Understanding Medicare
Find out how Medicare works with NYSHIP
On this page:
Action Items
- Learn when to enroll in Medicare
- Understand costs and reimbursements
Medicare is the federal health insurance program for people age 65 and older, and for those under age 65 with certain disabilities. It is administered by the Social Security Administration and the Centers for Medicare and Medicaid Services (CMS).
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
Retirees enrolled in New York State Health Insurance Program (NYSHIP) 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.
When Medicare Coverage Must be in Effect
While you are working and maintaining NYSHIP health insurance through your active employment, enrollment in Medicare may be deferred until you no longer have NYSHIP coverage as a result of active employment. These rules apply to dependents covered on your NYSHIP coverage regardless of their employment status.
It is recommended that all eligible individuals enroll in Medicare Part A upon initial eligibility if you are enrolled in NYSHIP through active employment. 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 will provide next steps for Medicare enrollment if you and/or your dependents have already met initial eligibility for Medicare.
EXCEPTIONS
Regardless of an enrollee’s employment status, Medicare is primary for a domestic partner dependent who is age 65 or older. If you have a domestic partner under age 65 who is Medicare eligible due to disability, NYSHIP is primary while you have coverage as an active employee; once you retire or otherwise terminate employment, Medicare becomes primary.
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
Most Medicare enrollees pay a standard Medicare Part B premium amount set by the federal government annually. When Medicare is primary to NYSHIP, NYSHIP reimburses you for the standard Medicare Part B premium (excluding any penalty for late enrollment) and any IRMAA you must pay for Part B.
If you have Family coverage under NYSHIP, NYSHIP also must reimburse you for the standard Part B premium and any Part B IRMAA imposed for any Medicare-primary dependent, provided the dependent is not reimbursed by another source or the premium is not paid by another entity. You are not entitled to any reimbursement for any Part D IRMAA costs.
What is IRMAA?
In addition to the standard premiums for Medicare Parts B and D, Medicare enrollees with a higher Modified Adjusted Gross Income (MAGI) pay an additional Income-Related Monthly Adjustment Amount (IRMAA), a Medicare premium amount adjusted for income, for Part B coverage and a separate IRMAA for Part D coverage.
Contact the Benefits Team
The State Benefit Services Team is available to answer your questions. Use our contact information below to access all team members for the fastest response.
Department Leadership
Contact our department leaders for additional assistance.
![Lissa Jasinowski.]()
Lissa Jasinowski
Assistant Director
Benefits and Work Life Balance
Phone: (716) 645-4488
Email: lmt22@buffalo.edu
