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Federal Retirement Benefits - Medicare

Medicare is a Federal health insurance program for people who:
• Are 65 or older, or
• Have been entitled to Social Security disability benefits for 24 consecutive months, or
• Have end stage renal disease (permanent kidney failure).

Medicare has two parts: Part A, hospital insurance which can help pay for inpatient hospital care, care in a skilled nursing facility, home health care and hospice care; and Part B, medical insurance which can help pay for medically necessary doctors' services, outpatient hospital services, home health services and a number of other medical services and supplies that are not covered by the hospital insurance part of Medicare.

NYSHIP requires retirees to be enrolled in Medicare Parts A and B when first eligible. Your covered dependents must also be enrolled when first eligible. Once Medicare becomes your primary insurance, the Empire Plan or the HMO you are enrolled in becomes secondary. This means your secondary insurance provides benefits for services which Medicare does not cover.

Requirements for enrolling in Medicare apply to both Empire Plan and HMO enrollees and dependents. Requirements for enrolling in Medicare also apply if you or your dependent has NYSHIP coverage plus coverage under another employer plan.

If you or your dependent is Medicare primary, the State will reimburse you for the usual (base) cost of "original" Medicare Part B monthly premiums unless you are receiving reimbursement from another source. Retirees, vestees, dependent survivors, enrollees covered under Preferred List provisions and COBRA enrollees who become Medicare primary at age 65 are reimbursed automatically. Domestic partners and enrollees who become Medicare primary before age 65 because of disability or end stage renal disease must apply for reimbursement.

For more information about Medicare, see Medicare: When You Must Enroll and Coordinating with NYSHIP in the General Information Book & Empire Plan Certificate, June 1, 2002 or online at the
Department of Civil Service/Employee Benefits Division web site.

Medicaid

Medicaid is a program for New Yorkers who can’t afford to pay for medical care. You may be covered by Medicaid if:
• You have high medical bills.
• You receive Supplemental Security Income (SSI).
• You meet certain income, resource, age, or disability requirements.

If you enter a nursing home and spend down your assets, you may become eligible for Medicaid. You can apply for Medicaid in any one of the following ways: write, phone, or go to your local department of social services.

In New York City, contact the Human Resources Administration by calling (718) 557-1399. Residents of the five boroughs of New York City may call toll free at 1-877-472-8411. For a listing of the Human Resources Administration Medical Assistance Program offices in the five boroughs of New York City go to
http://www.nyc.gov/html/hra/html/medicaid.html.

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