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April 19, 2019
You Must enroll in Medicare when eligible!!
Updated On: Jul 09, 2018


Medicare: This info is taken directly from the NYS Civil Service website:

Medicare is the federal health insurance program for people age 65 and older, disabled and receiving Social Security Disability Insurance (SSDI) for 24 months, with end-stage renal disease or with amyotrophic lateral sclerosis (ALS). It is administered by the Centers for Medicare & Medicaid Services (CMS).

As soon as you, as a NYSHIP retiree, vestee, dependent survivor or Preferred List enrollee, become eligible for Medicare coverage that pays primary to The Empire Plan, your Empire Plan coverage becomes secondary to Medicare Parts A and B. The Empire Plan coordinates benefits with Medicare and will not pay for any hospital and medical expenses that Medicare would cover.

The same rule applies to each dependent (spouse/domestic partner, if your agency offers domestic partner coverage, or child) covered under your Empire Plan policy. As soon as your dependent is eligible for primary Medicare coverage, The Empire Plan will not pay for any expenses for the dependent that Medicare would have covered.

Therefore, you and each of your covered dependents must have Medicare Parts A and B in effect by the first day of the month in which each of you reaches age 65 (or, if the birthday falls on the first of the month, in effect on the first day of the preceding month) or before reaching age 65 if Medicare-primary eligible because of disability, end-stage renal disease or amyotrophic lateral sclerosis (ALS).

Note:The requirement to enroll in Medicare Part A and Part B applies if you live in one of the 50 United States or Puerto Rico, Guam, the U.S. Virgin Islands, Northern Marianas or American Samoa.

Since The Empire Plan becomes secondary to Medicare Parts A and B as soon as you are eligible for primary Medicare coverage, if you fail to enroll in Medicare or are still in a waiting period for Medicare to go into effect, you will be responsible for hospital and medical expenses that Medicare would have covered if you had enrolled on a timely basis.

The responsibility is yours: To avoid a reduction in your benefits, you must make sure that you and each of your dependents are covered under Medicare Parts A and B when first eligible, even if you also have coverage through another employer's group plan.

Eligibility for Medicare

You and your dependents are eligible for primary Medicare when you:

  • are age 65 or older, or

  • regardless of age, have been receiving Social Security Disability Insurance (SSDI) benefits for 24 months, or

  • regardless of age, have end-stage renal disease (permanent kidney failure requiring dialysis or kidney transplant) and have completed Medicare's waiting period of up to 3 months and 30-month coordination period, or

  • have amyotrophic lateral sclerosis (ALS) and are receiving Social Security Disability Insurance (SSDI) benefits

You and your dependents each must enroll in Medicare Parts A and B as soon as each of you becomes eligible for any of these reasons. (Unlike NYSHIP, Medicare does not offer family coverage.) When you are eligible, Medicare becomes primary to NYSHIP for you; NYSHIP remains primary for your dependents until they are eligible for Medicare.


 
 
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