Integrated Service Center

Life Event: Gain or Loss of Eligibility for Medicare

Last updated Tuesday, January 18, 2022

Disclaimer: If the information on this page conflicts in any way with HCA documentation, the HCA documentation governs.

This Life Event is when any of the below scenarios take place.

You Gain Eligibility For, and Enroll In, Medicare

When you gain eligibility for and enroll in Medicare, you can:

  • Waive your enrollment in PEBB medical coverage, or
  • Change your medical and/or dental plan, or
  • Decrease your FSA contribution amount/cease your FSA contributions altogether

If you are enrolled in Medicare, you may not be enrolled in a Health Savings Account (HSA).

To make any of these changes, expand the relevant menu below for step-by-step guidance.

Complete these three steps no later than 60 days after gaining Medicare eligibility or the date the relevant WA State agency (e.g. HCA, PEBB, etc.) grants Medicare eligibility:

  1. Download and complete the Employee Enrollment Change form linked in the right-hand sidebar of this page.
  2. Obtain supporting documentation:
    • Medicare benefit verification letter, or
    • Copy of Medicare card, or
    • Medicare Entitlement Form
  3. Send the completed form and supporting documentation to the ISC either via email (preferred) or mail.

Effective Date
The effective date of the change is the last day of the month of the later of either:

  1. The date you gained eligibility for and enrolled in Medicare
    -OR-
  2. The date the Employee Enrollment Change form is received by the ISC

If the later of a. or b. is the 1st day of the month, the effective date is the last day of the previous month.

Complete these three steps no later than 60 days after gaining Medicare eligibility or the date the relevant WA State agency (e.g. HCA, PEBB, etc.) grants Medicare eligibility:

  1. Download and complete the Employee Enrollment Change form linked in the right-hand sidebar of this page.
  2. Obtain supporting documentation:
    • Medicare benefit verification letter, or
    • Copy of Medicare card, or
    • Medicare Entitlement Form
  3. Send the completed form and supporting documentation to the ISC either via email (preferred) or mail.

Information about medical and dental coverage can be found on UWHR’s Health Insurance pages.

Effective Date
The effective date of the change is the 1st of the month following the later of either:

  1. The date you gained eligibility for Medicare
    -OR-
  2. The date the Employee Enrollment Change form is received by the ISC

If the later of a. or b. is the 1st day of the month, the change takes effect on that day.

Complete these steps no later than 60 days after gaining Medicare eligibility or the date the relevant WA State agency (e.g. HCA, PEBB, etc.) grants Medicare eligibility:

  1. Prepare your supporting documentation – scan documents that serve as proof of the event.
  2. Follow the instructions in the FSA and/or DCAP – Enroll/Change Contribution Amount(s) User Guide.

Effective Date
The change is effective the 1st day of the month following the later of either:

  1. The date you gained your eligibility for Medicare
    -OR-
  2. The date you submit your requested changes in Workday

If the later of a. or b. is the 1st day of the month, the change begins on that day.

Your Dependent Gains Eligibility For, and Enrolls In, Medicare

When your dependent gains eligibility for and enrolls in Medicare, you can:

  • Remove the dependent who enrolled in Medicare from your medical and/or dental coverage, or 
  • Change your medical plan election, or
  • Decrease your FSA contribution amount/cease your FSA contributions altogether

To make any of these changes, expand the relevant menu below for step-by-step guidance.

Complete these three steps no later than 60 days after your dependent gains Medicare eligibility or the date the relevant WA State agency (e.g. HCA, PEBB, etc.) grants their Medicare eligibility:

  1. Download and complete the Employee Enrollment Change form linked in the right-hand sidebar of this page.
  2. Obtain an Enrollment letter from Medicare which shows the date that the subscriber’s dependent became entitled to and enrolled in Medicare.
  3. Send the completed form and supporting documentation to the ISC either via email (preferred) or mail.

Effective Date
The effective date of the change is the last day of the month of the later of either:

  1. The date your dependent gained eligibility for, and enrolled in, Medicare
    -OR-
  2. The date the Employee Enrollment Change form is received by the ISC

If the later of a. or b. is the first day of the month, the remove date is the last day of the previous month.

Complete these three steps no later than 60 days after your dependent gained their Medicare eligibility or the date the relevant WA State agency (e.g. HCA, PEBB, etc.) granted their Medicare eligibility:

  1. Download and complete the Employee Enrollment Change form linked in the right-hand sidebar of this page.
  2. Obtain supporting documentation:
    • Medicare benefit verification letter, or
    • Copy of Medicare card, or
    • Medicare Entitlement Form
  3. Send the completed form and supporting documentation to the ISC either via email (preferred) or mail.

Effective Date
The effective date of the change is the 1st of the month following the later of either:

  1. The date your dependent gained eligibility for Medicare
    -OR-
  2. The date the Employee Enrollment Change form is received by the ISC

If the later of a. or b. is the 1st day of the month, the change takes effect on that day.

Complete these three steps no later than 60 days after gaining Medicare eligibility or the date the relevant WA State agency (e.g. HCA, PEBB, etc.) grants Medicare eligibility:

  1. Prepare your supporting documentation – scan documents that serve as proof of the event.
  2. Follow the instructions in the FSA and/or DCAP – Enroll/Change Contribution Amount(s) User Guide.

Effective Date
The change is effective the 1st day of the month following the later of either:

  1. The date your dependent gained their eligibility for Medicare
    -OR-
  2. The date you submit your requested changes in Workday

If the later of a. or b. is the 1st day of the month, the change begins on that day.

You Lose Your Medicare Eligibility

When you lose your Medicare eligibility, you can:

  • Return from waived enrollment in medical, or
  • Change your medical plan

To make either of these changes, complete these three steps no later than 60 days after losing your Medicare eligibility:

  1. Download and complete the Employee Enrollment Change form linked in the right-hand sidebar of this page.
  2. Obtain supporting documentation:
    • Notice of Denial of Medicare coverage
      -or-
    • Social Security denial letter
  3. Send the completed form and supporting documentation to the ISC either via email (preferred) or mail.

Effective Date
The change is effective the 1st day of the month following the later of either:

  1. The date you or your dependent gained their eligibility for Medicare
    -OR-
  2. The date the Employee Enrollment Change form is received by the ISC

If the later of a. or b. is the 1st day of the month, the change begins on that day.