorado (Kaiser).
PERACare also offers dental plans with Cigna Dental and Delta Dental, and a vision plan with VSP.
More details on the plan options can be found in the PERACare Health Benefits Program booklets.
Yes. All of the health plans offered through PERACare include prescription drug coverage. The list of covered medications (Formulary) can be found here.
When you turn 65 you will enroll in Medicare and will have different plan options available to you. Visit the PERACare Turning 65 page for more information and be sure to sign up to attend a webinar to learn about enrolling in Medicare and your coverage options.
You can cancel PERACare coverage with 30-days’ written notice at any point, and can reenroll as explained above.
Medicare Part A Hospital benefits and Part B Medical benefits together are known as Original Medicare.
Everyone pays a premium for Medicare Part B. The standard monthly premium is $164.90 in 2023.
You qualify for Premium-Free Part A if any of the following apply:
- You have paid the Medicare tax for 10 or more years.
- You are currently married to someone who paid the Medicare tax for 10 or more years and have been married for at least 1 year.
- You are divorced, were married for at least 10 years, and your former spouse paid the Medicare tax for 10 years or more. You must be single.
- You are widowed and married for at least nine months before your spouse died. You must be single.
If none of the above apply, you do not need to purchase Part A coverage as PERACare’s Medicare plans include replacement Part A benefits.
Coverage in addition to Original Medicare is not required, but you may be subject to a penalty in the future if you do not enroll in Medicare Part D prescription drug when you first become Medicare-eligible. Therefore, most people choose to enroll in either a Medicare Advantage or Supplement plan as well as Medicare Part D prescription drug coverage.
A Medicare Supplement, also called a Medigap plan, is a private insurance policy that pays after Original Medicare. In a Medicare Supplement, your doctor sends claims to Original Medicare first. Medicare will pay its part of the costs, and then the Medicare Supplement will cover all or a part of the remaining cost. Anything not paid by Medicare or the Medicare Supplement is your responsibility.
Medicare Supplements do not typically include Part D prescription drug coverage, so you would need to buy drug coverage separately.
Medicare Advantage plans are offered by private insurance companies that must be approved by and follow rules set by Medicare. In a Medicare Advantage plan, you’ll still have Original Medicare, but your doctor sends claims to the Medicare Advantage plan, not Medicare. The Medicare Advantage plan will pay its part of the costs, and anything remaining is your responsibility.
Medicare Advantage plans cover all the same services as Original Medicare and most also include Part D prescription drug coverage. Medicare Advantage plans also provide additional benefits such as emergency and urgent care coverage outside of the US, vision and hearing aid benefits, expanded chiropractic benefits, fitness benefits, and other extras.
Per Medicare rules, both types of plans cover the same medical services, procedures, and conditions. The only difference is that pre-approval may be need for certain services within Medicare Advantage plans.
PERACare offers three Medicare Advantage plans: a Medicare Advantage HMO plan with Kaiser and two Medicare Advantage PPO plans with UnitedHealthcare.
Kaiser’s Medicare HMO is available to those who live in Kaiser’s Colorado service area, and enrollees can only go to Kaiser facilities or Kaiser’s network of physicians.
UnitedHealthcare’s Medicare PPO’s plans are available nationwide and enrollees have the same cost share when seeing a physician in the UnitedHealthcare network or when seeing an out-of-network physician who accepts Medicare and is willing to accept the UHC plan.
PERA has found that Medicare Advantage plans can provide lower premiums for retirees while still providing generous benefits in one coordinated and easy to understand plan.
No, you must first enroll in Medicare Part B. You may also enroll in Part A if eligible at no cost. Having Medicare Part B is what makes you eligible for Medicare Advantage coverage.
Medicare Part B coverage is required for enrollment into a Medicare Advantage plan, and you must pay the Medicare Part B premium directly to Medicare. You will also pay a monthly premium for the PERACare Medicare Advantage plan you have selected. If you are eligible for a PERA subsidy that amount will be applied to the premium for your plan, and anything remaining will be deducted from your monthly PERA benefit check.
No, Medicare rules do not allow you to enroll in more than one Medicare Advantage or Medicare Part D prescription drug plan. If you enroll in a Medicare Advantage or Part D plan outside of PERACare, Medicare will notify PERA to cancel you from your PERACare coverage.
PERACare plans will never require any underwriting, but you are limited to enrolling at certain life events or during the annual open enrollment period each fall.
Outside of PERACare, you can enroll in a Medicare Advantage plan without underwriting during any annual open enrollment period.
When you first turn 65 you can enroll in a Medicare Supplement plan without any underwriting, but if you enroll at a later date the plan will use an underwriting process to determine your monthly premium.