Jeffrey Wade
In New York, retirees and their dependents are eligible for the New York State Health Insurance Plan (NYSHIP) provided they meet the age requirement of the Employees' Retirement System retirement tier or are qualified to receive Social Security disability payments. Retirees can change their NYSHIP health insurance plan once during a 12-month period for any reason. Additionally, retirees with Medicare Part B coverage are reimbursed annually during April, with reimbursements deposited directly into their bank accounts if they receive their pension through Electronic Fund Transfer (EFT) or direct deposit. Those who paid more than the standard amount of $174.70 per month ($2,096.40 annually) for Medicare can submit an IRMAA application for reimbursement. To enrol in a Medicare HMO plan, retirees must complete a separate application for each enrollee and submit it to their chosen health plan.
| Characteristics | Values |
|---|---|
| Name of Insurance | New York State Health Insurance Plan (NYSHIP) |
| Eligibility | Employees meeting the retirement age requirement or those qualified to receive Social Security disability payments |
| Payment Options | Deductions from pension checks or direct billing by Civil Service |
| Medicare Part B | Reimbursements issued annually in April to eligible retirees |
| IRMAA | Applicable if paid above $174.70 per month ($2,096.40 annually) |
| Medicare Advantage Plans | Enrolment requires a special application directly with the chosen plan |
| Non-grandfathered health plan | Complies with the Affordable Care Act (ACA) and covers certain in-network preventive services with $0 co-payments |
| Plan Changes | Allowed once during a 12-month period |
| Deferral | Eligible if you have post-retirement employer coverage or dependent coverage through a spouse's employer |
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What You'll Learn
Enrolling in NYSHIP
NYSHIP, or the New York State Health Insurance Plan, is the health insurance plan for retirees from the New York State public service. NYSHIP provides primary coverage for retirees, their enrolled spouses, and other covered dependents.
To enrol in NYSHIP, you must meet the age requirement of the Employees' Retirement System retirement tier in effect at the time you last entered service, or be qualified to receive Social Security disability payments. You must also be enrolled in NYSHIP or be a dependent of an enrollee at the time of your retirement.
If you are an active employee eligible for Medicare because of age or disability, you can choose Medicare as your primary group insurer by cancelling your enrolment in NYSHIP. Your benefits will be reduced with only Medicare coverage. Your spouse or dependent may also choose Medicare as their primary insurer by cancelling their enrolment in NYSHIP, but their benefits will be reduced as no benefits will be available through NYSHIP.
NYSHIP requires retirees and their dependents to be enrolled in Medicare Parts A and B when first eligible for primary Medicare coverage due to age or disability. However, if you or your dependent becomes eligible for Medicare due to end-stage renal disease, NYSHIP will remain the primary insurer during the three-month waiting period for Medicare to become effective. During this time, you do not need to enrol in Medicare, and NYSHIP will not reimburse for the Part B premium. Once Medicare becomes the primary insurer, the State or your employer will reimburse you for the Medicare Part B premium.
As a retiree, you can change your NYSHIP health insurance plan once during a 12-month period for any reason. You are no longer restricted to the same option transfer period as active employees. If you have health insurance coverage through your post-retirement employer or as a dependent through your spouse's employer, you are eligible to defer your NYSHIP retiree coverage.
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Medicare Part B reimbursements
For retirees in New York State, health insurance is provided through the New York State Health Insurance Plan (NYSHIP). NYSHIP requires retirees and their dependents to be enrolled in Medicare Parts A and B when they first become eligible for primary Medicare coverage due to age or disability.
NYSHIP provides reimbursement for the standard Medicare Part B premium paid to SSA, excluding any penalties for late enrollment. Reimbursement begins automatically when a retiree turns 65 and Medicare becomes their primary coverage. If you receive a pension, reimbursement for Medicare Part B will be added to your pension check. If you pay your NYSHIP premium directly, any reimbursement will be credited toward your monthly premium payments. If your reimbursement exceeds your health insurance premium, you will receive a quarterly check.
If you have family coverage under NYSHIP, you will also be reimbursed for the standard Part B premium (and any Part B IRMAA) paid for any Medicare-primary dependent, provided they are not reimbursed by another source. Reimbursement is not automatic for any enrollee or dependent under 65 who is eligible for Medicare due to disability, ESRD, or ALS. To begin reimbursement in these cases, you must notify the Employee Benefits Division in writing and provide a photocopy of your Medicare card.
Medicare-eligible retirees and their dependents can submit an IRMAA application if they paid above the standard amount of $174.70 per month ($2,096.40 annually). The City reimburses retirees and their eligible dependents for Medicare Part B premiums paid. Reimbursements are issued annually in April, either by check or direct deposit.
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IRMAA reimbursements
In New York, retirees and their dependents are eligible for the New York State Health Insurance Plan (NYSHIP) if they meet the age requirement of the Employees' Retirement System retirement tier. NYSHIP requires retirees and their dependents to be enrolled in Medicare Parts A and B when first eligible for primary Medicare coverage.
Medicare-eligible retirees and their Medicare-eligible dependents will be reimbursed annually for the standard Medicare Part B amount, excluding penalties and late enrollment fees. The Income-Related Monthly Adjustment Amount (IRMAA) is an additional amount that retirees with higher annual earnings are required to pay for their monthly Medicare premiums. If you paid more than the standard monthly reimbursement rate for Medicare Part B, as an Income-Related Monthly Adjustment Amount (IRMAA), you may be eligible for additional reimbursement. IRMAA reimbursements are issued to eligible retirees annually during the month of April.
If you are a Medicare-eligible retiree or dependent and paid above the standard amount of $174.70 per month ($2,096.40 annually), you can submit an IRMAA application. If you did not pay more than the standard amount, you are not eligible for IRMAA. If you are receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement will be deposited directly into your bank account. This is separate from your pension payment. If you don’t have EFT or direct deposit, you should receive a check in the mail.
You may be eligible for a lower IRMAA if you have experienced significant life changes, such as marriage, divorce, or loss of income. Retirement or income loss are life-altering events that could potentially lower your IRMAA, leading to reduced Medicare premiums. If there has been a substantial change in circumstances, you may be able to revise your tax return using an IRS Form 1040X and decrease any additional costs.
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Aetna Medicare Advantage PPO Plan
In New York, retirees and their dependents are required to be enrolled in Medicare Parts A and B when they first become eligible due to age or disability. Retirees in New York are covered by the New York State Health Insurance Plan (NYSHIP). As a retiree, you can change your NYSHIP health insurance plan once during a 12-month period for any reason.
The Aetna Medicare Advantage PPO Plan is a health insurance option for retirees in New York City. This plan is administered by EyeMed and included in your health insurance premiums. The plan covers behavioral and mental health services, with visits to Medicare-qualified behavioral/mental health professionals requiring a copay. Dental plans are separate from the health plan coverage.
The Aetna Medicare Advantage PPO Plan does not require doctors to have a contract with Aetna. Doctors will be paid the same as they would with traditional Medicare. Most doctors accept this type of plan once they understand the details. If your doctor refuses to accept this plan, you can pay for the services upfront and then submit the bill to Aetna for reimbursement. You will only be responsible for the same copayment as if you had stayed in the network.
To be eligible for the Aetna Medicare Advantage PPO Plan, you must be enrolled in both Medicare Part A and Part B and continue to pay your Medicare Part B monthly premium to the federal government. This plan offers nationwide coverage and has an out-of-pocket maximum of $1,750 per year. Once you reach this maximum, the plan will pay 100% of the cost of your covered medical care expenses for the rest of the year.
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Changing your NYSHIP plan
As a retiree enrolled in the New York State Health Insurance Plan (NYSHIP), you can change your health insurance plan once during a 12-month period for any reason. This is a more flexible option than when you were an active employee, as you are no longer restricted to the same option transfer period.
If you have health insurance coverage through your post-retirement employer or as a dependent through your spouse's employer, you can defer your NYSHIP retiree coverage. You will need to meet certain requirements, such as being enrolled in NYSHIP or being a dependent of an enrollee at the time of your retirement.
To change your NYSHIP plan, you will need to complete and submit the relevant forms to your Health Benefits Administrator by the Option Transfer deadline. You can find these forms, as well as additional details, by contacting the health plan(s) directly or referring to NYSHIP's print publications.
It's important to note that NYSHIP requires retirees and their dependents to be enrolled in Medicare Parts A and B when first eligible for primary Medicare coverage due to age or disability. You may also want to consider the Opt-out Program, which requires the completion of specific forms.
Remember that there are different ways to pay for your health insurance in retirement. You may be billed directly by Civil Service, or you can choose to have deductions made from your pension check. These deductions may take several months to begin.
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Frequently asked questions
Retired NYS employees are enrolled in the New York State Health Insurance Plan (NYSHIP) or are dependents of an enrollee. Medicare-eligible retirees can also submit an IRMAA application if they paid above $174.70 per month. Additionally, retirees can change their NYSHIP health insurance plan once during a 12-month period.
To be eligible for health insurance coverage as a retired NYS employee, you must meet the age requirement of the Employees' Retirement System retirement tier or be qualified to receive Social Security disability payments.
There are two ways to pay for health insurance coverage as a retired NYS employee. You can either have deductions from your pension check or be billed directly by Civil Service and pay premiums directly.
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