The Connection

Getting Started

Part A

Hospital Insurance

Part B Medical

Insurance

Part C Medicare

Advantage (like HMOs and PPOs)

Part D Medicare

Prescription Drug

Coverage

3

Part A – Hospital Insurance◦ Hospital◦ Skilled Nursing Facility◦ Home health care◦ Hospice care◦ No Cost

Part B – Medical Insurance◦ Doctor’s visits – Medicare pays 80%, Plan pays 20%◦ Outpatient hospital services◦ Clinical lab tests◦ Preventive services◦ Premium -

4

Part C ◦ Another way to obtain Medicare known as Medicare

Advantage Plans◦ Offered by private companies that provide both Part

A (hospital) and Part B (medical) insurance◦ Act as HMO or PPO (Ex. Hip)

Part D o Drug Plan – 3 Tierso Must have Parts A & B o Late Enrollment Penaltyo Premium

5

Part A – Nothing Part B – Depends on income ◦ Standard - $ 134.00 for 2018◦ Income-Related Medicare Adjustment Amount (IRMAA ) ◦ Both Standard & IRMAA Part B Costs Reimbursed by NYC◦ Deductible - $183

Part D –o Monthly Premium (High Option Rider)o Co-pays – 3 Tierso Reimbursed $40 per month for each month in previouso year. (Valentine Day Check – max of $480) by Welfare Fundo Express Scripts – Network Pharmacy

6

Individual tax return Joint tax return IRMAAamount

total monthly premium

$85,000 or less $170,000 or less $0.00 $134.00$85,001 to $107,000 $170,001 to $214,000 $53.50 $187.50$107,001 to $133,500 $214,001 to $267,000 $133.90 $267.90$133,501 to $160,000 $267,001 to $320,000 $214.30 $348.30Above $214,000 Above $320,000 $294.60 $428.60

If your yearly income in 2016 (for what you pay in 2018) was:

NY City (OLR) reimburses Part B including IRMAA

Individual tax return Joint tax return Youpay

$85,000 or less $170,000 or less $0.00$85,001 to $107,000 $170,001 to $214,000 $13.30$107,001 to $133,500 $214,001 to $267,000 $34.20$133,501 to $160,000 $267,001 to $320,000 $55.20Above $160,000 Above $320,000 $76.20

If your yearly income in 2016 (for what you pay in 2018) was:

NY City does NOT reimburse surcharge

Receive Medicare card 3 months before 65th

birthday. Automatically enrolled in Part A Sign Card – Send copy to CSA Welfare Office Automatically enrolled in Part B after 1st visit

to doctor Enrolled in Part D – GHI Drug Plan – through

High Option Rider

12

The “Trick” Question !!

Medicare & You Handbook Other CMS publications 1-800-MEDICARE National Medicare Training Program◦ cms.hhs.gov/NationalMedicareTrainingProgram

Medicare Rights : medicarerights.org Guide to Medicare Products: medicare.com Official Govt Site for Medicare: medicare.gov

270

Q. Do you need to take a Medigap Insurance plan?

A. No, GHI is your Medigap plan.Q. If you are not receiving SS, how do you pay

Medicare Part B? A. SS sends you a bill.

05/05/2011Getting Started 28

CSAWelluFare

FUND

...WhenI’m64

The CSA Welfare Funds’ Guide to Turning65 and becoming eligible for Medicare

40 Rector St., 12th Fl., New York, NY 10006 | (212) 962-6061 | www.csawf.org

Congratulations!

On your next birthday, youturn 65 and you havesomething to really cele-

brate. You are eligible for one ofthe nation’s premiere entitlementprograms – Medicare.

When you sign up forMedicare, your city-providedhealth plan automatically becomesa Medicare supplement (some-times called a Medi-Gap policy)and your optional drug benefit au-tomatically becomes a plan thatmeets the federal requirements fora Medicare Part D prescriptiondrug plan.

But what is Medicare? Do youhave to sign up? How do you signup? What if you’re still working?The answer to these questions de-pends upon your individual cir-cumstances – whether you’remarried, still working for the DOE,working for another company orfully retired. Fortunately, mostpeople fall into one category or an-other. Further in this brochure,we’ll describe a number of scenar-ios and you’ll probably fall into oneof them.

But first, let’s cover the basics.What is Medicare?

Medicare is health insurancefor people age 65 or older,under 65 with certain dis-

abilities and for those of any agewith end-stage renal disease. Gen-erally, Medicare pays 80 percent ofan allowable charge. The remain-ing 20 percent is the patient’s out-of-pocket responsibility.

For most participants,Medicare consists of three parts:A, B, and D. Part A covers hospitaland facility services including hos-pitals, skilled nursing facilities,rehab facilities, home health care

and hospice care. Part A is auto-matic. You do not sign up for PartA. Do nothing and you’re coveredonce you turn 65. Medicare Part Ais provided without cost to anyonewho has worked 40 calendar quar-ters paying into Social Security.Part B generally covers physicianvisits and laboratory tests.

When we talk about Medicarepremiums, we’re really talkingabout Medicare Part B payments.Part D covers most prescriptionmedications. To join a MedicarePrescription Drug plan, you must

The Medicare Alphabet

CSAWelluFare

FUND

1

CSAWelluFare

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1CSA

WelluFareFUND

2

have Medicare Part A and/or Part B.You pay a monthly premium forPart D in addition to Part B premi-ums. (One source says the averagepremium is $31.92 a month, al-though it varies across the coun-try.) There are also annualdeductibles for both Part B and PartD. While there is a deductible for“standard” Part-D, the EnhancedPart-D plan that city retirees joindoes not have a deductible.

Medicare Part B generally paysfor 80 percent of out-of-pocketcosts. Participants, therefore, areresponsible for 20 percent. Mostparticipants, therefore, purchasesome form of supplemental insur-ance to help pay for this 20 percent.NYC municipal retirees do notneed to purchase any additionalcoverage, since their city coveragebecomes the Medicare supplementautomatically. The Municipal LaborCommittee, a coalition of publicemployee unions, negotiated thisbenefit for you.

Part C is a little more mysteri-ous to some people but it is simplyanother way to get Medicare. PartC is a program called Medicare Ad-vantage Plans. These are healthplans offered by private companiesthat provide both Part A (hospital)and Part B (medical) insurance.Part C plans operate as HMO orPPOs or other similar models. (HIPcan be a Medicare AdvantagePlan.) The plans are generally alower-cost alternative to the origi-nal Medicare plan and may offerbenefits that original Medicaredoes not provide but they do nothave the flexibility that MedicarePart A and B have. For example,Part C subscribers may only go toparticipating providers and mustfollow proscribed rules for seeingspecialists or getting referrals.Many Medicare Advantage Plansprovide a Medicare Part D drugbenefit in the basic premium withan option to purchase more exten-sive drug coverage.

How Do I Sign Up?

A bout three months beforeyour 65th birthday, if youare receiving a Social Secu-

rity check, Social Security willsend you an informational letterand an identification card. If you

do not receive this letter, you’llhave to call the Social SecurityAdministration at (1-800 772-1213). If you have decided to waitand collect Social Security at yourfull retirement age, you can apply

CSAWelluFare

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3

Just before your 65th birthday,you will also receive a mailingfrom the NYC Office of Labor

Relations (OLR). Thanks again tothe Municipal Labor Committee,NYC is contractually obligated toreimburse the Medicare Part B pre-mium, in full, for eligible NYC re-tirees and their dependents.

To do this, the OLR requires acopy of your Medicare identificationcard. As a special service to CSA re-tirees, the Welfare Fund can helpyou get a copy of your Medicarecard to OLR. Of course, you cansend it yourself by following the in-structions you receive but if wehelp, we make sure that the city is

Don’t CSA Retirees Get Part B Reimbursed?

online at www.ssa.gov. You may also visit your local

Social Security office if you prefera more personalized experience.

Generally, you are required toenroll in Medicare Part B whenyou are first eligible for it. Thereare exceptions to this rule andwe’ll discuss them below. Pleasenote: If you are eligible forMedicare Part B and you do notfit into any exemption categories,you will pay a higher premium ifyou fail to enroll within sixmonths of your initial eligibilitydate. In other words, if you delayenrolling, do not meet the ex-emption critera and ultimately doenroll, you will pay more for yourcoverage for the rest of your life.

To enroll in Medicare Part B,sign the identification card and

start using it the first day of themonth of your birthday. For exam-ple, if your birthday is Oct. 28,you can begin using Medicare onOct. 1.

If you fit into one of the ex-emption categories, or do notwant to sign up for Part B, followthe instructions for returning thecard to Social Security. (But theWelfare Fund urges you to makesure you understand the ramifica-tions before you do this.)

To sign up for Part C, aMedicare Advantage Plan, contact specific plans to get moreinformation about benefits andcosts. Once you choose a plan,you may be able to join by com-pleting a paper application, callingthe plan or enrolling on the plan’swebsite.

CSAWelluFare

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4

aware of your new Medicare status.If you want our help, send the copyto the CSA Retiree Welfare Fund.We’ll scan it and e-mail it to OLR.(CSA Welfare Fund, 40 Rector St.,12th Fl., New York, NY 10006.)

We’ll also mail it to yourMedicare supplemental health plan– your city-provided plan –so theytake the necessary action to ensureyou are properly enrolled in“crossover billing.” That’s insur-ance-speak for when Medicareelectronically sends claim informa-tion directly to your Medicare sup-plemental insurance company.Then you don’t have to submit billsor explanation of benefits to yoursupplemental plan; it’s done foryou! In our experience, not onlydoes this save you time, but sub-mitting data electronically both im-proves accuracy and speeds upreimbursements.

In addition:1) The spouse of a retired city

employee may be eligible for

Medicare Part B premium re-imbursement as well if coveredunder the member’s CityHealth Plan. You’ll need tosend a copy of his or herMedicare card to OLR as well.

2) Part B premium reimbursements are sent once a year in April. You will receive your 2018 Part B reimbursement in April 2019.

3) Some people pay a surcharge for Medicare Part B benefits based on the adjusted gross income they report to the IRS. This figure is called the Income-Related Medicare Adjustment Amount (IRMAA). The OLR will send you instructions on IRMAA reimbursement when you receive your initial reimbursement in April. IRMAA reimbursements are made in October. So 2018 IRMAA reimbursements will be paid in October 2019; 2019 IRMAA reimbursements will be paid in October 2020 and so on.

I’m Still Not Sure What To Do

OK. So you understandMedicare in principle, butyou’re still not sure what

to do. And your next step does de-pend on your individual circum-stances. Fortunately, most people

fit into one category or another,and below, we’ve provided a num-ber of scenarios. In all the follow-ing situations, you retain your CSARetiree Welfare Fund benefits ifyou have retired from the Depart-

CSAWelluFare

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5

ment of Education. If you reallyhave a unique situation, please con-tact the Welfare Fund and we willreview your situation with you. Wewant you to be properly insured.

Scenario 1: You have retired, youare not married, and you nolonger work.• You must enroll in Medicare B

to avoid penalties.• Sign your Medicare identifica-

tion card and send a copy toOLR for Medicare Part B reim-bursement. (Again, the WelfareFund can do that for you.)

Scenario 2: You have retired, youare not married, and you take ajob with a company with morethan 20 employees that offershealth benefits.• Medicare Part A becomes your

secondary coverage and youneed not enroll in Part B. Returnthe identification card to SocialSecurity.

• You may waive your city benefits.• Three months before you leave

the second job, complete a Spe-cial Enrollment Period (SEP)form, have it certified by thecompany’s human resources de-partment, and submit it directlyto a local Social Security office.(Please note: The Special Enroll-ment Period is not the same

thing as the Special Election Pe-riod, which refers to a set timein which a beneficiary canchange health plans.)

• Sign your Medicare identifica-tion card and submit to OLR forMedicare Part B reimbursement.

Scenario 3: You have retired, youare not married, and you nowwork for a company with fewerthan 20 employees.• You must enroll in Medicare

Part B (unless your employeragrees, in writing, to providethe primary insurance coveragefor your benefits.)

• Your employer coverage or citycoverage will be secondary toMedicare Part B.

• Sign your Medicare identifica-tion card and submit to OLR forMedicare Part B reimbursement.

Scenario 4: You’re retired, you’remarried, you’re both eligible forMedicare and neither of you has ajob.• Both you and your spouse must

enroll in Medicare Part B.• Sign your Medicare identifica-

tion card and submit forMedicare Part B reimbursement.

• Submit a signed copy of yourspouse’s Medicare card to OLR.The city will reimburseMedicare B premiums for thespouse of a city retiree provided

CSAWelluFare

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6

that spouse does not receive re-imbursement elsewhere, and is covered by the City.

Scenario 5: You are married andyou and your spouse are eligiblefor Medicare. Your spouse worksfor a company with more than 20employees and the member iscovered by spouse’s insurance. • Medicare is your secondary cov-

erage. You need not enroll in PartB at this time. Return the identi-fication card to Social Security.

• You may waive your city benefits.• Three months before your

spouse retires, complete a Spe-cial Enrollment Period (SEP)Form for both you and yourspouse, have them certified byyour spouse’s human resourcesdepartment, and submit themdirectly to a local Social Securityoffice. When you receive yourMedicare card, sign it and use.

Scenario 6: You and your spouseare retired, neither of you worksbut one of you is not eligible forMedicare yet.• Medicare is the primary cover-

age for a person age 65 or older.• Sign the Medicare identification

card and submit for MedicarePart B reimbursement

• City coverage is then considereda “split contract”. The Medicare-eligible person will receive sec-ondary benefits through the city

health plan. The non-Medicareeligible person will receive thesame benefits as before.

• Pension deduction is for oneperson on Medicare + one non-Medicare.

• CSA Retiree Welfare Fund pro-vides a supplemental benefit toboth members.

Scenario 7: You’re still workingfor the NYC Department of Educa-tion when you turn 65 and youare not married.• You need not enroll in

Medicare Part B (you will auto-matically be enrolled in Part A).Return the identification cardto Social Security.

• You remain in the CSA WelfareFund. The CSA Welfare Fundprescription drug benefit is con-sidered credible coverage withrespect to Medicare Part D andyou will not incur a penalty bynot enrolling in a Medicare PartD plan at this time.

• Three months before you retire,complete a Special EnrollmentPeriod (SEP) form, have it certi-fied by your human resourcesperson, and submit directly to alocal Social Security office.

• When you receive yourMedicare identification card,sign it and submit for MedicarePart B reimbursement.

CSAWelluFare

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7

Scenario 8: You’re married andworking for the NYC Departmentof Education. Your spouse is eligi-ble for Medicare.• Medicare is your spouse’s sec-

ondary coverage, and he or sheneed not enroll now. Return theidentification card to Social Se-curity.

• Your spouse maintains your CSAWelfare Fund benefits. The CSAWelfare Fund prescription drugbenefit is considered credible cov-erage with respect to MedicarePart D and will not incur apenalty by not enrolling in aMedicare Part D plan at this time

• Three months before you retire,complete a Special EnrollmentPeriod (SEP) form for spouse,have it certified by your humanresources person, and submit di-rectly to a local Social Securityoffice.

• Your spouse will now receive aMedicare identification card.

Scenario 9: You’re working for theNYC Department of Education andyour domestic partner becomes el-igible for Medicare.• The federal government does

not recognize domestic partner-

ships. Your domestic partnerMUST enroll in Medicare Part B.If a domestic partner who isMedicare-eligible fails to enrollin Medicare during the appropri-ate time period, he or she will bepenalized when the city em-ployee retires.

• The CSA Welfare Fund will coverprescription drugs for your domes-tic partner as long as you remainan in-service member.

• When you retire from the DOE,your domestic partner must im-mediately enroll in a MedicarePart D prescription drug plan toavoid penalties.

Last, but not least: What do we mean by “You must enroll in Part B to avoid penalties”? For each 12-month period you delay enrollment in Part B, you will have to pay a 10 percent premium penalty. The penalty is calculated based on the standard Part B premium, $134.00, even if you pay a higher premium because of IMRAA. So if you turned 65 in 2016, had no exemption status and didn’t sign up for Medicare Part B until 2018, you’ll pay a 20 percent penalty or $26.80 more a month for Medicare Part B.

New York City Office of Labor Relations

Health Benefits Program

nyc.gov/olr 1/VP

Medicare Part B Reimbursement Program Application

The City of New York Health Benefits Program reimburses Medicare eligible retirees and their Medicare eligible dependents for any Medicare Part B premiums (excluding any penalties) paid during the calendar year, as long as the following conditions are met:

1. The Medicare eligible retiree is receiving a pension from a City of New York pension system, and 2. The Medicare eligible retiree and/or Medicare eligible dependent(s) is covered under a City of New York health

plan, and 3. The health plan has Medicare eligible retiree and/or Medicare eligible dependent(s) in Medicare status, and 4. The retiree is currently paying Medicare Part B premiums and is not receiving Medicare Part B reimbursement(s)

from any other source including Medicaid.

Reimbursement will be distributed to you in the same manner in which you receive your pension payments; if you receive direct deposit of your pension payments, your reimbursement will also be made via direct deposit.

Reimbursement will occur in the Spring of the year, following the close of the year in which you paid Medicare Part B premiums. For example, any Medicare Part B premiums you paid in 2017, would be reimbursed to you in the Spring of 2018.

Once you submit this application, you will be enrolled in the Medicare Part B Reimbursement Program and will not have to resubmit an application every year.

Section I: Retiree Information: YOU MUST PROVIDE A COPY OF YOUR MEDICARE CARD

Name (Last, First, MI):

Social Security Number: Address:

Phone Number: City

State Zip

Section II: Eligible Dependent Information: YOU MUST PROVIDE A COPY OF YOUR DEPENDENT'S MEDICARE CARD

1) Name (Last, First, MI):

Social Security Number: Address:

Phone Number: City State Zip

2) Name (Last, First, MI):

Social Security Number: Address:

Phone Number: City State Zip

Please submit this form, along with a copy of applicable Medicare Card(s), to:

NYC Health Benefits Program Attn: Medicare Unit

40 Rector Street, 3" Floor New York, NY 10006

Please note Queens Borough Public Library retirees, Brooklyn Public Library retirees, and City University of New York retirees should contact their agency's benefits office.

Retired NYCTA civilians, with the exception of NYCTA Police Officers, must contact the Transit Authority.

Furthermore, the Medicare Part MAMMA reimbursement by the City, pursuant to Section 12-126 of the New York City Administrative Code, of the Medicare Part B premiums actually paid to Medicare by retirees, are excludable from the gross income of the retirees under Section 106 of the Internal Revenue Code.