Turning 65

What you NEED to do when you or your spouse are turning 65 or become Medicare eligible and how to apply for Medicare Part B Reimbursement!

Three months prior to you 65 Birthday you must apply for

Medicare Part A and B.

Part A is Hospital (no cost) Part B is Doctors (premium will be charged)

NOTE: We have received many inquiries regarding Medicare Part B Reimbursement and have decided to publish this UPDATED article:

When a member/spouse nears Medicare Part B eligibility (https://www.medicare.gov/basics/get-started-with-medicare), the following OLR   notifications must be made:

• Notification to OLR (Office of Labor Relations) Health Benefits Program. The member/spouse must complete the “Notification of Your Medicare Part B Enrollment Application” form. This form is available on the OLR website at: health-retiree-medb-irmaa, and by clicking Medicare Part B Reimbursement Program Application.  Instructions for submission are on the application form.  Once you submit this application along with a copy of your Medicare card, you will be enrolled in the Medicare Part B Reimbursement Program and will not have to resubmit an application every year. Please read the application carefully, it contains information regarding eligibility and requirements/conditions that must be met.

Once you have submitted the Medicare Part B Reimbursement Program Application, the City will reimburse Medicare-eligible retirees and their Medicare-eligible dependents annually for the preceding year you were eligible for Medicare Part B Reimbursement. The reimbursement amount is based on the standard Medicare Part B premiums. 

Medicare Part B reimbursement checks will be issued beginning with the third week of April each year. Please check your bank account/statement (or the mail, if you are receiving a physical check). 

Again, please note if you have submitted your Medicare Part B Reimbursement application along with your Medicare Part A & B card to the City Employee Health Benefits Program, this reimbursement payment is automatic, and you will receive it annually, you are not required to complete the Medicare application annually

You may be entitled to receive IRMAA (Income-Related Monthly Adjustment Amount) reimbursement or Medicare Part B  Differential reimbursement.

Please visit the OLR website at: health-retiree-medb-irmaa. Here, you will find all the information, requirements, and applications needed regarding IRMAA and Differential reimbursement, as well as the Medicare Part B reimbursement.

The IRMAA Medicare Part B Reimbursement . The IRMAA  annual reimbursements are issued during the 3^rd week of October .  As a reminder if you did not pay more than the standard Medicare Part B premium amount then you are not eligible for IRMAA.

IMPORTANT: The IRMAA Medicare Part B Reimbursement Application MUST be submitted each year that you pay above the standard amount. If you did not pay more than the standard amount, then you are not eligible for IRMAA.

In conclusion, please visit OLR’s website at health-retiree-responsibilities for additional information regarding Medicare Part B & IRMAA Reimbursements. Their website contains a wealth of information that will have answers to most questions or concerns.

*******Additional Important Prescription information***********

DEA HEALTH BENEFITS FUND                                                                                                                                                                                                                                                             

• Members/spouses who are over the age of 65 are not required to send the DEA Health Benefits Fund a copy of your Medicare card. If you are under the age of 65 you must notify the DEA Health Benefits office as you will need to send a copy of your Medicare card to the DEA office
• Once you are 65 or under 65 and on Medicare, your prescription plans under the City (PICA/EMBLEM) will no longer be in effect.
• Coverage for you/family for Prescriptions that were covered under the NYC PICA program, (injectibles & Chemo) and prescriptions that were covered by the City under the Medical plan (Emblem) for Diabetes & Preventative   medications will no longer be covered.
• ALL medications will go through the DEA Prescription plan and co-pays will be per the DEA plan.