Private SOC Content
MISCELLANEOUS BENEFITS
Medicare is health insurance for the following:
• People 65 or older
• People under 65 with certain disabilities
• People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)
DIFFERENT PARTS OF MEDICARE
The different parts of Medicare help cover specific services:
Medicare Part A (Hospital Insurance)
• Helps cover inpatient care in hospitals
• Helps cover skilled nursing facility, hospice, and home health care
Medicare Part B (Medical Insurance)
• Helps cover doctors’ services, hospital outpatient care, and home health care
• Helps cover some preventive services to help maintain your health and to keep certain illnesses from getting worse
Medicare Part D (Medicare Prescription Drug Coverage)
• A prescription drug option run by Medicare-approved private insurance companies
• Helps cover the cost of prescription drugs
• May help lower your prescription drug costs and help protect against higher costs in the future
NOTE: In most cases we do not recommend members subscribe to a Medicare Part D Prescription Plan. The SOC Prescription Plan will under most circumstances provide you and your family with sufficient prescription drug coverage. However, there may be occasions where the prescription benefits offered by Medicare Part D are more cost efficient than those offered by the SOC. If you need further assistance, contact the SOC Fund Office at (212) 964-7500, option 1.
COST OF MEDICARE
Medicare Part A
You don’t pay a monthly premium for Medicare Part A coverage. The taxes you paid to Medicare while working will cover the cost of your Medicare Part A coverage.
Medicare Part B
You pay the Part B premium each month. Most people signing up for Medicare Part B will pay the standard amount of $148.50 for 2021. However, if your modified adjusted gross income as reported on your IRS tax return from two years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount, you may pay more.
Each year Social Security will notify you if you must pay more than the standard premium. Whether you pay the standard premium or a higher premium can change each year depending on your income. For more information regarding Medicare premium rates visit www.medicare.gov.
The Medicare monthly premium is deducted from your Social Security check. If you are not currently receiving a Social Security Check, Medicare will send you a bill for your Part B premiums every three months.
If you don’t sign up for Part B when you’re first eligible, you may have to pay a late penalty for as long as you have Medicare. Your monthly premium for Part B may go up 10% for each full 12-month period that you could have had Part B, but didn’t sign up for it.
Medicare Part D
For information regarding Medicare Part D premiums, visit www.medicare.gov.
HOW TO ENROLL IN MEDICARE
Medicare has different guidelines for eligibility. It is important that you know when and how to enroll in Medicare.
If you already get benefits from the Social Security Administration you will automatically be entitled to Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) starting the first day of the month that you turn 65. You do not need to do anything to enroll. You will receive a Medicare card approximately 3 months before your 65th birthday.
If you are not receiving Social Security you can enroll in Medicare up to three months before your 65th birthday and no later than three months after the month of your birthday. This is called the initial enrollment period. You will need to submit an application to the Social Security Administration. You can also sign up for Part B at your local Social Security office. They will determine your eligibility and send you a Medicare card.
If you wait until you are 65, or sign up during the last three months of your initial enrollment period, your Medicare Part B start date will be delayed.
If you are under age 65 and disabled, and have been entitled to disability benefits under Social Security for 24 months, you will be automatically entitled to Medicare Part A and Part B beginning the 25th month of disability benefit entitlement. You do not need to do anything to enroll in Medicare. Your Medicare card will be mailed to you approximately three months before your Medicare entitlement date.
For more information, visit www.medicare.gov or call 1(800)MeDiCare (1(800) 633-4227), 24 hours a day, seven days a week for assistance.
Both the member and their spouse are eligible for the Medicare Rebate once they become Medicare eligible. When you, or a spouse, become eligible for Medicare, whether it is by reaching the age of 65 or by receiving Social Security Disability, you must accept Medicare Part B. The premiums you pay for Medicare Part B may be reimbursable through the New York City Health Benefits Medicare Rebate Program.
The Medicare Rebate Program will reimburse you for the standard premiums associated with Medicare Part B, as well as the higher premium (see “Income Related Monthly Adjustment Amount – IRMMA” below) some members may pay based on their annual income. Standard rebate checks are issued annually during August and higher premium (IRMAA) reimbursement checks are usually issued in March. If you and your spouse are both covered by Medicare, you will receive one Rebate check, including rebate payment for yourself and your spouse, with the check issued in the name of the retiree.
INCOME-RELATED MONTHLY ADJUSTMENT AMOUNT (IRMAA)
Federal law requires some Medicare beneficiaries to pay a higher premium for their Medicare Part B coverage based on income. If you and/or your eligible dependent paid a Medicare Part B income-related monthly adjustment amount (IRMAA) you may be entitled to an additional reimbursement through the NYC Health Benefits Program (surcharge for late enrollment does not qualify as an amount that is eligible for additional reimbursement).
OTHER INFORMATION
• Rebate checks are computer generated. Please be cautious in reviewing your mail during the rebate period
• You must promptly notify the Health Benefits Program of any changes to your mailing address or the death of your spouse
• Upon the death of a member, the rebate is no longer issued to the surviving spouse, unless she is designated a Line-of-Duty widow
• The surviving spouse may be entitled to collect the rebate up until the time of the member’s death (see Note below)
NOTE: To request the Medicare Rebate after a member’s death, the widow/widower must request a claim affidavit from the Retired Employee Benefit Section, 40 Rector St., NY, NY 10006, complete it and return it with a copy of the retiree’s death certificate.
ENROLLING IN THE NEW YORK CITY MEDICARE REBATE PROGRAM
To enroll in the Medicare Part B Rebate Program, you must mail a short note requesting inclusion in the program along with a photocopy of your Medicare Card indicating that you are enrolled in both Parts A & B to:
The NYC Health Benefits Program
40 Rector Street
New York, NY 10006
Attn: Medicare Unit
Upon receiving a copy of your Medicare Card, the NYC Health Benefits Program will automatically enroll you and/or eligible dependents in the Medicare Part B Rebate Program.
If you did not enroll your spouse in the rebate plan when they became Medicare eligible you can request retroactive reimbursement up to but not more than three (3) years. You will be required to provide the Health Benefits Program listed above with a written request for enrollment and a copy of your spouse's Medicare Card.
APPLYING FOR THE IRMMA REBATE
To claim the additional reimbursement, you must document the eligible amount paid in excess of the standard premium. Submit a copy of your and/or your eligible dependent’s Social Security Administration (SSA) statement issued to you and/or your eligible dependent showing what the income related monthly adjustment amount will be in the upcoming calendar year, and submit a copy of your and/or your eligible dependent’s Form SSA-1099 issued by the SSA at the end of the calendar, as proof of the monthly Medicare Part B premium actually paid for the calendar year. You MUST submit BOTH items indicated to receive a reimbursement.
You can obtain further information and download forms regarding IRMAA by visiting the NYC Office of Labor Relations website at www.nyc.gov/olr and clicking on the “Health Benefits Program” icon.
Documents submitted for eligible dependents must include the retirees name and full Social Security Number. Submit copies of both documents for each eligible person, along with a completed Submission Form to:
City of New York
Office of Labor Relations Health Benefits Program
40 Rector Street, 3rd Floor
New York, NY 10006
Atten: IRMA
NOTE: If you cannot provide a Form SSA-1099 because you did not receive Social Security benefits in the year in question, you must provide official documentation that you paid Medicare premiums (a receipt from Social Security, cancelled checks for Medicare premium payment, or similar official documentation).
OTHER INFORMATION
• Rebate checks are computer generated. Please be cautious in reviewing your mail during the rebate period
• You must promptly notify the Health Benefits Program of any changes to your mailing address or the death of your spouse
• Upon the death of a member, the rebate is no longer issued to the surviving spouse, unless she is designated a Line-of-Duty widow
• The surviving spouse may be entitled to collect the rebate up until the time of the member’s death (see Note below)
NOTE: To request the Medicare Rebate after a member’s death, the widow/widower must request a claim affidavit from the Retired Employee Benefit Section, 40 Rector St., NY, NY 10006, complete it and return it with a copy of the retiree’s death certificate.
For further information regarding the Medicare Rebate Program and to download forms pertaining to IRMAA, visit the NYC Office of Labor Relations website at www.nyc.gov/olr and click on the “Health Benefits Program” icon