Coverage For Employees 65+
If you’re over 65, still working for the City and enrolled in the NYC Health Benefits Program, do not use your Medicare card when you visit your doctor’s office. Instead, be sure to use the member ID card provided to you by your current HBP health plan.
These benefits are intended to provide you and your eligible dependents with the fullest possible protection that can be purchased with the available funding.
The OLR website and the NYC Health Benefits Program Summary Program Description provide you with information about your benefits under the New York City Health Benefits Program.
Those Enrolled In The Medicaid Buy In For Working People With Disabilities :
-
MBI-WPD is a program for people under 65 who are disabled and working. They have two big financial advantages:
-
They can be eligible for Medicaid at much higher income limits. The 2022 MBI WPD net income limit is $2,832 per month , compared to the regular disabled/aged/blind Medicaid income limit of $934 per month. . See this article for current income limits.
-
Earned income has a special “disregard” as a work incentive. Subtract $65 from monthly gross earned income, then deduct half of the remainder. So less than half of gross monthly income counts against the higher MBI-WPD income level. See links in this article for a more detailed explanation.
Therefore, many MBI WPD consumers have incomes higher than what MSP normally allows, but still have full Medicaid with no spend down. Those consumers can qualify for MIPP and have their Part B premiums reimbursed. See HIPP/MIPP DOH Training Notebook– Health Insurance Training Center 2017 . Here is an example.
-
Sam is age 50 and has Medicare and MBI-WPD. She gets $1500/mo gross from Social Security Disability and also makes $400/month through work activity.
-
$ 167.50 — EARNED INCOME – Because she is disabled, the DAB earned income disregard applies:
$400 – $65 = $335. Her countable earned income is 1/2 of $335 = $167.50
-
+ $1500.00 — UNEARNED INCOME from Social Security Disability
-
= $1,667.50 ––TOTAL income. This is above the SLIMB limit of $1,359 but she can still qualify for MIPP.
Court Rules Retirees Can Keep Current Insurance Free Of Charge As Alternative To A Planned Cost
Retired municipal workers workers celebrate outside City Hall a legal victory protecting their healthcare benefits.
Ben Fractenberg/THE CITY
A years-long fight over a planned cost-cutting change to retired city employees health coverage reached a critical juncture Thursday with a judges decision that allowsretirees to choose to keep their current plan.
The ruling from Judge Lyle Frank in Manhattan state Supreme Court allows a joint city-union effort to shift retired municipal workers health coverage from traditional Medicare to a privatized Medicare Advantage program by April 1 to proceed. But the city must now let current and future retirees opt out of the shift and maintain their current health care free of charge.
The ruling was a partial win for the city, which under former Mayor Bill de Blasio reached agreement with municipal unions to pursue the Medicare switch and other cost savings as existing workers sought raises.
But its also a victory for the group of retirees who sued to stop the switch, citing fears of higher costs, smaller networks, and greater administrative obstacles to accessing health care and preferred doctors under the new plan.
Especially for retirees at the lower end of the citys pension scale, which bottoms out around $15,000 a year, that cost threatened a significant financial burden.
A spokesperson for City Hall said We are reviewing the courts decision and evaluating our options.
You May Like: At What Age Can I Retire With Full Benefits
Medicare Part B Reimbursement
The City will reimburse retirees and their eligible dependents for Medicare Part B premiums paid, excluding any penalties. You must be receiving a City pension check and be enrolled as the contract holder for City health benefits in order to receive reimbursement for Part B premiums.
For most retirees, the refund is issued automatically by the Health Benefits Program. If you are currently receiving your pension check through Electronic Fund Transfer or direct deposit, your reimbursement will be deposited directly into your bank account. This will be separate from your pension payment. If you dont have EFT or direct deposit, you will receive a check in the mail in June.
Medicare Part B And Irmaa
dateApr 14, 2022
Medicare Part B standard reimbursement for Medicare Part B of $148.50 /month will be issued sometime during the month of April. If you receive your pension via direct deposit, you will see a deposit on your bank statement. If you receive your pension via paper check, you will receive your Medicare Part B reimbursement via paper check.
If you already submitted your Medicare Part A & B card to the Health Benefits Program, this payment is automatic and you will receive it annually. Visit the OLR website if you have any questions.
if you have direct deposit, be sure to check your bank account. The City started making deposits on April 14. Checks will take a few more days.
application is now available online.IRMAA application is available on the OLR website. For those who are eligible, IRMAA 2021 reimbursement will be issued in October 2022. Applications will be available from the OLR website in May.
Use this link to submit your documents.
Be sure to have all your documents ready by using the check list below:
- SSA Notice of Medicare Part B premium award letter
- this form can also be used for 2019 and 2020 reimbursements
Don’t Miss: How Estimate Social Security Benefits
City Coverage For Medicare
In order to maintain maximum health benefits, it is essential that you join Medicare Part A and Part B at your local Social Security Office as soon as you are eligible. If you do not join Medicare, you will lose whatever benefits Medicare would have provided. Read More
The Citys Health Benefits Program supplements Medicare but does not duplicate benefits available under Medicare. Medicare-eligible members must be enrolled in Medicare Parts A and B in order to be covered by a Medicare HMO plan. To enroll in Medicare and assure continuity of benefits upon becoming age 65, contact your Social Security Office during the three-month period before your 65th birthday. In order not to lose benefits, you must enroll in Medicare during this period even if you will not be receiving a Social Security check.
If you are over 65 or eligible for Medicare due to disability and did not join Medicare, contact your Social Security Office to find out when you may join. If you do not join Medicare Part B when you first become eligible, there is a 10% premium penalty for each year you were eligible but did not enroll. In addition, under certain circumstances there may be up to a 15-month delay before your Medicare Part B coverage can begin upon re-enrollment.
If you or your spouse are ineligible for Medicare Part A although over age 65 , contact us at:
NYC Health Benefits Program22 Cortlandt Street, 12th FloorNew York, NY 10007
When Should I Contact My Health Plan
Find out when you should contact your Health Plan. Read More
- If you have questions regarding covered services
- To obtain written information about covered services
- For information about the status of pending claims or claim disputes
- For claim allowances
- For health plan service areas
When writing to a health plan, include your name and address, certificate number, date of service, and claim number, if applicable. Some plans also allow inquiries through their web sites.
Recommended Reading: Veteran Owned Business Tax Benefits
What You Need To Know To Make A Decision
TO GET YOUR QUESTIONS ANSWERED TAKE THESE STEPS IN ORDER
- Barbara Caress Presentation at 10/04/21 chapter meeting: Choosing Traditional Medicare or Medicare Advantage.
FAQS FROM QUESTIONS ASKED AT CHAPTER AND INFORMATION MEETINGS
ENROLLMENT GUIDES
In response to a Temporary Restraining order, the New York City Office of Labor Relations changed the opt out and enrollment dates to the end of March. Leon E. Frank, the judge who issued a Temporary Restraining Order, determined that the original enrollment guides were inaccurate or incomplete in several areas and Instructed the City to notify all municipal retirees of errors in the original MA+ material, telling them how to obtain a corrected enrollment guide.
Below are links to the original guides:
OPT OUT FORMS
OPT-OUT CONFIRMATIONS
OPT OUT PAYMENTS
VENDOR RELEASES PRE-AUTHORIZATION LIST
NY RETIREE HEALTH RATE CHARTS EFFECTIVE JANUARY 1, 2022
If you opt out of the Alliance Medicare Advantage plan in order to continue with your current NYC health care plan, you will have to pay a monthly premium . Click here to see the rates on the NYC Office of Labor Relations website. Note that you will NOT be paying for prescription drug coverage since that is already covered by the PSC CUNY Welfare Fund.
NYC OFFICE OF LABOR RELATIONS ON RETIREE HEALTHCARE BENEFITS
When The Part B Premium Reduces Countable Income To Below The Medicaid Limit
- Since the Part B premium can be used as a deduction from gross income, it may reduce someone’s countable income to below the Medicaid limit. The consumer should be paid the difference to bring her up to the Medicaid level . They will only be reimbursed for the difference between their countable income and $904, not necessarily the full amount of the premium.
Read Also: Saint Francis Hospital Employee Benefits
Medicare Insurance Premium Payment Program
Some “dual eligible” beneficiaries are entitled to receive reimbursement of their Medicare Part B premiums from New York State through the Medicare Insurance Premium Payment Program . The Part B premium is $148.50 in 2021. MIPP is for some groups who are either not eligible for — or who are not yet enrolled in– the Medicare Savings Program , which is the main program that pays the Medicare Part B premium for low-income people. Some people are not eligible for an MSP even though they have full Medicaid with no spend down. This is because they are in a special Medicaid eligibility category — discussed below — with Medicaid income limits that are actually HIGHER than the MSP income limits. MIPP reimburses them for their Part B premium because they have full Medicaid but are ineligible for MSP because their income is above the MSP SLIMB level . Even if their income is under the QI-1 MSP level , someone cannot have both QI-1 and Medicaid). Instead, these consumers can have their Part B premium reimbursed through the MIPP program.
In this article:
Nyc Health Benefits Program
Welcome to the Employees Benefits Program Secure File Upload. You can use this service to send documents securely. All transfers are confidential and SSL encrypted. Once you select the topic below you will be able to enter your information on the next page and to attach your document for submission to the Employee Benefits Program. Please allow 30-45 days from the day you submit your document for them to be processed. Coverage will be retroactive to the effective date of retirement. Please do not submit your forms more than once, as that will only slow down the processing of all forms.Please note: Employees should contact their agency health benefits/payroll office or 1) NYCAPS Central by Phone 487-0500 or email at nycapscentral@dcas.nyc.gov or HealthBenefits@dcas.nyc.gov or 2) Department of Education employees can contact HR Connect at 935-4000 or email: HRCONNECTBENEFAX@SCHOOLS.NYC.GOV, or 3) H + H employees can contact Shared Services at 458-5634 or email:hhcbenefits@nychhc.org
If you are having problems uploading please see the tutorial HERE.
Available Recipients
Don’t Miss: Winn Dixie Part Time Employee Benefits
Medicare Part B Reimbursement Program For City Retirees And Dependents
Once you have collected 24 months of Social Security Disability Insurance benefits , you automatically become eligible for Medicare. Medicare becomes your primary medical coverage your city coverage remains as secondary coverage.
Medicare charges a premium which is automatically deducted from your monthly benefit from Social Security. Medicare-eligible City retirees and dependents are eligible to have that premium reimbursed. Once you receive your Medicare card, you must notify the New York City Office of Labor Relations by providing a copy of your Medicare card and completing an application, available on the NYC OLR website: .
You only need to submit this application one time, once you are enrolled in the reimbursement program you should not have to refile every year. The reimbursement is usually made in each Spring it is distributed in the same manner in which you receive your pension payments.
Irmaa Or Medicare Part B Reimbursements
Information about Medicare and IRMAA Reimbursement Read More
Medicare Part B 2021 Reimbursement
Medicare-eligible retirees and their Medicare-eligible dependents will be reimbursed annually for the standard Medicare Part B amount of $148.50 per month , excluding any penalties and late enrollment fees, and subject to be pro-rated.
Medicare Part B 2021 reimbursements were issued in April 2022. Please check your bank account/statement for your payment.
If you already submitted your Medicare Part A & B card to the Health Benefits Program, this payment is automatic and you will receive it annually.
Medicare Part B 2020 Reimbursement
Medicare Part B 2020 reimbursements were issued in April 2021. Please check your bank account/statement for your payment.
If you already submitted your Medicare Part A & B card to the Health Benefits Program, this payment is automatic and you will receive it annually.
Medicare Part B 2019 Differential Reimbursement
Please note that if you were Medicare-eligible prior to 2016, you must complete the Medicare Part B Differential Form for 2019 in order to receive the Medicare Part B differential payment. The payment was based on the amount that you paid in 2019.
If you were enrolled in Medicare Part B effective after 2016, then you are already receiving the full payment and do not need to complete the Medicare Part B Differential Form.
IRMAA 2021 Reimbursement
IRMAA 2021 annual reimbursements will be issued during the 3rd week of October 2022.
Read Also: Benefits Of Paying Quarterly Taxes
What Clix Revenue Users Say
We are projecting up to 10% higher reimbursements per bed thanks to CLiX revenue
With CLiX we are able to quickly deliver results on an unprecedented scale and pace, reducing costs and driving revenue”
CLiX can capture the deep clinical meaning critical to support high cost DRGs, but can still avoid frustrating false positives
Customer feedback in the KLAS-Chime Partnership Performance Report into Healthcare AI 2019
Questions About Your Irmaa Or Medicare Part B Reimbursements
Medicare Part B 2021 Reimbursement
Medicare-eligible retirees and their Medicare-eligible dependents will be reimbursed annually for the standard Medicare Part B amount of $148.50 per month , excluding any penalties and late enrollment fees, and subject to be pro-rated.
Medicare Part B reimbursements were issued in April 2022. Please check your bank account/statement .
If you already submitted your Medicare Part A & B card to the Health Benefits Program, this payment is automatic and you will receive it annually.
Medicare Part B 2020 Reimbursement
Medicare Part B 2020 reimbursements were issued in April 2021. Please check your bank account/statement for your payment.
If you already submitted your Medicare Part A & B card to the Health Benefits Program, this payment is automatic and you will receive it annually.
Medicare Part B 2019 Differential Reimbursement
Please note that if you were Medicare-eligible prior to 2016, you must complete the Medicare Part B Differential Form for 2019 in order to receive the Medicare Part B differential payment. The payment was based on the amount that you paid in 2019.
If you were enrolled in Medicare Part B effective after 2016, then you are already receiving the full payment and do not need to complete the Medicare Part B Differential Form.
Medicare Part B 2019 differential reimbursements were issued in March 2021. Please check your bank account/statement for your payment.
IRMAA 2021 Reimbursement
IRMAA 2020 Reimbursement
Don’t Miss: What Does The Employee Benefits Security Administration Do
Those With Special Budgeting After Losing Ssi
Disabled Adult Child :
-
Special budgeting is available to those who are 18+ and lose SSI because they begin receiving Disabled Adult Child benefits . Consumer must have become disabled or blind before age 22 to receive the benefit. If the new DAC benefit amount was disregarded and the consumer would otherwise be eligible for SSI, they can keep Medicaid eligibility with NO SPEND DOWN. See this article.
-
Consumers may have income higher than MSP limits, but keep full Medicaid with no spend down. Therefore, they are eligible for payment of their Part B premiums. See page 96 of the Medicaid Reference Guide . If their income is lower than the MSP SLIMB threshold, they can be added to MSP. If higher than the threshold, they can be reimbursed via MIPP.
-
“Individuals who are certified as DAC MA eligible and who are in receipt of Medicare Part B are eligible to have MA pay the appropriate Medicare premium on their behalf through the Buy-In system.”
Pickle & 1619B:
-
Similarly, consumers with full Medicaid under the Pickle Amendment or 1619B are also eligible to have their premiums reimbursed under the buy-in program. See page 80 of the Medicaid Reference Guide .
Dc 37 Health & Security Plan Benefits
Important Information for DC 37 Members About to Retire
For medicare-eligible* retirees who are eligible to receive a pension from NYCERS/BERS/TRS/NYSERS/CIRS* Medicare-eligible = age 65 and/or disability
Eligibility
You must be a DC 37 member, Medicare eligible, and be pension eligible under NYCERS/BERS/TRS/NYSERS/CIRS.
City Health Insurance
You may wish to refer to the City of New Yorks Health Benefits Program Summary Program Description booklet.
Complete a Health Benefits Application form.
Apply for Medicare Parts A and B at your nearest Social Security office. If you are retiring before or at the age of 65, ` apply for Medicare Parts A and B in the three months before your 65th birthday. You will not be eligible for Medicare Parts A and B until you reach your 65th birthday.
When you retire and are age 65 or over, you must have Medicare Parts A and B to continue your City health insurance. The premium cost of Medicare Part B will be taken out of your Social Security check. When you retire, you and your eligible dependents will be reimbursed for the cost of Medicare Part B once a year.
City of New York40 Rector Street, 3rd FloorNew York, NY 10006 513-0470
Medicare
Medicare is the primary health insurance for retirees age 65 or over . City health insurance is the secondary health insurance. If you are retired and receiving Medicare Parts A and B, you may choose a supplement to Medicare or a Medicare + Choice health insurance plan.
Social Security
Don’t Miss: Help With Social Security Disability Benefits