Health Insurance FAQ's
Will my health insurance coverage continue in retirement?
Yes, the health insurance and prescription drug coverage you are enrolled in as an active employee will continue into retirement if you meet the eligibility requirements. You may also continue to cover eligible dependents under your family coverage.
What are the eligibility requirements for continuing health insurance in retirement?
You must have at least 10 years of NYSHIP benefits-eligible service (combination of State, Participating Agencies and/or Participating Employers); you must qualify for retirement as a member of a NYS-administered retirement system; you must have NYSHIP coverage at the time of retirement; you must be 55 years of age or older at retirement.
Who do I contact with questions about my health insurance coverage after I retire?
The NYS Department of Civil Service, Employee Benefits Division, at (800) 833-4344.
Do I have to pay for health insurance coverage in retirement, or is it for free?
Yes, you must pay for retiree health insurance coverage. The cost changes each year; view the Health Insurance Rates for Retirees under Planning for Retirement.
How will I pay for my retiree health insurance?
At retirement, up to 200 days of unused sick leave accruals convert to a monthly lifetime credit to offset coverage cost. You only pay if the premium exceeds your credit, in which case you pay the difference. The credit is calculated using accrued sick leave days, salary, age, and an actuarial table.
If I predecease my covered spouse after retirement, can my spouse continue health insurance coverage under my plan?
Yes, as long as your spouse remains un-remarried. Your spouse must contact the Employee Benefits Division (EBD) for details.
How will my covered spouse pay for retiree health insurance coverage after my death?
At retirement, you may elect the Dual Annuitant Sick Leave Credit so your surviving spouse uses your monthly lifetime credit. The form must be submitted before retirement. If you chose 70% of your credit, your spouse continues at 70%. If you chose 100%, the credit stops at your death and your spouse pays the full individual premium.
Can I change my health insurance plan after retirement?
Yes, once during any twelve-month period, by contacting the Employee Benefits Division at (800) 833-4344.
Medicare FAQ's
What is Medicare Parts A and B?
Together, Parts A and B are a fee-for-service plan. NYSHIP supplements this and requires enrollment in both when Medicare is primary. Part A covers inpatient hospital/skilled nursing care, hospice, and home health care. Part B covers doctors' services, outpatient hospital services, preventive services, durable medical equipment, and other supplies not covered by Part A.
When I retire, do I have to enroll in Medicare even if I am enrolled in NYSHIP?
Yes. NYSHIP requires retirees to enroll in Medicare Parts A and B once eligible. Medicare then becomes primary. Covered dependents must enroll when they become eligible (e.g., age 65). NYSHIP will not provide benefits Medicare would have covered if enrollment is not completed when eligible; you would be responsible for the full cost.
Do I need to enroll in Medicare Parts A and B once I turn 65?
If you remain an active employee with NYSHIP coverage (or are a dependent of an active employee), you are NOT required to enroll in Medicare Parts A or B. This exemption also covers eligible dependents. However, you should at least enroll in Part A since it is free; NYSHIP remains primary for hospital benefits with Medicare as secondary.
When I retire do I need to enroll in Medicare Part D?
No. Medicare-primary enrollees in The Empire Plan have prescription coverage under Empire Plan Medicare Rx. If enrolled in a NYSHIP HMO, the HMO provides Part D coverage.
Can I enroll in multiple Medicare Plans?
NYSHIP requires enrollment in Medicare Parts A and B ONLY. Medicare allows enrollment in only one Medicare product at a time, so enrolling in a Part D plan or Medicare Advantage Plan (MAP) in addition to NYSHIP will cancel NYSHIP coverage. This includes Medicare products through another employer.
I am an active employee with a domestic partner enrolled in NYSHIP as my dependent who is turning 65. Are the Medicare rules different for domestic partners?
Yes. Medicare does not recognize domestic partners as IRS-eligible dependents, so Medicare becomes primary for your domestic partner at 65 even while you are still working. They must have Parts A and B in place when first eligible. NYSHIP remains secondary, and they are eligible for Part B reimbursement from NYS Civil Service. Call 1-800-833-4344 for details.
Is there a cost associated with Medicare Part B?
Yes, the monthly cost usually changes each year and is automatically deducted from your social security check. Part B premiums are determined by individual or joint income in retirement (IRMAA - Income Related Monthly Adjustment Amount), an extra amount paid by higher earners. The state reimburses the minimum premium charged each calendar year.
Will I be reimbursed for the cost of Medicare B?
Yes, the Employee Benefits Division reimburses you for Medicare Part B. If your spouse is a dependent on your state health plan, EBD also reimburses your spouse's Part B cost when applicable.
How will I be reimbursed for the cost of Medicare Part B?
State retirement plan retirees receive reimbursement (for themselves and/or spouse) in their monthly retirement check. ORP retirees are reimbursed by separate check quarterly.
How do I apply for Medicare?
Visit your local Social Security office or call 1-800-772-1213. Information is also available at www.ssa.gov.