Understanding Medicare
On this page:
Find out what Medicare premiums will be reimbursed to you.
Action Item
Learn when Medicare will be your primary coverage
Parts of Medicare
There are four parts to Medicare:
- Part A Hospital Coverage
- Part B Medical Coverage
- Part C Medicare Advantage Plans
- Part D Drug Coverage
Generally, employees and retirees do not need to be concerned with Parts C and D coverage. NYSHIP retiree health insurance acts as supplemental coverage once a retiree is enrolled in Medicare Parts A and B. NYSHIP retiree coverage also contains credible drug coverage and therefore Part D enrollment is generally not required.
Enrolling in Medicare
I'm an Active Employee
If you and your covered dependent(s) meet the following criteria, you may be eligbile to defer enrolling in Medicare Part B once you become eligible:
- You are actively working and covered by a group-sponsored health insurance plan as an active employee.
- Your dependent is covered by your group-sponsored health insurance plan (not retiree coverage) regardless of if they are actively working or not.
You must continue to meet these requirements in order to continue deferring Medicare Part B.
It is recommended that you or your dependent(s) enroll in Part A when you are eligible because it is free to insured individuals. Once you retire from the university, Human Resources can assist you with Special Enrollment Period (SEP) forms for Part B enrollment that you will take to your local Social Security office.
I'm a Retired Employee
- Once you transition from active employee health insurance to retiree health insurance, you must enroll in Medicare Parts A and B if you are eligible.
- If your dependent is covered under your retiree health insurance, they must enroll in Medicare Parts A and B when eligible even if they are actively working.
- If you are retiring after becoming eligible for Medicare, Human Resources can assist you with Special Enrollment Period (SEP) forms for Part B Enrollment that you will take to your local Social Security office.
When Medicare Becomes Your Primary Coverage
Medicare becomes your primary coverage once you are retired and eligible to enroll. Your NYSHIP health insurance becomes your supplemental coverage.
Medicare enrollment is specific to individuals. Medicare enrollment is based on the eligibility of you and your covered dependents.
- If you retire prior to age 65, Medicare will become primary coverage the 1st of the month in which you turn 65.
- If you retire after age 65, Medicare will become primary the 1st of the month following your transition to retiree coverage.
The Cost of Medicare
Part A Medicare is free to insured individuals. There is a monthly cost for Part B Medicare which may be adjusted based on income. Social Security determines if you are charged at a rate higher than the base rate, called Income Related Monthly Adjustment Amounts (IRMAA).
Medicare Reimbursement for Retirees
Once retired, you may receive a reimbursement for the monthly cost of Medicare Part B from the NYS Department of Civil Service, Employee Benefits Division.
- You must be enrolled in a NYSHIP retiree plan and enrolled in Medicare as your primary coverage.
- To receive a reimbursement for your dependent, he/she must be enrolled as a dependent under your NYSHIP retiree plan and enrolled in Medicare as his/her primary coverage.
To ensure that you receive your reimbursement, use the Model Letter for Contacting the Employee Benefits Division to request reimbursement and include copies of your and your dependent's Medicare cards.
Receiving Your Retiree Medicare Reimbursement
- ERS/TRS retirees will receive the reimbursement in their monthly pension check.
- ORP retirees will receive a quarterly reimbursement in a paper check mailed to your home address.
- If you/your dependent is charged IRMAA (higher rate for Part B), you will be reimbused at the base monthly rate and will have an opportunity to receive reimbursement for the overage once a year.
