The Health Plan recommends all participants, no matter your coverage type, enroll in Medicare Part A when you first become eligible, but there may be other parts of Medicare you need to enroll in once you reach age 65. To learn about Medicare parts and coverage basics or to prepare to enroll, explore Medicare’s official website, Medicare.gov, through the links below:

Medicare Parts A, B, C and D	Coverage costs	When coverage starts/Enrollment Periods
Medicare when working past 65	Medicare & You handbook	Prepare to sign up

Medicare Parts A, B, C and D

Coverage costs

When coverage starts/Enrollment Periods

Medicare when working past 65

Medicare & You handbook

Prepare to sign up

STEP 1: UNDERSTAND YOUR COVERAGE TYPE

The first step to understanding how the Health Plan works with Medicare is to understand your coverage type. Your Health Plan coverage type determines how we work with Medicare, so it is important to regularly monitor your coverage from year to year for any changes.

There are two Health Plan coverage types: Active Coverage and Inactive Coverage:

If you have Active Coverage, you’ve met the Health Plan’s minimum earnings threshold with initial compensation only (not from residuals).
If you have Inactive Coverage, you’ve met the minimum earnings threshold with any amount of residual compensation (Carry-Over, Certified Retiree, Retiree Carry-Over).

If you are unsure which coverage type you have, check the Health Eligibility tab on the myPHP online benefits portal or recent Plans documents sent to you, including Open Enrollment cover letters. For questions about your coverage status, please contact the Health Plan’s Eligibility department at (323) 866-2200, Ext., 502 or via email at eligibility@dgaplans.org.

STEP 2: ENROLL IN THE APPROPRIATE MEDICARE PARTS BASED ON YOUR HEALTH PLAN COVERAGE TYPE

This section briefly describes the Medicare parts necessary based on whether you have Active or Inactive Health Plan coverage. It is important to enroll into Medicare in a timely manner as appropriate for your circumstances to avoid potential lifetime penalties. For more detailed descriptions of the Medicare parts, visit Medicare.gov.

Part A
Part B
Part C
Part D

Part A

Medicare Part A

Medicare Part A is hospital insurance and premium free.

Everyone should enroll in Part A once eligible.

Part B

Medicare Part B

Medicare Part B is medical insurance.

If you have Active Coverage through the Health Plan or through your spouse’s plan, you do not need to enroll in Part B.

If you have Inactive Coverage (or no coverage), you should start enrolling in Part B at least three months prior to your 65th birthday.The maximum amount the Health Plan will pay is 20% of covered expenses because your claims will be processed as if you are enrolled in Medicare Part B.

Part C

Medicare Part C

Medicare Part C (also called Medicare Advantage) is a Medicare-approved plan from a private company.

Part D

Medicare Part D

Medicare Part D is prescription drug coverage.

If you have any Health Plan coverage that includes prescription drug benefits, you do not need to enroll in Medicare Part D.

This includes: (1) Earned Active (2) Earned Inactive (3) Certified Retiree (4) Retiree Carry-Over or Regular Carry-Over and (5) Self Pay (except for the Bronze Plan)

STEP 3: DETERMINE WHETHER THE HEALTH PLAN IS PRIMARY OR SECONDARY

Once you know whether you have Active or Inactive Coverage with the Health Plan, you will also know which plan—the Health Plan or Medicare— will pay your medical bills first (that is, be your primary plan) and what portion of your medical bills each plan is responsible for. This process is called coordination of benefits.

Your primary plan is responsible for the largest portion of your medical bill’s covered expenses and is who you should submit your medical claims to first. To learn how the Health Plan determines what expenses are covered, read about the Health Plan’s Allowed Amount on page 47 of the March 2025 Health Plan Summary Plan Description.

STEP 4: SUBMIT YOUR CLAIMS TO YOUR PRIMARY PLAN FIRST

How you submit your medical claims when you are covered by both the Health Plan and Medicare depends on your type of Health Plan coverage (see above). Click the appropriate heading below for your circumstances for information on how to submit your claims and how your claims are processed.

I have Active coverage with the Health Plan

The Health Plan is your primary insurance.

When you have a medical claim:

Submit it to the Health Plan first
We will process your claim, pay our portion in accordance with Health Plan rules and issue an Explanation of Benefits (EOB).
Then, submit your Health Plan EOB along with your medical claim to Medicare.
Medicare will process your claim, apply the remaining 20% of their allowed amount (provided it is a covered service and does not exceed the amount Medicare would have paid if it was primary) and issue their EOB.
Compare the payment amount issued on Medicare’s EOB with the bill your provider sends to you. These amounts should match.

I have Inactive coverage with the Health Plan

The Health Plan is your secondary insurance.

DOCTORS WHO DO NOT PARTICIPATE IN MEDICARE: If you are a Medicare-eligible retiree and choose to use a non-Medicare participating provider, you will have substantially higher medical costs. If you go to a doctor who does not participate in Medicare or who has opted out of Medicare, and Medicare is your primary plan, the Health Plan will cover you as if Medicare is primary. This means, for most procedures, the Health Plan will pay 20% of the Allowable Charge, subject to deductible and co-payments, if any.

When you have a medical claim:

Submit it to Medicare first
They will process your claim, pay their portion (typically 80% of their allowed amount) and issue an Explanation of Benefits (EOB)
Then, submit your Medicare EOB along with your medical claim to the Health Plan
We will process your claim, apply the remaining 20% of Medicare Part B’s allowed amount (provided it is a covered service and does not exceed the amount the Plan would have paid if it was primary) and issue our EOB.
Compare the payment amount issued on the Health Plan’s EOB with the bill your provider sends to you. These amounts should match.

NOTE: If Medicare is your primary plan and the service or treatment is not covered by Medicare but covered by the Health Plan, the Health Plan will pay as primary.

QUESTIONS?

For questions, please contact the Health Plan’s Eligibility department at (323) 866-2200, Ext., 502 or via email at eligibility@dgaplans.org.

MEDICARE & RETIREE HEALTH

Learn the Basics of Medicare

STEP 1: UNDERSTAND YOUR COVERAGE TYPE

STEP 2: ENROLL IN THE APPROPRIATE MEDICARE PARTS BASED ON YOUR HEALTH PLAN COVERAGE TYPE

Medicare Part A

Medicare Part B

Medicare Part C

Medicare Part D

STEP 3: DETERMINE WHETHER THE HEALTH PLAN IS PRIMARY OR SECONDARY

STEP 4: SUBMIT YOUR CLAIMS TO YOUR PRIMARY PLAN FIRST

The Health Plan is your primary insurance.

The Health Plan is your secondary insurance.

QUESTIONS?

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