Health Insurance and Prescription Drugs

Q. Do I need to enroll in Medicare Part A and B once I turn 65?

A. If you continue to be an active employee in a "benefits eligible" position and you have New York State Health Insurance Program (NYSHIP) coverage either under your own or as a dependent of an active NYS employee (i.e. spouse), you are NOT required to enroll in Medicare (Parts A or B). This exemption also includes eligible dependents (i.e. spouse) of NYSHIP enrollees.  However, in most cases you should at least enroll in Part A (hospital insurance) as for most people, Part A is free. NYSHIP would still be your "primary" insurer under hospital benefits as an active employee or dependent of an active employee with Medicare being your "secondary" payor.

 

Q. How to apply for Medicare if I want to enroll in just Part A (hospitalization) as an active benefits eligible employee?

A. About three months before you turn 65, contact the Social Security Office to arrange for enrollment in Medicare Part A ONLY. Visit your local Social Security office or call Social Security at 1-800-772-1213. Additionally, information about applying for Medicare is available on the web at http://www.ssa.gov/

 

Q. I am an active employee with a domestic partner who is enrolled in NYSHIP as my dependent and who is turning 65. Are the Medicare rules different for domestic partners?
A. Yes. Because Medicare is a federal program that does not recognize domestic partners as Internal Revenue Service-eligible dependents, Medicare becomes primary for your domestic partner at age 65 even though you are still working and he/she is enrolled in NYSHIP as a dependent. Regardless of your employment status, your domestic partner must have Medicare Parts A and B in place when first eligible due to age for Medicare. Please note that your domestic partner would retain NYSHIP as secondary coverage, and he/she would be eligible for Medicare Part B reimbursement from the NYS Department of Civil Service.  Please call (1-800-833-4344) for further details.

 

Q. When I retire do I have to enroll in Medicare even if I am enrolled in NYSHIP?

A. Yes, NYSHIP requires retirees to enroll in Medicare Parts A and B once you are retired and eligible for Medicare. Medicare becomes your primary insurance (Medicare pays first) at that point. Your covered dependents must also enroll when eligible (i.e. they turn age 65).  If you have questions about Medicare eligibility, enrollment, or cost, contact Social Security at 1-800-772-1213.

NYSHIP will not provide any benefits for coverage available under Medicare if you or a dependent are eligible for Medicare coverage that is primary but fail to enroll when eligible. You will then be responsible for the full cost of services that Medicare would have covered.

 

Q. Can I enroll in multiple Medicare Plan’s (i.e., a spouse’s coverage)?

A. If an inactive Medicare eligible employee (and/or their dependent) enroll in other parts of Medicare, it may negatively impact an enrollee’s NYSHIP retirement coverage. When enrollees are no longer active employees and become eligible for Medicare, the combination of their health insurance benefits under Medicare and NYSHIP provides them with comprehensive coverage. Medicare has several parts, including Parts A, B, C and D. NYSHIP requires enrollment in Medicare Parts A and B ONLY. Medicare allows enrollment in only one Medicare product at a time. Therefore, enrolling in a Part D plan or a Medicare Advantage Plan (MAP/Part C plan) in addition to NYSHIP will result in the cancellation of a NYSHIP enrollee’s coverage. This includes Medicare products that the enrollee or covered dependents may be enrolled in through another employer. 

 

Medicare Parts A and B  
Together, Parts A and B are a fee-for-service plan. NYSHIP supplements this coverage and requires the enrollee and eligible dependents to enroll in both Part A and B when Medicare is primary to NYSHIP. Medicare Part A covers inpatient care in hospitals or skilled nursing facilities, hospice care and home health care. Medicare Part B covers doctors’ services, outpatient hospital services, preventive services, durable medical equipment and some other services and supplies not covered by Part A. 

Medicare Advantage Plans (Medicare Part C)  
MAPs replace the enrollee's original fee-for-service Medicare Parts A and B coverage. The benefits offered by the plan and all medical care (except for emergency or out-of-area urgent care) must be provided, arranged or authorized by the MAP.  

All NYSHIP HMOs provide Medicare Advantage coverage to Medicare-primary enrollees and dependents. If the enrollee is enrolled in Medicare Parts A and B, their NYSHIP HMO will automatically enroll them and their covered dependents in the HMO’s MAP. This means their HMO will provide both their Medicare and NYSHIP benefits. 

Medicare Part D 
Medicare Part D provides prescription drug benefits. Medicare-primary enrollees and dependents enrolled in The Empire Plan have prescription drug coverage under Empire Plan Medicare Rx. If the enrollee and their dependent(s) are Medicare primary and enrolled in a NYSHIP HMO, the HMO provides their Medicare Part D prescription drug coverage. 

If you or any of your dependents are Medicare primary and enrolled in The Empire Plan, you will be automatically enrolled in Empire Plan Medicare Rx. You and each of your Medicare-primary dependents will receive a separate benefit card that you must use to access your Empire Plan Medicare Rx prescription drug benefits. You also will receive additional plan documents that explain your Empire Plan Medicare Rx benefits, as well as your rights and responsibilities.

For more information on Empire Plan Medicare Rx, refer to your Empire Plan and Empire Plan Medicare Rx documents or visit the Empire Plan Prescription Drug Program website at www.empireplanrxprogram.com and select SilverScript. If you have any questions about your Empire Plan prescription drug coverage, call 1-877-7-NYSHIP (1-877-769-7447, TTY 711) and press or say 4 on the main menu.

If you have questions about your NYSHIP HMO prescription drug coverage, call your HMO.

For more information on Medicare and NYSHIP, review the Medicare and NYSHIP publication (see above CS EBD web site link), or contact NYSHIP at 1-800-833-4344. As a reminder, all retirement benefits (i.e. health insurance) are processed thru the HR Benefits Office, so contact us approximately 3-4 months prior to your date of retirement.