Are you becoming eligible for Medicare due to turning 65, disability, or a diagnosis of End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS)? This page has information about how your Medicare benefits will work with your NYSHIP coverage.*
Medicare becomes your primary insurer when you are eligible for Medicare and enrolled in NYSHIP as a retiree, vestee, dependent survivor, or are covered under Preferred List provisions. To coordinate Medicare with your NYSHIP benefits, you should make sure that you:
Contact the Social Security Administration (SSA) to enroll in Medicare three months before your birthday month. Visit https://www.ssa.gov/onlineservices or call 1-800-772-1213.
Enroll in Medicare Parts A and B (be sure not to decline Part B).
If you are eligible for Medicare before age 65, you must notify the Employee Benefits Division that you have enrolled in Medicare Parts A and B, and provide a copy of your Medicare card.
Do not sign up for any non-NYSHIP Medicare Advantage Plan or Part D prescription plan.
To help you remember to enroll in Medicare, NYSHIP will send you a letter and Medicare information packet a few months before your 65th birthday.
*Some people confuse Medicare with Medicaid. Both are administered by the Centers for Medicare and Medicaid Services (CMS). Medicaid is a health insurance program for low-income persons of any age, is jointly funded by federal and state governments, and usually administered at the county or local level. Medicare is a health insurance program administered by the federal government to individuals over age 65 or who are eligible due to disability.
The section below includes a video, FAQs, publications, contact information and links to important resources about Medicare.
Medicare & NYSHIP Video
Medicare Part B Premium Reimbursement
When Medicare is primary to NYSHIP coverage, NYSHIP reimburses you for the standard Medicare Part B premium you pay to SSA, excluding any penalty you may pay for late enrollment.
NYSHIP automatically begins reimbursement for the standard cost of original Medicare Part B when Medicare becomes primary to NYSHIP coverage at age 65 for retirees, vestees, dependent survivors, and enrollees covered under Preferred List provisions, and their dependents who turn 65.
If you receive a pension, any reimbursement for Medicare Part B will be added to your pension check. If you pay your NYSHIP premium by direct payments to the Employee Benefits Division, Medicare Part B reimbursements will be credited toward your monthly NYSHIP premium payments, and if your Medicare reimbursement exceeds your health insurance premium, you will receive a quarterly reimbursement check from the Office of the State Comptroller.
If you have family coverage under NYSHIP, NYSHIP will also reimburse you for the standard Part B premium (and any Part B IRMAA) paid to SSA for any Medicare-primary dependent, provided the dependent is not reimbursed by another source or the premium is not paid by another entity.
I am (or my dependent is) Medicare-eligible prior to age 65, how will I/they be reimbursed for Part B?
Reimbursement is not automatic for any enrollee or covered dependent who is under age 65 and is eligible for Medicare due to disability, ESRD, or ALS. You must notify the Employee Benefits Division in writing and provide a photocopy of your (or your dependent's) Medicare card to begin the reimbursement in these cases.
Medicare Part B IRMAA (Income-Related Monthly Adjustment Amount)
The Income-Related Monthly Adjustment Amount (IRMAA) is an additional amount that you may be required to pay for your monthly Medicare premiums if you have higher annual earnings.
The Social Security Administration does not notify the Employee Benefits Division when enrollees are required to pay IRMAA. You may contact your local SSA office to verify whether you pay IRMAA by visiting https://www.ssa.gov/onlineservices or call 800-772-1213.
No, the IRMAA amount assessed by SSA for Part D is not reimbursed by NYSHIP.
To be reimbursed for IRMAA, you must complete the IRMAA Reimbursement Request application and submit it to the Employee Benefits Division along with proofs of payment of your Medicare Part B premium. Please refer to the IRMAA Reimbursement Application instructions for more information.
Yes, you can apply for IRMAA on behalf of a deceased enrollee. The person who is listed as the Executor/Executrix for the deceased enrollee may apply for reimbursement on their behalf. You will need to submit a copy of the Executor/Executrix paperwork in order to process the application.
Medicare Part D Information
Medicare-primary Empire Plan enrollees and dependents will automatically be enrolled in the Empire Plan Medicare Rx, a Medicare Part D prescription drug program with expanded coverage designed especially for Empire Plan members.
The Employee Benefits Division is required to send a Medicare Part D Prescription Drug Program notice annually to all active and retired NYSHIP enrollees and dependents who are 65 or older, or eligible for Medicare due to disability. The notice attests to the creditable coverage status of the NYSHIP prescription drug program.
Notice of Creditable Coverage Letter
Notice of Creditable Coverage Letter (COBRA)
New Medicare ID numbers and cards
New Medicare cards began mailing to all Medicare enrollees in April 2018. Your new card will have a unique ID that does not use your Social Security number. This will help protect your identity. For more information on the new cards, please visit http://go.medicare.gov/newcard.
The information provided in these publications relates to Medicare.
Links and Phone Numbers:
Social Security Administration: 1-800-772-1213, http://www.ssa.gov
Medicare: 1-800-633-4227, http://www.medicare.gov
The Empire Plan: 1-877-769-7447
Empire Plan Medicare Rx: 1-877-769-7447, Option 4
New York State Employee Retirement System: 1-866-805-0990, https://www.osc.state.ny.us/retire