Medicare

State of Illinois Group Insurance Program Medicare Requirements

Employee Actively Working and Becomes Eligible for Medicare (Age 65) or
Dependent Becomes Eligible for Medicare (Age 65)

If you are actively working and become eligible for Medicare (turning age 65), or your dependent becomes eligible for Medicare (turning age 65) while you are actively working, neither of you are required to enroll in premium-free, Medicare Part A (inpatient/hospital) or at a premium, Medicare Part B (outpatient/medical) coverage.

However, provided you are not enrolled in the Consumer Driven Health Plan and Health Savings Account through the State of Illinois, you may choose to enroll in premium free, Medicare Part A coverage that can provide benefit to you if you become hospitalized. As long as you are actively working, the State of Illinois coverage will be primary for you and all covered dependents, but this premium free benefit could supplement your coverage should you or your dependent have an inpatient hospital claim.

Employee Planning to Retire and Eligible for Medicare (Age 65 or Older) and/or Dependent Eligible for Medicare (Age 65 or Older)

If you are planning to retire, participate in the State of Illinois Group Insurance Program, and you or your dependent is eligible for Medicare, those eligible are required by the State of Illinois to enroll in both premium-free, Medicare Part A (inpatient/hospital) and at a premium, Medicare Part B (outpatient/medical) coverage.

Once you are no longer actively working, Medicare is the primary payer for health insurance claims over the State Group Insurance Program. Failure to enroll and maintain enrollment in Medicare Parts A and B when Medicare is the primary insurance payer will result in a reduction of benefits under the State Group Insurance Program and will result in additional out-of-pocket expenditures for health-related claims.

Employee Becomes Disabled

Regardless of age, if you qualify for Federal Social Security Disability, you will be automatically eligible for Medicare Parts A and B after receiving Social Security disability payments for a period of 24 months.

If you are on a leave of absence and are age 65 or older or turn age 65 while on leave you are required to enroll in both Medicare Parts A and B should your leave be expected to last longer than six months. Medicare will become primary when you have been off work for six months or greater. If you later return to work, Medicare Part B can be stopped because the State of Illinois insurance will become primary again.

Enrolling in Medicare Part A and Medicare Part B

Enrollment in Medicare Part A can be done three months prior to your 65 birthday and can be requested online on the Social Security Administration website.

As a reminder, there is no premium for Medicare Part A coverage.

Enrollment in Medicare Part B can be done three months prior to your retirement and can be requested online on the Social Security Administration website. When applying for Medicare Part B you will need to have two forms completed:

CMS-40B – Application for Enrollment in Medicare Part B

• Employee completes.
  • Note date you want Medicare to begin in the Remarks section.

CMS-L564 – Request for Employment Information (PDF)

• NIU Insurance Office completes.
  • Employees with last names beginning A – D please contact Stephanie Kruizenga (skruizenga@niu.edu) for assistance.
  • Employees with last names beginning E – K please contact Vickie Hueramo (vhueramo@niu.edu) for assistance.
  • Employees with last names beginning L – Z please contact Renee’ Bechtel (rbechtel@niu.edu) for assistance.

The Social Security Administration website also indicates that completed forms can be sent or faxed to the local Social Security field office. The closest office to NIU is:

Social Security Elgin Office
Suite 100
790 Fletcher Drive
Elgin, IL 60123
Fax – (833) 950-3437

There is a premium for Medicare Part B coverage. For calendar year 2023, the standard Medicare Part B premium is $164.90 monthly. Based on your adjusted gross income, it is possible that you could also be required to pay an additional income-related monthly adjustment. More information on Medicare Part B premiums can be found on the Medicare website.

To ensure that benefits are coordinated appropriately and to prevent financial liabilities with healthcare claims, employees and retirees must notify the State of Illinois CMS Medicare COB Unit when they become eligible for Medicare. 

Once you receive a copy of your Medicare card, a copy should be sent via mail, email or fax.

State of Illinois Medicare COB Unit
PO Box 19208
Springfield, Illinois 62794 – 9208

CMS.BEN.MedicareCOB@illinois.gov

Fax: 217-557-3973

If the Social Security Administration determines that you or your covered dependent are not eligible for Medicare coverage, you must request a written statement of the Medicare ineligibility from the Social Security Administration. Upon receipt, the written statement must be forwarded to the State of Illinois Medicare COB Unit to avoid a financial penalty.