If you retired from a school district, state agency, or public college in South Carolina, your insurance runs through PEBA — and PEBA's rules at 65 don't work like anyone else's. Here's the plain-English version.

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Talk to a retired teacher in Lexington or a former state agency employee in Columbia about their health insurance, and you'll hear the same thing: "It's through PEBA... and I get a stack of paperwork every year that I mostly hope I'm reading right."

Fair enough. The South Carolina Public Employee Benefit Authority covers hundreds of thousands of state employees, teachers, higher-ed staff, and their families — and its Medicare handoff has its own vocabulary, its own deadlines, and a couple of traps that don't exist anywhere else. PEBA's own Medicare handbook is thorough, but it's written like a plan document, because it is one. Here's what it means in practice.

The big one: Part B isn't "required" — but skipping it will cost you a fortune

PEBA's language is gentle: retirees "must be covered by Part A" and are "encouraged" to enroll in Part B. Don't let the word encouraged fool you. Once you're a Medicare-eligible PEBA retiree, the State Health Plan pays as if Medicare paid first — whether or not you actually enrolled. Skip Part B, and you personally owe everything Part B would have paid: typically 80% of your doctor visits, outpatient care, and therapy.

In other words: for a PEBA retiree, Part B is effectively mandatory. The only question is whether you learn that before your 65th birthday or from an explanation of benefits afterward.

One more wrinkle: the plan coordinates only with Original Medicare — Parts A and B. It does not coordinate with Medicare Advantage (Part C). Enrolling in an Advantage plan while keeping PEBA retiree coverage puts two systems in conflict, and you'd be paying premiums into both. If you're on PEBA retiree coverage, Original Medicare is the lane.

What happens at 65, step by step

• Three months before your birthday, PEBA mails you a notification. Don't file it — act on it.
• Enroll in Parts A and B through Social Security so they start the month you turn 65.
• Within 31 days of Part A eligibility, send PEBA a completed Retiree Notice of Election with a copy of your Medicare card (or hand it to your benefits administrator). This 31-day window is PEBA-specific, shorter than any federal deadline, and easy to miss.
• Choose your track: the Medicare Supplemental Plan (the default for Medicare-eligible retirees) or opting out of it into the Standard Plan carve-out. The supplemental plan is designed to pair with Original Medicare and is what most PEBA retirees land on — but the right answer depends on your spouse's status and your dependents.
• Drug coverage happens automatically: PEBA enrolls Medicare-eligible members in the State Health Plan's Medicare Part D program (SilverScript/Express Scripts). Don't buy a separate Part D plan — and be careful: enrolling in an outside Part D or Advantage plan can knock you out of PEBA's drug coverage.

Still working for the state or district at 65?

Active employees are different: the State Health Plan stays primary while you're working, and you can delay Part B without penalty until you actually retire — same as any large employer. The "effectively mandatory Part B" rule applies to retirees. When you do retire after 65, your Part B needs to start when your active coverage ends, and the 31-day Notice of Election clock applies then too.

The money question: what will your premiums be?

This is where PEBA retirees differ wildly from one another, and where a neighbor's advice can mislead you. Whether the state pays some, all, or none of the employer share of your premium — "funded," "partially funded," or "non-funded" retiree status — depends on your years of earned service credit, your hire date, and whether your last five years were with an employer in the state's Retiree Health Insurance Trust Fund. A 28-year classroom veteran and a 12-year second-career state employee can retire the same day with completely different premium bills.

That funding status should drive your decision-making:

• Funded retirees usually do well keeping PEBA retiree coverage — the subsidized premium paired with Original Medicare and PEBA's Part D is hard to beat.
• Non-funded retirees paying the full freight owe it to themselves to compare the open market. A Medigap Plan G or N plus a standalone Part D — or in some cases a Medicare Advantage plan instead of PEBA coverage entirely — can come out ahead. Leaving PEBA is a serious, often one-way decision (re-enrollment rights are limited), so run the numbers before you jump, not after.
• Spouses and dependents complicate everything — a younger spouse still on your PEBA coverage may be the single best reason to keep it, since your retiree coverage can carry them until their own Medicare.

Where we come in

We're in Lexington — PEBA country — and we do this comparison every week:

• We decode your specific situation: funded status, service years, spouse ages, and what your PEBA paperwork actually says.
• We run PEBA vs. the open market side by side — your real premiums against Medigap + Part D or Advantage alternatives, with your doctors and prescriptions in the math. As independents, we have no stake in which side wins.
• We protect the deadlines: Part B timing, the 31-day Notice of Election, and the one-way doors (leaving PEBA coverage, outside Part D conflicts) that can't be undone casually.
• We tell you when to stay put. For many funded retirees the honest answer is "keep PEBA, enroll in A and B on time, send the form, done." If that's your answer, it's free, and you'll know it's right instead of hoping.

The bottom line

PEBA's Medicare handoff rewards people who act early and punishes people who assume. The rules aren't hard once they're translated — Part B on time, form within 31 days, know your funding status, never mix in outside Advantage or Part D without understanding the consequences. If you're a teacher, state employee, or public retiree anywhere in the Midlands and 65 is within sight, bring us your PEBA paperwork. The review costs nothing, and you'll walk out knowing exactly which track you're on and what it'll cost.

Mauldin Insurance Group is an independent insurance agency in Lexington, SC. We are not affiliated with or endorsed by PEBA, the State of South Carolina, Medicare, or any government agency. PEBA rules and premiums change; consult PEBA's official publications at peba.sc.gov for current plan details.