Why LGERS is different
Under G.S. 135-48.1, State Health Plan retiree coverage goes to people receiving benefits from TSERS, the Consolidated Judicial Retirement System, the Legislative Retirement System or the state's Optional Retirement Programs. LGERS isn't on that list. Retirement Systems' guidance for LGERS retirees says to check with "your employer or former employer about the availability of health insurance coverage, if any, for its retirees," and adds that "other systems are not eligible for health coverage under the State Health Plan."
Some local governments do participate in the State Health Plan for their workers. G.S. 135-48.47 lets a local government unit join by resolution and agreement with the Plan; the local government decides which employees and dependents are eligible, and joining is generally irrevocable. Retiree benefits remain your former employer's decision.
What to ask your former employer
- Do you offer retiree health coverage, and who is eligible? Ask about years of service, age and any hire-date cutoff.
- What happens at 65? Ask whether the plan becomes a group Medicare Advantage plan, a plan that pays after Original Medicare, or ends.
- Must I have Part A and Part B? Medicare.gov warns that retiree coverage might not pay your costs for any time you were eligible for Medicare but didn't sign up.
- Is the drug coverage creditable? If not, you may need a Part D plan to avoid a late penalty.
- What if I join an individual Medicare plan? Some group plans end your coverage if you do. Ask before you enroll.
How Medicare works with local retiree coverage
When you have Medicare and retiree coverage from a former employer, Medicare generally pays first. Retiree coverage is not coverage from current work, so it doesn't let you delay Part B without a penalty. If retiree coverage that pays after Medicare ends, you get a federal guaranteed-issue right to buy certain Medigap policies within 63 days. North Carolina has no Medigap birthday rule, so outside that and your 6-month open enrollment, health questions can apply. See Medigap in North Carolina.
The full guide for public retirees: State Health Plan retirees and Medicare. To compare individual plans from the companies they work with, you can request a call from a licensed insurance agent.
Related questions
Hired after 2021: eligible for retiree health?
The 2021 cutoff.
Do state retirees need Part B?
The State Health Plan's rules.
Do federal retirees need Part B with FEHB?
Another public retiree plan.
Sources
- NC Retirement Systems — Health benefit coverage for other retirement system retirees
- NC Retirement Systems — Health benefit coverage for eligible retirees
- N.C. General Statutes 135-48.1, definitions (retiree)
- N.C. General Statutes 135-48.47, local government participation
- Medicare.gov — Retiree insurance and Medicare
- Medicare.gov — Choosing a Medigap Policy (guaranteed-issue rights)
More questions in this guide
- Are NC state employees hired after 2021 eligible for retiree health coverage?
- Can I drop the State Health Plan and buy my own Medicare plan in NC?
- Can my spouse stay on the State Health Plan when I go on Medicare?
- Do federal retirees in North Carolina need Medicare Part B with FEHB?
- Do North Carolina state retirees need Medicare Part B?
- Does the NC State Health Plan pay for Medicare Part B?
- What happens to my State Health Plan coverage when I turn 65?
- What Medicare plans does the NC State Health Plan offer retirees?
Part of the guide: State Health Plan retirees and Medicare in North Carolina · All questions
Frequently asked questions
My county or city is on the State Health Plan. Does that cover me when I retire?
Not necessarily. G.S. 135-48.47 lets a local government put its employees and their dependents on the Plan, but the statute is about employees. Ask your former employer's benefits office whether it offers retiree coverage and through what plan.
I have both LGERS and TSERS service. Am I eligible?
Possibly, through TSERS. You need at least 5 years of TSERS contributions earned before January 1, 2021, and Retirement Systems says service transferred from LGERS doesn't count toward those 5 years. Ask Retirement Systems at (919) 814-4590 to review your record.
If I have no retiree coverage, what should I do at 65?
Sign up for Medicare Part A and Part B in your Initial Enrollment Period, then choose a Medicare Advantage plan, or Original Medicare with Medigap and a Part D plan. Your 6-month Medigap open enrollment is the best time to buy Medigap in North Carolina.
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