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
Medicare Eligibility
Medicare eligibility begins:
- At age 65
- Regardless of age, after receiving Social Security Disability Insurance (SSDI benefits for 24 months)
- Regardless of age, after completing Medicare's waiting period of up to three months due to end-stage renal disease (ESRD)
- When receiving SSDI benefits due to amyotrophic lateral sclerosis (ALS)
Parts of Medicare
There are four parts to Medicare:
Individuals enrolled in New York State Health Insurance Program (NYSHIP) retiree health insurance will have supplemental coverage including prescription drug coverage through their NYSHIP plan when Medicare coverage is required and therefore do not need to enroll in Part C and Part D plans.
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 for Medicare:
- You are actively working and covered by NYSHIP group-sponsored health insurance plan as an active employee.
- Your dependent is covered by your NYSHIP 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 all eligible individuals enroll in Medicare Part A upon initial eligibility. Part A coverage will not affect NYSHIP coverage through your active employment for you or your covered dependents.
Once you retire from the university, Human Resources can assist you with Special Enrollment Period (SEP) forms for Part B enrollment that you will submit to Social Security.
I'm a Retired Employee
- Once you transition from NYSHIP active employee health insurance to NYSHIP retiree health insurance, you must enroll in Medicare Parts A and B if you are eligible.
- If your dependent is covered under your NYSHIP retiree health insurance, they must enroll in Medicare Parts A and B when eligible regardless of their employment status.
- 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 submit to Social Security .
When Medicare Becomes Your Primary Coverage
When you no longer have NYSHIP coverage as the result of active employment and are enrolled in NYSHIP as a retiree, vestee or dependent survivor and meet eligibility requirements for Medicare.
Exceptions
- Regardless of an enrollee's employment status, Medicare is primary for a domestic partner dependent is age 65 or older. If a domestic partner qualifies for Medicare due to disability, Medicare becomes primary when you retire or otherwise terminate employment.
- When Medicare eligibility is due to end-stage renal disease (ESRD), contact Medicare at the time of diagnosis for further information.
The Cost of Medicare
You usually don't pay a monthly premium for Medicare Part A coverage if you or your spouse paid Medicare taxes for a certain amount of time while working.
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, they must be enrolled as a dependent under your NYSHIP retiree plan and enrolled in Medicare as their primary coverage.
