CDPHP is pleased to offer Medicare Advantage plans, including the Group Medicare ChoiceRx (HMO) and Group Medicare Choice (HMO) for Medicare-primary NYSHIP retirees and their spouses.
What is the difference between Medicare and nyship?
Medicare, which is a fee-for-service plan. NYSHIP supplements this coverage and requires you and your eligible dependents to be enrolled in both Part A and Part B when Medicare is primary to NYSHIP. Medicare Part A covers inpatient care in a hospital or skilled nursing facility, hospice care and home health care.
Does nyship cover Medicare Part B premiums?
Medicare, which is a fee-for-service plan. NYSHIP supplements this coverage and requires you and your eligible dependents to enroll in both Parts A and B when Medicare is primary to NYSHIP. Medicare Part A covers inpatient care in a hospital or skilled nursing facility, hospice care and home health care. Medicare Part B covers doctors’ services,
Does nyship require Medicare enrollment during the waiting period?
you and your dependents underThe Empire Plan or a NYSHIP HMO. Enrolling in a Medicare Part D plan separate from your NYSHIP coverage may drastically reduce your benefits overall. For …
When did nyship replace Empire plan Medicare RX?
CDPHP is pleased to offer Medicare Advantage plans, including the Group Medicare ChoiceRx (HMO) and Group Medicare Choice (HMO) for Medicare-primary NYSHIP retirees and their …
Does Nyship cover Medicare deductible?
Your NYSHIP plan covers much of the Medicare Part A and Part B deductible and coinsurance amounts if you use the NYSHIP plan provider network and may cover some other medical expenses Medicare does not cover.
Is Empire Nyship Medicare?
Effective January 1, 2013, NYSHIP replaced the Empire Plan Prescription Drug Program coverage for Medicare-primary enrollees and dependents with Empire Plan Medicare Rx (PDP), a Medicare Part D prescription drug program with expanded coverage designed especially for NYSHIP.
Is Nyship the same as Empire plan?
The Empire Plan is NYSHIP's unique health insurance plan designed exclusively for New York State's public employees and employers. The Empire Plan pays for covered hospital services, physicians' bills, prescription drugs and other covered medical expenses.
What is the most widely accepted Medicare Advantage plan?
AARP/UnitedHealthcare is the most popular Medicare Advantage provider with many enrollees valuing its combination of good ratings, affordable premiums and add-on benefits. For many people, AARP/UnitedHealthcare Medicare Advantage plans fall into the sweet spot for having good benefits at an affordable price.
Is the Empire Plan the same as Empire Blue Cross Blue Shield?
Empire BlueCross BlueShield is a plan (HMO and LPPO) with a Medicare contract. Empire BlueCross is an HMO DSNP plan with a Medicare contract and a coordination of benefits agreement with the New York State Department of Health.
Is Nyship a PPO or HMO?
SUNY participates in the New York State Health Insurance Program (NYSHIP). This program offers a PPO, known as the Empire Plan, and several different HMOs, varying by geographic region around the State. Specific coverage provisions and plan design vary by health insurance plan and by employee bargaining unit.
Is Nyship United Healthcare?
Your SEHP medical coverage will be through insurance carriers under contract with NYSHIP: Empire Blue Cross Blue Shield (for hospital benefits), UnitedHealthcare Insurance Company of New York (medical/surgical), GHI/ValueOptions (mental health and substance abuse) and CIGNA/Express Scripts (prescription drugs).
What is the Nyship Empire Plan group number?
1-877-769-7447For more information, call The Empire Plan toll free number at 1-877-7-NYSHIP (1-877-769-7447) and press 1 for the Medical Program.
Is the Empire Plan Accepted in Florida?
The Empire Plan offers an expanded physician network in Arizona, Connecticut, Florida, Maryland, New Jersey, North Carolina, Pennsylvania, South Carolina, Virginia,Washington D.C., West Virginia and the greater Chicago area.
What are the negatives of a Medicare Advantage plan?
Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.
What are 4 types of Medicare Advantage plans?
Below are the most common types of Medicare Advantage Plans.Health Maintenance Organization (HMO) Plans.Preferred Provider Organization (PPO) Plans.Private Fee-for-Service (PFFS) Plans.Special Needs Plans (SNPs)
Can you switch back and forth between Medicare and Medicare Advantage?
Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.
When does Medicare become primary for spouse?
Since you are no longer actively employed, Medicare becomes primary to NYSHIP for your spouse at age 65. Medicare does not become primary for you until you reach age 65 or otherwise become eligible for Medicare.
What is Medicare Part A and B?
Medicare Part A covers inpatient care in a hospital or skilled nursing facility, hospice care and home health care.
What is a MAP plan?
Medicare Advantage plans (MAPs) replace your original fee-for-service Medicare Parts A and B coverage. The benefits offered by the plan and all of your medical care (except for emergency or out-of-area urgently needed care) must be provided, arranged or authorized by the MAP. Most NYSHIP HMOs provide Medicare Advantage coverage to Medicare-primary enrollees and dependents. Check the current NYSHIP Health Insurance Choices publication to see if any are offered in your area. If you are enrolled in a NYSHIP HMO that offers a MAP, you receive both your Medicare and NYSHIP benefits from that plan when you become Medicare-primary.
Is Empire Plan covered by Medicare?
If you receive services from a provider who does not participate in The Empire Plan, and these services are covered under The Empire Plan but not under Medicare, it is your responsibility to file a claim or have the provider file a claim with the appropriate Empire Plan administrator for Basic Medical or non-network benefits.
Does Medicare send an EOMB?
Medicare will send you an Explanation of Medicare Benefits (EOMB) that will note whether your claim was sent to The Empire Plan. This process, known as Medicare Crossover, is automatic for the medical program, hospital program and outpatient mental health and substance abuse program; however, inpatient mental health and substance abuse services are not crossed over directly from Medicare to Beacon Health Options. For these services, you will need to submit your EOMB to Beacon Health Options if you receive a bill.
Is NYSHIP a dependent?
If you return to work for New York State (or if you worked for a Participating Employer and you return to work for the same employer) in a benefits-eligible position after retiring, NYSHIP is primary for you as an active employee and, in most cases, for your Medicare-eligible dependents .
Do you have to file a claim for NYShip?
For medical/surgical or mental health/substance abuse expenses, you and your enrolled dependents age 65 and over generally have no claims to file because you are automatically enrolled in NYSHIP’s Medicare Crossover Program in the state where you reside.
Medicare: A Federal Program
Medicare is a federal health insurance program for people who are age 65 or older, or have been entitled to Social Security disability benefits for 24 months, or have end stage renal disease (permanent kidney failure). Medicare is directed by the federal Centers for Medicare and Medicaid services (formerly Health Care Financing Administration).
NYSHIP is primary for most active employees
NYSHIP (Empire Plan or HMO) provides primary coverage for you, your enrolled spouse and other covered dependents while you are an active employee, regardless of age or disability.
You and your dependents must have Medicare in effect
As soon as you or your covered dependent becomes eligible for Medicare coverage that pays primary to NYSHIP (because of end stage renal disease or domestic partner status), you or your covered dependent must be enrolled in Medicare Parts A and B.
When you are no longer an "active employee"
When you are no longer an active employee of the State or a Participating Employer, NYSHIP or Medicare will be primary as follows:
If you are also covered by another employer's group plan
If you are no longer an active employee of the State or a Participating Employer and you have coverage under another employer's group plan, the order of claims payment is 1) current employer plan; 2) Medicare; and 3) NYSHIP.
When to enroll in Medicare
As an active employee, contact Medicare immediately if you, your spouse or enrolled dependent is eligible for primary Medicare coverage due to end stage renal disease. Also, the domestic partner of an active employee must have Medicare Part A and Part B in effect by the first of the month in which the domestic partner reaches age 65.
Planning to retire: Avoid a gap in coverage
If you are planning to retire or otherwise leave service with your employer and are under 65, Medicare becomes primary to NYSHIP on the first day of the month in which you reach age 65. Contact Social Security three months before you reach age 65 to be sure of having Medicare in effect at that time.
What is Medicare for people 65 and older?
Medicare. Medicare is the federal health insurance program for: People who are 65 or older. Certain younger people with disabilities. People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD) and. group health plan.
What is a group health plan?
group health plan. In general, a health plan offered by an employer or employee organization that provides health coverage to employees and their families. (retiree) coverage from a former employer, generally Medicare pays first for your health care bills, and your. group health plan. In general, a health plan offered by an employer ...
Does stop loss cover out of pocket costs?
It might only provide "stop loss" coverage, which starts paying your. out-of-pocket costs. Health or prescription drug costs that you must pay on your own because they aren’t covered by Medicare or other insurance. only when they reach a maximum amount.
Does retirement insurance include extra benefits?
and deductibles. Sometimes retiree coverage includes extra benefits, like coverage for extra days in the hospital.
