What if I want Medicare to be my primary coverage?
If you are a Medicare-eligible active employee and want Medicare to be your primary coverage, you must complete the waiver section of the Health Benefits Application. By doing so, you will not be eligible for the City’s group health plan.
When does nyship become my primary insurer for Medicare?
Medicare becomes your primary insurer when you are eligible for Medicare and enrolled in NYSHIP as a retiree, vestee, dependent survivor, or are covered under Preferred List provisions. To coordinate Medicare with your NYSHIP benefits, you should make sure that you:
Does New York City offer health insurance to employees over 65?
Federal law requires the City of New York to offer employees over 65 the same coverage under the same conditions as offered to employees under 65. The same stipulation applies also to dependents over 65 and those covered by Medicare through the Special Provisions of the Social Security Act for the Disabled.*
Does New York State offer Medicare Select Insurance?
Currently no insurers are offering Medicare Select insurance in New York State. Medicare Advantage Plans Offered in New York State Medicare Advantage Plans are approved and regulated by the federal government's Centers for Medicare and Medicaid Services (CMS).
What group size is Medicare primary?
Medicare is primary when your employer has less than 20 employees. Medicare will pay first and then your group insurance will pay second. If this is your situation, it's important to enroll in both parts of Original Medicare when you are first eligible for coverage at age 65.
In what conditions does Medicare become primary?
If you have a disability, you're younger than 65, and your employer-based health plan has fewer than 100 employees, Medicare will pay first.
What are the 3 requirements for a member to be eligible for a Medicare?
You're 65 or older.You are a U.S. citizen or a permanent legal resident who has lived in the United States for at least five years and.You are receiving Social Security or railroad retirement benefits or have worked long enough to be eligible for those benefits but are not yet collecting them.More items...•
What is the minimum number of employees required to be covered under a group medical insurance plan?
Number of employees matters To be eligible for small business health insurance, a company must have between one and 50 employees. That is considered a small business for purposes of purchasing group health insurance. If you have more than 50 employees, you'll need to: apply for large group coverage.
Can you have Medicare and employer insurance at the same time?
Can I have Medicare and employer coverage at the same time? Yes, you can have both Medicare and employer-provided health insurance. In most cases, you will become eligible for Medicare coverage when you turn 65, even if you are still working and enrolled in your employer's health plan.
Is Medicare always primary?
Medicare is always primary if it's your only form of coverage. When you introduce another form of coverage into the picture, there's predetermined coordination of benefits. The coordination of benefits will determine what form of coverage is primary and what form of coverage is secondary.
Who is not eligible for Medicare Part A?
Why might a person not be eligible for Medicare Part A? A person must be 65 or older to qualify for Medicare Part A. Unless they meet other requirements, such as a qualifying disability, they cannot get Medicare Part A benefits before this age. Some people may be 65 but ineligible for premium-free Medicare Part A.
Do I automatically get Medicare when I turn 65?
You automatically get Medicare when you turn 65 Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care. Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services.
Can I get AARP health insurance at 62?
Full AARP membership is available to anyone age 50 and over.
How many employees would an employer require in order to be considered a small employer?
A Small Employer is any person, firm, corporation, partnership, or association that is actively engaged in business and has 50 employees or less.
What is the minimum number of employees that must be insured under contributory employer sponsored group health insurance plans?
If a company has 1,000 employees who are eligible for a contributory group health insurance program, how many would be required to participate? In most states, if a group health insurance plan is contributory, 75% of eligible persons must be insured.
What are some of the reasons for having a minimum participation requirement before a group is eligible for insurance?
Minimum participation is generally required so that expenses per member can be reduced and because the group is unlikely to have a large proportion of higher risk individuals. With noncontributory plans, the employer pays 100% of the cost, so the insurance coverage can be extended to every eligible employee.
About Medicare in New York
Medicare beneficiaries in New York enjoy a variety of Medicare offerings, from the federal option of Original Medicare, Part A and Part B, to plans...
Types of Medicare Coverage in New York
Original Medicare, Part A and Part B, refers to federal Medicare coverage. Medicare Part A (hospital insurance) and Part B (medical insurance) are...
Local Resources For Medicare in New York
Medicare Savings Programs in New York: Programs in New York can assist beneficiaries in paying for things like their monthly premiums. Usually in o...
How to Apply For Medicare in New York
To apply for Medicare in New York, you must be a United States citizen or legal permanent resident of at least five continuous years. You’re genera...
When is Medicare Primary?
For the most part, when you have more than one form of coverage, Medicare is primary. Some examples include having group coverage through a smaller employer, COBRA, being on inactive duty with TRICARE, or Medicaid. Usually, secondary insurance will only pay if the primary insurance paid its portion first.
How to learn more about Medicare?
How to Learn More About Your Medicare Options. Primary insurance isn't too hard to understand; it's just knowing which insurance pays the claim first. Medical billing personnel can always help you figure it out if you're having trouble. While it's not hard to understand primary insurance, Medicare is its own beast.
What is a small employer?
Those with small employer health insurance will have Medicare as the primary insurer. A small employer means less than 20 employees in the company. When you have small employer coverage, Medicare will pay first, and the plan pays second. If your employer is small, you must have both Part A and Part B. Having small employer insurance without ...
What is secondary insurance?
Secondary insurance helps cover out-of-pocket costs left over after your primary coverage pays their portion. There are a few common scenarios when Medicare is secondary. An example includes having group coverage through a larger employer with more than 20 employees.
Is Medicare a part of tricare?
Medicare is primary to TRICARE. If you have Part A, you need Part B to remain eligible for TRICARE. But, Part D isn’t a requirement. Also, TRICARE covers your prescriptions. Your TRICARE will be similar to a Medigap plan; it covers deductibles and coinsurances.
Can you have Medicare and Cobra at the same time?
There are scenarios when you’ll have Medicare and COBRA at the same time. The majority of the time, Medicare will be primary and COBRA will be secondary. The exception to this is if your group coverage has special rules that determine the primary payer.
Is Cobra better than Medicare?
It’s not common for COBRA to be the better option for an individual who’s eligible for Medicare. This is because COBRA is more expensive than Medicare. Once you enroll in Medicare, you can drop your COBRA coverage.
How to coordinate Medicare with NYShip?
To coordinate Medicare with your NYSHIP benefits, you should make sure that you: Contact the Social Security Administration (SSA) to enroll in Medicare three months before your birthday month. Visit https://www.ssa.gov/onlineservices or call 1-800-772-1213. Enroll in Medicare Parts A and B (be sure not to decline Part B).
When do you have to notify Medicare?
If you are eligible for Medicare before age 65, you must notify the Employee Benefits Division that you have enrolled in Medicare Parts A and B, and provide a copy of your Medicare card.
When does NYSHIP start?
NYSHIP automatically begins reimbursement for the standard cost of original Medicare Part B when Medicare becomes primary to NYSHIP coverage at age 65 for retirees, vestees, dependent survivors, and enrollees covered under Preferred List provisions, and their dependents who turn 65.
What is Medicare for disabled?
Medicare is a health insurance program administered by the federal government to individuals over age 65 or who are eligible due to disability. The section below includes a video, FAQs, publications, contact information and links to important resources about Medicare.
Is Medicare reimbursement automatic?
Reimbursement is not automatic for any enrollee or covered dependent who is under age 65 and is eligible for Medicare due to disability, ESRD, or ALS. You must notify the Employee Benefits Division in writing and provide a photocopy of your (or your dependent's) Medicare card to begin the reimbursement in these cases.
Does Medicare Part B go into your pension?
If you receive a pension, any reimbursement for Medicare Part B will be added to your pension check. If you pay your NYSHIP premium by direct payments to the Employee Benefits Division, Medicare Part B reimbursements will be credited toward your monthly NYSHIP premium payments, and if your Medicare reimbursement exceeds your health insurance premium, you will receive a quarterly reimbursement check from the Office of the State Comptroller.
Does NYSHIP pay for Medicare Part B?
Medicare Part B Premium Reimbursement. When Medicare is primary to NYSHIP coverage, NYSHIP reimburses you for the standard Medicare Part B premium you pay to SSA, excluding any penalty you may pay for late enrollment. Q.
When do you have to bring proof of Medicare for NYC?
3 months before the retiree turns age 65. At time of retirement; Coordinated with date of retirement (1) Retirees over age 65, and their covered dependents over age 65, must bring proof of Medicare Part A and B when applying for NYC Retiree Health Benefits coverage. The City reimburses the monthly Medicare Part B premiums.
How old do you have to be to get Medicare?
Employees and their dependents covered by Medicare have identical benefits to those provided to employees and their dependents under age 65.
When do you have to apply for Medicare Part B?
Employees do not have to apply for Medicare Part B until retirement from City service and they are over age 65. Covered dependents, under age 65, also continue to receive non-Medicare coverage under City Health Benefits.
Can a spouse who has Medicare not been covered by their plan re-enroll in the city health benefits program?
Close. At retirement, employees who have chosen Medicare as their primary plan or whose dependents have not been covered on their plan because their spouse/domestic partner elected Medicare as the primary plan may re-enroll in the City health benefits program.
Does Medicare cover dependents over 65?
The same stipulation applies also to dependents over 65 and those covered by Medicare through the Special Provisions of the Social Security Act for the Disabled.* Read More
Is Medicare a secondary insurance?
In such cases, enrollment in the City health plans is automatic (unless waived) and Medicare becomes secondary coverage. If you are a Medicare-eligible active employee and want Medicare to be your primary coverage, you must complete the waiver section of the Health Benefits Application.
Does New York offer health insurance to employees over 65?
Federal law requires the City of New York to offer employees over 65 the same coverage under the same conditions as offered to employees under 65.
How long do you have to be a resident of New York to qualify for Medicare?
How to apply for Medicare in New York. To apply for Medicare in New York, you must be a United States citizen or legal permanent resident of at least five continuous years. You’re generally eligible when you are 65 or older, but you may qualify under 65 through disability or having certain conditions. You’ll be enrolled automatically as soon as ...
How many Medicare Supplement plans are there?
Medicare Supplement, also called Medigap, features up to 10 plans, each with a letter designation (A, B, C, D, F, G, K, L, M, N). Plan benefits within each letter category do not change, no matter where the plan is purchased;
What is Medicare Part A and Part B?
Original Medicare, Part A and Part B, refers to federal Medicare coverage. Medicare Part A (hospital insurance) and Part B (medical insurance) are available in any state in the U.S. Medicare Advantage, Part C, refers to plans offered by private health insurance companies with Medicare’s approval.
When do you get Medicare benefits?
A “Welcome to Medicare” packet should be mailed out approximately three months before you turn 65. If you are under 65 and collect disability benefits from the Social Security Administration (SSA), or certain disability benefits from the Railroad Retirement Board (RRB), then you become eligible for Medicare once you enter into the 25th consecutive month of collecting those benefits. If you have ALS, your Medicare coverage starts the first month you collect SSA or RRB benefits.
Does New York have Medicare?
About Medicare in New York. Medicare beneficiaries in New York enjoy a variety of Medicare offerings, from the federal option of Original Medicare, Part A and Part B , to plans offered by Medicare-ap proved insurance companies such as Medicare Advantage, Medicare Part D (prescription coverage), and Medicare Supplement insurance plans.
Does Medicare Part B cover vision?
These plans must cover at least what Original Medicare , Part A and Part B does, but can also include additional benefits, like vision, dental, and prescription drug coverage. You continue paying your monthly Medicare Part B premium when you’re enrolled in a Medicare Advantage plan along with any premium charged by the Medicare Advantage plan chosen.
What languages are eligible for Medicare?
You Must Apply for Medicare. This document is also available in the following languages: Spanish, Russian, Italian, Korean, Chinese, Haitian Creole. If you are turning 65 within the next 3 months or you are 65 years of age or older, you may be entitled to additional medical benefits through the Medicare program.
Can medicaid pay for premiums?
If so, then the Medicaid program can pay or reimburse your Medicare premiums. If the Medicaid program can pay your premiums, you will be required to apply for Medicare as a condition of Medicaid eligibility. You may apply for Medicare by calling the Social Security Administration at 1-800-772-1213 or by applying on-line at: ...
Is Medicare a federal program?
Medicare is a federal health insurance program for people over 65 and for certain people with disabilities regardless of income. When a person has both Medicare and Medicaid, Medicare pays first and Medicaid pays second. You are required to apply for Medicare if:
How much health insurance do you need for part time employees?
You can offer group health insurance to part-time and seasonal workers if you wish. But it is important to understand, usually you must enroll at least 70 percent of your uninsured, full-time employees. If some of your employees have other individual or group health insurance coverage, they don’t count toward the 70 percent rule.
How many employees are needed for small business insurance?
To be eligible for small business health insurance, a company must have between one and 50 employees. That is considered a small business for purposes of purchasing group health insurance. If you have more than 50 employees, you’ll need to: apply for large group coverage. meet group coverage reporting requirements.
What is a full time equivalent employee?
Full-time equivalent employees are non-full-time employees, but who , in combination, are the equivalent of a full-time employee. For example, 3 employees who each work 10 hours per week are equivalent to 1 full-time employee for purposes of determining eligibility for small business group health insurance.
When does the 70 percent rule apply for small business insurance?
And there is a caveat to the 70 percent rule. If you enroll in small business group health insurance from November 15 to December 15 of the year, the 70 percent participation rule does not apply. You can be approved for small business group health insurance with fewer than 70 percent of your eligible full-time at this time.
Who can be on a group health insurance plan?
One of the employees on the group health insurance plan can be the employer or owner. However, at least one other employee who is not an owner must exist and enroll in the group health plan. That other employee must be someone who is:
Do sole proprietors need health insurance?
Sole proprietors need individual coverage. If you’re the only one who works at your company, you’re actually a sole proprietor and don’t qualify for small business group health insurance (even if you take a salary and consider yourself an employee).
Is group health insurance cheaper than individual health insurance?
Group health insurance can often be less expensive than individual plans that offer the same benefits and coverage options. However, not everyone qualifies for group coverage plans. If you have a small business, you’ll want to determine whether you qualify for group health insurance before you apply for coverage.
What is the number to call for Medicare in New York?
1-800-MEDICARE (800) 633-4227 for assistance to find out more about coverage options. TTY users should call (877) 486-2048. Medicare and You Handbook. One-on-one counseling assistance from the New York State Office for Aging Health Information Counseling and Assistance Program (HIICAP).
What is open enrollment for Medicare?
During the federal Open Enrollment period, current or newly eligible Medicare beneficiaries, including people with Original Medicare, can review current health and prescription drug coverage, compare health and drug plan options available in their area, and choose coverage that best meets their needs. This is the time when Medicare eligible individuals can enroll in Medicare Advantage and Medicare Part D prescription drug plans.
What is the 80 percent excess benefit for Medicare?
The 80 percent Medicare Part B Excess benefit, available in Plan G, was changed to a 100 percent coverage benefit. Insurers are also now required to offer Plans A and B, as well as either Plan C or Plan F. Previously insurers only had to offer Plans A and B.
How to contact Medicare for prescription drug coverage?
TTY users should call (877) 486-2048.
How to contact Medicare Advantage?
For more information about the Medicare Advantage Plans or Medicare Prescription Drug Plans available in your area, visit the federal Medicare website or call 1-800-MEDICARE (800) 633-4227. TTY users should call (877) 486-2048.
When did Medigap change?
As of June 1, 2010, changes to Medigap resulted in modifications to the previously standardized plans offered by insurers. Medigap plans H, I, and J, which contained prescription drug benefits prior to the Medicare Modernization Act, were eliminated. Plan E was also eliminated as it is identical to an already available plan. Two new plan options were added and are now available to beneficiaries, which have higher cost-sharing responsibility and lower estimated premiums:
How often does Medicare Part B exam?
If you have had Medicare Part B for longer than 12 months, you can get a yearly wellness visit to develop or update a personalized prevention plan based on your current health and risk factors. Again, you will pay nothing for this exam if the doctor accepts assignment. This exam is covered once every 12 months .
How many hospitals are part of Empire Plan?
A. The Empire Plan has over 15,000 network hospitals, skilled nursing facilities and hospice care facilities nationwide. The Empire Plan offers over 190,000 participating providers nationwide. For medical, mental health and other providers, see the Participating Provider Directory. The Empire Plan Prescription Drug Program has more than 50,000 participating pharmacies nationwide as well as a mail service pharmacy.
How often does NYSHIP change?
A. The State negotiates NYSHIP health insurance benefits with State employee unions every three or four years. The President of the Civil Service Commission can and usually does extend negotiated benefit changes administratively to unrepresented groups such as Participating Agencies. Occasionally, a benefit change is introduced gradually over the course of time. Policies and benefits may also be affected by State and federal legislation and court decisions. The New York State Department of Civil Service Employee Benefits Division provides quarterly reports to employers and mails Empire Plan information directly to enrollees.
Does Empire Plan cover retirees?
Most public employers (Participating Agencies) that offer NYSHIP’s Empire Plan permit employees who retire and have met certain requirements to continue their coverage after retirement and contribute to the cost. For complete details about eligibility for employees, retirees, spouses and dependents, see the “Who Is Eligible?” and the “Continuing Coverage When You Retire” sections of the NYSHIP General Information Book for Participating Agencies.
Does Empire Plan have a minimum eligibility?
A. The State has established minimum Empire Plan eligibility requirements, but local government employers may adopt modified rules within specific limits. Generally, to be eligible, the employee must:
Does NYShip pay Medicare?
For retirees and their dependents, NYSHIP requires enrollment in Medicare Parts A and B when first eligible. NYSHIP’s Empire Plan pays secondary to Medicare. Participating Agencies are required by law to reimburse Medicare-primary enrollees and dependents for the Part B premiums.