Retirees with Medicare

If you are age 65 or older or otherwise eligible for Medicare (e.g. disability or End State Renal Disease (ESRD), SFHSS requires that you enroll in Medicare as soon as you are eligible before you enroll in SFHSS-administered benefits.

The Social Security Administration may take up to three months to process your Medicare enrollment so be sure to apply for Medicare at least three months BEFORE your 65th birthday.

Enrollment must take place within 30 days of the initial retirement date, no later than 30 days after a qualifying event, or during the annual Open Enrollment period in October.

Be sure to read through our New Retiree Enrollment page for a summary of the most important deadlines and next steps on initiating the process of transitioning from active employee benefits coverage to retiree benefits coverage.

An employee must meet age and minimum service requirements and have been enrolled in SFHSS health benefits at some time during active employment to be eligible for retiree health coverage. SFHSS calculates service (service requirements may vary).

If hired on or after January 9, 2009, Proposition B applies. If a retiree chooses to take a lump sum pension distribution, retiree health premium contributions will be unsubsidized and paid at full cost. 

Newly eligible retirees must enroll in retiree medical and/or dental coverage within 30 days of their retirement date.

To enroll, you must provide SFHSS with a completed enrollment application and all required eligibility documentation, including retirement system paperwork.

Members eligible for Medicare must provide proof of Medicare enrollment. Medicare applications take three to four months to process by Social Security, so apply in advance of your 65th birthday. If you do not meet the required deadlines, you must wait until the next Open Enrollment period, which takes in October.

New retiree coverage will take effect on the first day of the month following the retirement effective date.

Depending on your retirement date, there may be a gap between when your employee coverage ends and your retiree coverage begins. Setting your retirement date at the end of the month will help avoid a coverage gap. 

Contact Member Services team at (628) 652-4700 three months before your retirement date to prepare for enrollment in retiree benefits.

You must notify SFHSS of retirement even if you are not planning to elect SFHSS coverage on your retirement date.

SFHSS requires all retirees and dependents who are eligible for Medicare to enroll in Medicare Part A and Part B.

The Social Security Administration (SSA) is the federal agency responsible for Medicare eligibility, enrollment, and premiums. Start by downloading the Medicare & You handbook at medicare.gov.

Medicare is a federal health insurance program administered by the Centers for Medicare & Medicaid Services (CMS) for people age 65 or older, or under age 65 with a Social Security-qualified disability. You can visit cms.gov to learn more about CMS.

The different parts of Medicare help cover specific types of services:

• Medicare Part A: Hospital Insurance
• Medicare Part B: Medical Insurance
• Medicare Part D: Prescription Drug Coverage

SFHSS Rules require you and your eligible covered dependents to enroll in Medicare Part A and Part B as soon as you become eligible. Failure to enroll by the required deadlines may result in penalties assessed by the Social Security Administration (SSA) and changes to or loss of your SFHSS medical coverage.

Medicare Part A: Hospital Insurance

Medicare Part A helps cover inpatient care in hospitals, including critical access hospitals and skilled nursing facilities (but not custodial or long-term care). It also helps cover hospice care and certain home healthcare services.

You are eligible for premium-free Medicare Part A if you are age 65 or older and have worked and paid Social Security taxes for at least 10 years (40 quarters). You may also qualify through your current, former, or deceased spouse, or if you have End-Stage Renal Disease or a Social Security-qualified disability.

If you are under age 65 with a qualifying disability, Medicare coverage generally begins 24 to 30 months after you become eligible. If you have questions about your eligibility for premium-free Medicare Part A, contact the Social Security Administration at (800) 772-1213.

Medicare Part B: Medical Insurance

SFHSS Rules require you and your eligible dependents to enroll in Medicare Part B as soon as you become eligible. Medicare Part B helps cover the cost of doctor visits and outpatient medical services.

Most people pay a monthly Part B premium to the federal government. Your monthly premium is based on your income under CMS regulations and is usually deducted from your Social Security benefit.

If your income decreases after you enroll in Part B, you may qualify for a premium reduction. For information about Medicare Part B premiums or to request a premium reduction, contact the Social Security Administration.

If you do not enroll in Medicare Part B when you first become eligible, you may have to pay a higher monthly premium and late enrollment penalties. These higher costs may continue for as long as you are enrolled in Medicare.

Medicare Part D: Prescription Drug Insurance

There are two types of Medicare Part D prescription drug plans: individual plans and group plans. Individual Part D coverage is purchased directly from an insurance company or pharmacy.

If you enroll in an SFHSS Medicare medical plan, you are automatically enrolled in the plan's group Medicare Part D prescription drug coverage. Because your SFHSS medical plan already includes enhanced group Medicare Part D coverage, you should not enroll in an individual Medicare Part D plan.

All SFHSS members are required to enroll in Medicare as soon as they become eligible or may face penalties.

If you are enrolled in Medicare, do not enroll in any outside Medicare Part D plan. Prescription drug coverage is already included in your SFHSS medical plan. Enrolling in an outside Part D plan will terminate your SFHSS medical coverage.

Retirees with Medicare can choose between Blue Shield Medicare Advantage PPO or Kaiser Permanente Senior Advantage HMO plans. Please note that Retiree medical plan coverage and premium costs differ from active employee medical plans and premiums.

Please note that Kaiser Permanente Senior Advantage HMO requires retirees to live in a zip code serviced by the plan. In addition to California, Kaiser Permanente Senior Advantage HMO is also available in a limited number of areas in Oregon, Northwestern Washington and Hawaii. Blue Shield's Medicare Advantage PPO does not have service area requirements.

Blue Shield Medicare Advantage PPO Highlights

• Must be eligible for Medicare
• Live anywhere in the USA
• One ID card for all your covered services and prescription drugs nationwide
• Out-of-pocket; fixed co-pay
• No deductible
• Obtain service from any willing Medicare provider in the USA

Your Medicare dependents will be enrolled in Blue Shield Medicare Advantage PPO. Your non-Medicare dependents can be enrolled in Blue Shield PPO. Blue Shield Medicare members who live in California also have the option of enrolling non-Medicare dependents in the Blue Shield Trio HMO or Blue Shield Access+ HMO.

Kaiser Permanente Senior Advantage Plan Highlights

• Must be eligible for Medicare Part B
• Must live in Kaiser Permanente service area
• In-network service only
• Out-of-pocket, fixed co-pays
• No deductible
• One ID card for all your covered services and prescription drugs

Your Medicare dependents will be enrolled in Kaiser Permanente Senior Advantage. Your non-Medicare dependents will be enrolled in Kaiser Permanente HMO Plan.

SFHSS recognizes that dental benefits are a very important part of your healthcare coverage and for maintaining your good overall health well into your retirement.  Retirees have three dental plans to choose from: Delta Dental PPO, DeltaCare USA DHMO or UnitedHealthcare Dental DHMO.

Unlike the active employee dental plans, retirement dental plans have different premiums and coverage levels. To learn more, refer to SFHSS' Retiree Guide (see below) for the current plan year.

PPO-style dental plans, like Delta Dental PPO, allows you to visit any in-network or out-of-network dentist. DHMO (short for Dental Health Maintenance Organization) plans require you to receive all your dental care from within a network of participating doctors.

Before you retiree and transition from your current dental plan into one of our retiree dental plans, take note that you may be eligible to continue your employee dental plan for an additional 18 months using COBRA before enrolling in a dental plan for retirees. Many members elect this option in order to complete major or higher-cost dental care under a plan with a higher annual deductible before starting their retiree dental plan.

All SFHSS retirees and their dependents who are enrolled in an SFHSS medical plan are automatically enrolled in VSP Basic Plan at no additional cost.

We also offer an enhanced plan called the VSP Premier Plan at an additional cost based on the number of members enrolled in coverage. Please note that the VSP Premier Plan premiums for retirees differ from the active employee Premier Vision Plan and premiums.

If you do not enroll in a medical plan, you and your dependents cannot access VSP Vision Care benefits.

San Francisco Health Service System (SFHSS) recognizes the importance of supporting members in establishing their families. In 2016, SFHSS established the City and County of San Francisco Adoption and Surrogacy Assistance Plan. This plan provides a one-time benefit of reimbursement of up to $15,000 to an eligible employee or eligible retiree for qualified expenses incurred in connection with either an eligible adoption or eligible surrogacy. 

To learn more about the Plan, its terms, qualifications and limitations, please click below.

2026 Retiree Health Benefits Guide