Paying for Coverage
Rates
The 2024 NYSHIP health plan rates for retirees, vestees, dependent survivors and enrollees covered under Preferred List provisions of the State of New York and Participating Employers and their enrolled dependents are posted below.
You may change your option once at any time during a 12-month period. You may change from a NYSHIP-approved Health Maintenance Organization (HMO) to The Empire Plan, from The Empire Plan to an HMO or from one HMO to another HMO in your area.
Note: If you reside outside New York State, your only option is The Empire Plan. NYSHIP HMOs have limited service areas. If you move into an area served by a NYSHIP HMO, you will be eligible to change your option to an HMO at that time.
Your Share of the Premium
Retirees of the State of New York
The amount that you must contribute toward the NYSHIP premium in retirement is based on your salary grade (or equivalent) at the time you retired. See your General Information Book for additional details.
Retirees of Participating Employers
Your former employer is responsible for determining the amount that you must contribute toward the NYSHIP premium in retirement. Several factors are considered, including your contribution rate, type of health plan (Empire Plan or NYSHIP HMO) and type of coverage (Individual or Family). See your General Information Book for additional details.
Medicare Premium and Reimbursement Information
Premiums
Unless you do not meet Social Security eligibility requirements, there is typically no cost for Medicare Part A.
Most Medicare enrollees pay a standard Part B premium amount that is set annually by the federal government and paid either via deductions from their monthly Social Security benefit or directly to Medicare by credit card, debit card or from a checking or savings account.
If you are covered under The Empire Plan with Empire Plan Medicare Rx coverage or a NYSHIP HMO Medicare Advantage Plan, the Part D premium is included in your NYSHIP premium.
Medicare enrollees with higher annual earnings pay a surcharge for both Part B and Part D, otherwise known as the Income-Related Monthly Adjustment Amount (IRMAA). IRMAA is assessed by the Social Security Administration using information from enrollee income tax returns. The earnings threshold is recalculated each year.
Reimbursements
When Medicare is primary to NYSHIP, NYSHIP reimburses you for the standard Medicare Part B premium* (excluding any penalty for late enrollment). This reimbursement will either be added to your pension check or credited toward your monthly NYSHIP premium payments, as applicable.
If you must pay IRMAA, NYSHIP will reimburse you for the Medicare Part B portion. This reimbursement is not automatic; to receive it, you must submit an application and proof of payment to NYSHIP each year. If your application is approved, the Office of the State Comptroller will mail you a reimbursement check. There is no reimbursement for the Part D IRMAA costs.
If no premium is due, you will receive quarterly refund checks. These checks are issued on the last Thursday of February, May, August and November by the Office of the State Comptroller.
For more information about Medicare-related reimbursements, see Medicare & NYSHIP and the IRMAA Reimbursement FAQ.
* Unless you receive reimbursement from another source.
How Payment Works
Once you retire, you pay your share of the NYSHIP premium either through deductions from your monthly pension check or by remitting monthly payments directly to the Employee Benefits Division (EBD).
Monthly Pension Deductions If you receive your pension from the New York State and Local Retirement System (NYSLRS) or the New York State Teachers' Retirement System (NYSTRS), you may arrange for your share of the premium to be deducted automatically from your pension each month.
Bills from EBD
If you receive your pension from a retirement system other than NYSLRS or NYSTRS, you are billed by EBD (or by your former Participating Employer, if applicable) each month for your share of the premium and it is your responsibility to remit payment in a timely manner.
Lifetime Sick Leave Credit
When you retired, you may have been entitled to convert your unused sick leave into a lifetime monthly credit that reduces your cost for health insurance for as long as you remain enrolled in NYSHIP.* Your monthly credit amount will remain the same throughout your lifetime. However, because health insurance premiums generally increase annually, the balance you will owe may change each year. To calculate the balance you are responsible for paying, subtract your monthly sick leave credit amount from the current monthly premium.
* Not all employers offer sick leave credit. Please contact EBD if you have questions about whether this provision is available to you.
Copayments and Coinsurance
What They Are
The amount of money you are expected to pay upon receiving covered services under your health insurance plan is referred to as either a copayment or coinsurance.
A copayment is a fixed dollar amount that has been set for the service being received, regardless of the total cost of the service.
Coinsurance is a fixed percentage of the cost of the service being received.
Note: Copayment and coinsurance amounts for The Empire Plan and all NYSHIP HMOs may be viewed in Health Insurance Choices for 2024.
Annual Deductible
What It Is
The dollar amount you are required to pay before a health plan begins to reimburse for covered services received from non-network providers.
2024 Deductible Amounts
The 2024 Empire Plan deductible amounts may be viewed in Health Insurance Choices for 2024.
NYSHIP HMOs do not have annual deductibles.
Maximum In-Network Out-of-Pocket Limit
What It Is
The Maximum In-Network Out-of-Pocket (OOP) Limit is the most you will pay out of your own pocket in a given plan year for covered health care services delivered by in-network providers under your plan. Once you reach this limit, your copayments will be reimbursed by your plan for the remainder of the plan year.
2024 Empire Plan Maximum In-Network OOP Limits
| Individual Coverage | $1,400* | $2,600 |
| Family Coverage | $2,800* | $5,200 |
* Does not apply to Medicare-primary enrollees.
2024 HMO Maximum In-Network OOP Limits
The 2024 Maximum In-Network OOP Limits for the HMOs participating in NYSHIP vary by plan and may be viewed in
Health Insurance Choices for 2024.
Questions?
Additional information can be found in the following publications/documents:
Health Insurance Choices for 2024
General Information Book (NY Retiree)