Q. If I retire in the State pension system, do I automatically get retiree health benefits?
A. Not necessarily. You will receive health benefits as a retiree if you have met the service requirements for retiree health benefits. For example, a CSEA retiree employed by the County on or after August 22, 2003 is eligible to retire after five years in the pension system but must have at least ten years of County employment to be eligible for retiree health benefits. Please check with your department’s Human Resources Representative to confirm your eligibility for retiree health benefits.
Q: As a retiree, is my primary medical carrier Medicare?
A: If you are over age 65 and no longer working full time, you qualify for Medicare and Medicare is your primary carrier. You may also qualify for Medicare if you are under age 65 and disabled. The County will reimburse you for the regular cost of your Medicare Part B premium through checks issued twice a year. If you are being reimbursed for your Medicare Part B premium from another source, please notify us immediately. Failure to notify us may affect your future Medicare reimbursements. It is unlawful to accept a Medicare reimbursement check where you or your spouse/partner receives a duplication of benefits, such as a reimbursement check from another agency or company.
Please note that enrollment in Medicare is not automatic, so please contact Social Security Administration, approximately three months before you or your spouse turns 65. If you fail to enroll in Medicare when required, it may adversely affect your benefit, as NYSHIP will only reimburse costs not covered by Medicare regardless of whether or not you have enrolled.
Q: Why haven't I received my Medicare Part B reimbursement check?
A: Part B reimbursement checks are currently mailed out in June and December. If your address has recently changed, you must send the Comptroller’s Office a signed letter with the change of address information.
If it is not an address problem, please contact the Comptroller’s Office, Health Benefits Unit by e-mail at ComptrollerHealthBenefits@nassaucountyny.gov or by phone at (516) 571-2369.
Q: I earned enough that I had to pay an extra amount for Part B. How does the County reimburse me?
A: In the year following payment, Social Security will send you an official notification of the additional charge for Part B coverage. This official notification will usually come in the form of a 1099. Send a copy of the document to the Comptroller’s Health Benefits Unit for the additional reimbursement.
If you are currently not collecting Social Security Benefits and are being billed directly by the Centers for Medicare and Medicaid Services (CMS), please send a copy of each quarterly bill for the affecting year to the Comptroller’s Health Benefits Unit for the additional reimbursement.
Q: Does the Medicare Part D program for drug coverage benefit me if I already have drug coverage under The Empire Plan?
A: As an Empire Plan enrollee or covered dependent eligible for Medicare, you should consider joining a Medicare prescription drug plan ONLY if you are currently contributing to your health insurance premium and are eligible for extra help provided by the Medicare Part D Low Income Subsidy. The prescription drug benefits provided under your Empire Plan coverage will, in most cases, give you better coverage and lower out-of-pocket costs than the coverage offered under a Medicare Prescription Drug Plan.
Q: What is the Medicare Part D Low Income Subsidy Program and what are the eligibility requirements?
A: Under the Low Income Subsidy, individuals with limited incomes and resources are eligible for extra help with drug plan costs under Medicare Part D. If you qualify for this extra help from Medicare, your out-of-pocket cost for prescription drug coverage may be lower through Medicare than under The Empire Plan. For more information on eligibility requirements and/or to apply for the Low Income Subsidy, call Social Security at (800) 772-1213 or visit www.socialsecurity.gov.
Q: If I currently pay for a portion of my health insurance premium and I find that I do qualify for the Low Income Subsidy under Medicare Part D, what will happen to my drug plan under Empire?
A: At present, if you choose to enroll in a Medicare Drug program such as Medicare Part D, your prescription drug coverage under The Empire Plan will become secondary to your Medicare prescription drug coverage and you will continue to be billed your full share of The Empire Plan monthly premium. The Medicare prescription drug plan will be primary, or paid first, for your prescription drugs. Your out-of-pocket costs under your Empire Plan prescription drug coverage may then be higher and you will have to submit a claim form for reimbursement under your Empire Plan coverage. There will be no automatic coordination of benefits, and therefore, a retiree would have to manually submit a claim form to Empire’s drug carrier for secondary benefits.
For more information about how Medicare prescription drug coverage relates to your Empire Plan drug coverage call 1-877-7-NYSHIP 1-877-769-7447.
Q: If my prescription drug plan has a gap period, should I use my NassauRx prescription drug discount card during the gap to reduce the cost of medications that would usually be covered by my plan?
A: It depends. If your prescription drug plan has a gap period, such as the Medicare “doughnut hole,” that requires you to pay a certain amount of prescription drug costs out of pocket before coverage resumes, and you are sure you will not meet that spending threshold before the calendar year ends, you may want to use the NassauRx card to reduce your out-of-pocket costs. If you are not sure, you should continue purchasing your medication through your prescription plan.
Q: I do not see my question answered here and I need help. How do I proceed?
A: For answers to questions not covered here, please mail a letter to the Nassau County Comptroller’s Office, Health Benefits Unit, 240 Old Country Road, Mineola, New York, 11501 or e-mail ComptrollerHealthBenefits@nassaucountyny.gov or call 516 571 -2369.