Washington Programs

PEBB Medicare retirees in Washington

If you or a covered dependent has PEBB retiree coverage and becomes eligible for Medicare, HCA requires that person to enroll in and stay enrolled in Medicare Parts A and B and move to a PEBB Medicare plan. Send proof of Medicare no later than 30 days before turning 65, and remember that buying a private Medicare plan instead may end your right to PEBB retiree coverage.

By the Benefits Life Editorial Team, licensed insurance agents · Reviewed November 9, 2026

What PEBB is

PEBB, the Public Employees Benefits Board Program, provides health coverage for Washington state agency and higher education employees, employees of participating employer groups, and retirees of those employers. It also covers retirees from Washington school districts, educational service districts and charter schools. The PEBB Program is run by the Washington State Health Care Authority (HCA).

Turning 65 as a PEBB retiree

The most important rule: when you or a covered dependent becomes eligible for Medicare, that person must enroll in Medicare Part A and Part B and stay enrolled. HCA lists failing to respond to its requests about Medicare as one of the ways to lose PEBB retiree coverage.

Becoming eligible for Medicare is a special open enrollment event that requires you to change to a PEBB Medicare plan, which may cost less. Medicare then pays first. The steps HCA gives:

Apply for Medicare early. HCA encourages applying with Social Security three months before you turn 65.
Choose a PEBB Medicare plan.
Send proof of Medicare and the form. HCA must receive a copy of the Medicare card or benefit verification letter showing your Part A and Part B dates, with the Retiree Change Form (form E) or through Benefits 24/7, no later than 30 days before you or your dependent turns 65 (or, if Medicare is delayed, no later than 60 days after turning 65).

PEBB Medicare plan options

PEBB offers retirees on Medicare three kinds of PEBB Medicare plans:

A coordination-of-benefits plan with Part D drug coverage, which pays after Original Medicare
Medicare Advantage plans with Part D from the companies PEBB contracts with (network and benefits vary)
A Medicare Supplement Plan G, which has no prescription drug coverage

All PEBB Medicare plans except Plan G include Part D or drug coverage at least as good as Part D. PEBB does not offer standalone Part D plans. If you choose Plan G, consider a standalone Part D plan on the open market (or keep other creditable drug coverage) to avoid a Part D late enrollment penalty. If you or your spouse or partner enroll in a standalone Part D plan, Plan G is your only PEBB medical option.

Plans and availability change, and some depend on your county. Check HCA's plans-by-county list and PEBB open enrollment materials each year. PEBB open enrollment for 2027 coverage runs October 26 through November 23, 2026.

Buying a private plan can cost you PEBB. HCA warns that if you or a dependent buy a Medicare Advantage or Medicare Supplement plan from an insurance company instead of through PEBB, you may lose your right to PEBB retiree coverage. Enrolling in a separate Medicare plan while in a PEBB plan with Part D can also end your PEBB coverage. Check with PEBB before you enroll in any outside Medicare plan.

How PEBB premiums work

Retirees pay a monthly PEBB premium, by pension deduction, monthly invoice or electronic debit, in addition to the Part B premium paid directly to Medicare. Once at least one person on your account is enrolled in Parts A and B, HCA reduces your premium to the lower Medicare rate, and premium surcharges stop when the subscriber enrolls in Parts A and B.

State law (RCW 41.05.085) also sets aside part of the state's benefit funding as a subsidy that lowers medical and drug premiums for retirees eligible for Medicare Parts A and B. HCA publishes the current retiree monthly premiums; PEBB can confirm your amount.

Spouse coverage

You can keep covering an eligible spouse or state-registered domestic partner, including one who reaches Medicare age. Each person who becomes eligible must enroll in Medicare Parts A and B. Generally you and your dependents must be in the same medical plan, but HCA has exceptions: when one person is on Medicare and the other is not, each Medicare plan is paired with a non-Medicare plan for the other person.

If your spouse is younger than 65, they usually stay on a non-Medicare PEBB plan until they become eligible for Medicare, and then move to a PEBB Medicare plan.

Common transition mistakes

Not enrolling in Part B. PEBB requires it. And because PEBB retiree coverage is not coverage from current employment, it does not give you a Medicare Special Enrollment Period to sign up for Part B later without a penalty.
Missing the paperwork deadline. HCA's deadline is 30 days before your 65th birthday (or 60 days after, if Medicare is delayed), not 60 days after your Medicare starts.
Assuming your current plan continues. A Medicare-eligible person must change to a PEBB Medicare plan; deductibles and out-of-pocket maximums may restart.
Not coordinating Part D. Only Plan G lacks drug coverage. Adding an outside Part D plan to a PEBB plan that already includes Part D can cost you PEBB coverage.

If you deferred PEBB at retirement

When you retire you generally have 60 days after your employer-paid, COBRA or continuation coverage ends to enroll in PEBB retiree coverage or formally defer it. If you do neither, you lose the chance to enroll later. You can defer only while enrolled in qualifying coverage, such as:

employer-based group medical coverage as an employee or dependent (not another employer's retiree coverage)
PEBB or SEBB dependent coverage
TRICARE, the Federal Employees Health Benefits Program or CHAMPVA (a one-time opportunity to enroll later)
Medicare Parts A and B plus Medicaid that provides creditable coverage
an exchange plan if you are not eligible for Medicare (a one-time opportunity)
Medicare while living permanently outside the United States

To enroll after deferring, you must show continuous qualifying coverage, with gaps of no more than 31 days, and enroll during PEBB open enrollment or within 60 days after the other coverage ends. Confirm your situation with PEBB before declining initial enrollment.

SEBB retirees

SEBB, the School Employees Benefits Board Program, covers active employees of school districts, educational service districts and charter schools. When they retire, eligible school employees enroll in PEBB retiree coverage, not SEBB, and the same Medicare rules apply. More on SEBB retirees →

Comparing PEBB with other Medicare options

Because declining PEBB retiree coverage is hard to undo, compare carefully before you choose anything else. Things to compare:

Total premium, including the Medicare rate and state subsidy
Whether your doctors are in the plan's network, including out of state if you travel
What you pay for hospital stays, doctor visits and other services
Whether your prescriptions are covered
What happens to your spouse's or partner's coverage

A licensed insurance agent with Benefits Life can explain how Medicare works with your PEBB coverage and walk through plans from the companies they work with, at no cost to you. Call (206) SENIORS (206-736-4677), TTY 711.

Where to get help

PEBB Benefits Services (for retirees and employees about to retire): 1-800-200-1004, TRS 711, or hca.wa.gov PEBB retirees
Department of Retirement Systems: 1-800-547-6657
Social Security (to enroll in Medicare Parts A and B): 1-800-772-1213
Medicare: 1-800-MEDICARE (1-800-633-4227) or Medicare.gov

Sources

Frequently asked questions

What is PEBB?

The Public Employees Benefits Board Program provides health coverage for Washington state agency and higher education employees, employees of participating employer groups, and retirees, including retirees from school districts. It is run by the Washington State Health Care Authority (HCA).

Do PEBB retirees need Medicare at 65?

Yes. HCA requires PEBB retirees and covered dependents to enroll in and stay enrolled in Medicare Part A and Part B as soon as they are eligible. PEBB retiree coverage then works with Medicare, and you pay your Part B premium directly to Medicare.

What plans are available for PEBB Medicare retirees?

PEBB Medicare plans include a coordination-of-benefits plan with Part D drug coverage, several Medicare Advantage plans with Part D, and one Medicare Supplement Plan G, which has no drug coverage. PEBB does not offer standalone Part D plans. HCA lists the current plans and which are available in your county.

What's the deadline to move to a PEBB Medicare plan?

HCA must receive your proof of Medicare Parts A and B and the required form no later than 30 days before you or your dependent turns 65, or, if Medicare is delayed, no later than 60 days after turning 65. HCA encourages applying for Medicare three months before turning 65.

Can my spouse stay on PEBB?

Yes, an eligible spouse or state-registered domestic partner can stay covered. Each person who becomes eligible for Medicare must enroll in Parts A and B. Generally everyone on the account is in the same medical plan, but HCA has paired plans so a Medicare member and a non-Medicare member can be covered together.

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Licensed insurance agents for Washington

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