Recording of October 5, 2021 Queens Regional Virtual General Meeting

To view the recording please click on the link below.


Directory of Useful Telephone Numbers & Websites

Attached is a list of useful telephone numbers and websites for Federal Agencies and other organizations.   Click on the white button for the list.






How You Can Help Your Family After Your Death or Incapacitation

A Checklist for a Surviving CSA Spouse or Domestic Partner





2021 IRMAA Application

The 2021 Medicare Part B IRMAA Reimbursement Form has been released by the City Office of Labor Relations.  It is available by clicking here or going to CSA Welfare Fund website,, and clicking on the MEDICARE REIMBURSEMENT tab on the left, then clicking on the form.





CSA Legal Service Plan

CSA has negotiated a free legal service plan for all CSA Retirees.  Click on the red button below for detailed information.



Zoom Hosting Resource Sheet

On December 21, 2020 the CSA Queens Retiree Chapter held a virtual a Zoom Hosting Workshop presented by Susan Rippe Hoffman.  Click on the white button for the Resource Sheet from that workshop.




Updates from Norm Sherman 

Informational Update Vol 13 #4  May 4, 2022


    1. 2021 Medicare Part B Reimbursement


On or around April 15, 2022, Medicare-eligible retiree members and their Medicare-eligible dependents received the annual Part B standard reimbursement for 2021 of $1,782 ($148.50 x 12 months), except for those who were penalized or went on Medicare sometime during 2021. This group will receive a pro-rated amount, although the exact date when this will happen is unknown at this time.


Those members who receive their pension payments electronically should check their bank account for the payment. Those members who receive their pensions by check, should have received the reimbursement the same way.


Unlike IRMAA, the standard reimbursement is automatic and requires no application providing the Office of Labor Relations (OLR) has a copy of your Medicare Parts A & B card. As a courtesy, the CSA Retiree Welfare Fund will send OLR a copy of your card providing you first send the Fund a copy. 


     2. 2021 IRMAA  


Federal law requires Medicare-eligible retirees to pay a surcharge on top of the Part B standard amount and Part D (drugs) premium if their taxable income surpasses a certain amount. This surcharge is called the Income-Related Monthly Adjustment Amount (IRMAA). The Part B IRMAA is reimbursable, but, unfortunately, the Part D is not.


Medicare-eligible members and their Medicare-eligible dependents who filed an application in a timely manner, should receive their 2021 Medicare Part B IRMAA reimbursement in October 2022.


Those members who receive their pension payments electronically, will have their reimbursement deposited in their bank account. This amount is separate from the pension payment. Those who receive their pension checks in the mail, will have their IRMAA reimbursement mailed to them.


 3. Something New: The $15 Copay


Effective January 1, 2022, members in Senior Care became responsible for a $15 copay for PCP and specialist services. These co-payments are supposed to start after the $233 Medicare deductible and $50 Emblem Health deductible have been met.


Unfortunately, there have been some problems associated with co-payments which I can best explain by example.


1. The doctor charges you a $15 copay for a visit even though you have not met your deductible. This is an example of you paying twice – once for your $15 copay and the 2nd to meet your deductible. 

2. The doctor charges you a $15 copay. According to Emblem Health’s Summary of Claims, they allow for the service 11.91, a difference of $3.09.


The only way you can resolve these issues is by apprising your doctors’ offices. The offices should give you credit if you paid a copay before you met your deductible or paid more than you should have. I also strongly suggest you review your Emblem Health Summary of Claims and keep track of your co-payments.


4. Question of the Month


I was told by Express Scripts recently that one of my drugs, which is extremely expensive, will not be covered when I go on Medicare unless I try 4 drugs from my preferred list. I do not wish to try these drugs as they may have serious adverse side effects. Should I look for another drug plan that covers this drug?


That is entirely up to you. If you feel the drug will be too costly, you may drop the GHI/Express Scripts plan when you go on Medicare and enroll directly with a plan that covers your drug. Since you will no longer be enrolled in the GHI/Express Scripts plan, the Fund will continue to reimburse 80% of your copays after an annual $100 deductible up to $10,000. The Retiree Chapter will also continue to reimburse you an additional 20% of whatever the Fund reimburses you.


Since you will longer be in the GHI/Express Scripts plan, you no longer will receive the $40 per month “Valentine” gift. You may, however, re-enroll in the drug plan each year during the transfer period should you desire to do so.    

Informational Update Vol 13 #3       March 31, 2022


1.    Signing Up for Medicare


I often receive calls from retired members approaching Medicare eligibility – 65 years old - about how to sign up for Medicare. Generally, the conversation lasts a few minutes because the explanation takes almost no time.

  •     If you are ON Social Security, you will receive a Medicare card and an informational letter on how Medicare works about 3 months before your 65th birthday. If you do not get the letter, call the Social Security Administration (SSA) at 1-800-772-1213 or, if you prefer, visit your local Social Security office.

  •  Mail a copy of your Medicare card to the CSA Welfare Fund, 40 Rector St., 12th floor. New York, NY 10006. That’s all you need to do. The CSA Welfare Fund will ensure through the Office of Labor Relations that you are enrolled in Medicare Part A, B and, if you are paying a high option rider (deducted from your pension), enrolled in the GHI Enhanced Plan D drug plan. While there is no premium for Part A, there is one for Part B.

  •   If you are NOT on Social Security, you will have to sign up for Medicare. You can do so by

 Calling SSA at the number listed above. Make sure to take down the name of any representative that you speak to.

  •  Visiting your local SSA office. When you are finished, ask for a written receipt.

  • Mailing a signed and dated letter to Social Security that includes your full name, Social Security number, and the date you wish to be enrolled in Medicare. Use certified mail and request a return receipt.

  • Or, by signing up online at Be sure to print out the confirmation page.  

If you don’t sign up for Medicare during your initial enrollment period, which begins 3 months before the month of your 65th birthday and continues until 3 months after that birthday, you face a 10% increase in your Part B premiums for every year you’re eligible but don’t enroll, unless you happen to qualify for an exception. For example, you can delay Medicare if you are covered by your spouse’s medical plan and his or her employer has 20 or more employees. Once that insurance ends you will have to sign up for Medicare. If there are fewer than 20 employees, you will have to sign up when you are first eligible.

The Part B premium is divided into 2 parts: a standard amount that everyone pays and a surcharge that you pay only if your taxable income is greater than a certain amount. The good news is that the Office of Labor Relations (OLR) reimburses both the standard amount (automatically) and the surcharge, if there is one. The surcharge will require filing an application.

In summary, if you are on Social Security, there is nothing for you to do to enroll in Medicare other than sending a copy of your Medicare card to the CSA Welfare Fund. They will do the rest,

2. Prescription Co-Pays

In the February issue of the CSA News, Dr. Douglas Hathaway, CSA Welfare Fund Administrator, mentioned that non-Medicare eligible retirees are eligible for reimbursement for Prescription co-pays. All they have to do to secure the reimbursement for 2021, is submit a copy of the 4 quarterly reports from Express Scripts/GHI to the CSA Welfare Fund. The Fund will then reimburse 80% of the co-pays after a $100 deductible up to a maximum of $10,000.

In a seamless operation, the CSA Retiree Chapter will then kick in an additional 20% of the Fund payment in a separate check. For example, if you have $400 in prescription co-pays, you will get back $400 – the $100 deductible = $300 x 80% = $240 + $240 x 20% = $240 +$48 for a total of $288.

The Fund will send you a check for $240 and then the Retiree Chapter will send you a check for $48 about two weeks later.

3. Question of the month

    Q. Why am I paying a $15 co-pay to my doctor if the new plan is not being implemented on April 1, 2022?

A. The $15 co-pay was supposed to go into effect for Senior Care on Jan 1, 2022 regardless of whether the new plan was going to be implemented.   

  Informational Update Vol 13 #2 dated 3/4/2022


1. Medicare Part D Drug Costs

The GHI enhanced Medicare Part D drug plan consists of 3 stages. If you noticed a change in your prescription costs in January it may be the result of starting again in Stage I on January 1, 2021, no matter what stage you ended in on December 31, 2020. In Stage I, you pay 25% of the drug cost while the plan (GHI enhanced Plan D) pays the other 75%.


If your total drug cost (what you and your plan both pay} exceeds $4,430 (up $300 from 2021) at some point in 2022, you enter Stage II, formally known as the donut hole. Fortunately, the donut hole has closed for both generic and non-generic drugs; you continue to pay the same 25% of the drug cost while your plan pays 75%


If your true-out-of-pocket expense – known as TrOOP – for both Stages I & II exceed $7,050 (up $500 from 2021) you enter Stage III, or the Catastrophic Coverage. In this Stage your co-payment continues as it was in 2021: you pay 5% of the drug cost. Medicare pays 80% and the plan pays the remaining 15%.


The CSA Welfare Fund also offers an added benefit in this Stage by reimbursing you the 5% cost up to $5,000. There is no deductible. Just send your Express Scripts statements to the CSA Welfare Fund for reimbursement. These statements should be sent at the end of the calendar year to help facilitate the CSA Retiree Fund’s processing of your claim.


2. “Valentine’s Gift”


 If you are Medicare eligible and have the GHI Enhanced Plan D plan, you should have received your “Valentine’s” gift of $480 for 2021 toward the latter part of February, depending on your mail service. This is a CSA Welfare Fund benefit designed to help defray the cost of the High Option Rider that pays for the Enhanced Plan D. If you were eligible for reimbursement, but were not on Medicare for the full year, you should have received a pro-rated check. The pro-rata is $40 a month for every month on Medicare.


If you have not yet received your check, wait a little longer before calling the Welfare Fund as there may have been a delay in the mail. 

 Please note that only Medicare-eligible CSA retirees are entitled to the “Valentine’s” gift; non-CSA Medicare-eligible people are not. If both husband and wife are Medicare-eligible CSA retirees, then both are entitled to the $480 providing EACH has their own NYC medical coverage. If one member is covering the other member, then only the member who is covering is entitled to the $480.


For non-Medicare CSA retirees and non-Medicare dependent spouses, the CSA Welfare Fund and CSA Retiree Chapter will continue to cover copays, providing the member and spouse are under the GHI or City HMO plans. After a $100 deductible, the reimbursement is 80% of the drug cost up to a maximum of $10,000. In addition, the CSA Retiree Chapter automatically (no filing of a claim necessary) supplements this reimbursement with an additional 20% of the Fund payment.


3. COVID-19 at-Home Tests


Good news! You are now entitled to 4 free COVID-19 at-home tests shipped directly to your home. To get these tests, go on the website and in your profile information.


These are “self” tests that do not require a lab drop-off. The tests can be taken anywhere and will give results within 30 minutes.

Be careful against scammers trying to steal your personal information or selling fake and unauthorized at-home COVID test kits in exchange for your personal information. Only order the “self” tests through the official government website mentioned above.

Informational Update Vol 13 #1  January 29, 2022


Here is some important information:

     1. 2022 Medicare Part B Deductible & Premiums

As you start to visit your Medicare doctors in 2022, you will have to pay Medicare Part B deductibles again since they reset January 1, 2022.  The deductible for Medicare Part B increased $$30 from $203 to $233. The GHI Emblem Health Medicare Part B remains at $50. The part of the $233 deductible that you pay when you visit a doctor will depend on the doctor’s service and what Medicare allows for the service. The likelihood is that it will be less than the full amount of the deductible. You will pay the amount that is left at future doctor visits. Remember, Medicare will not pay its part of a doctor’s bill, which is about 80%, until you have fully met the deductible.


As of now the NYC Medicare Advantage Plus Plan (NYCMAPP) goes into effect on April 1. The deductible will be $283 ($233 + 50). Any part of the deductible that was paid under your current plan (in most cases, Senior Care) from Jan 1, 2022 thru March 31, 2022 will be credited to the NYCMAPP.


This year the standard Medicare Part B premium increased $21.60 from $148.50 to $170.10. However, not everyone who is on Medicare pays the same amount.


A small percentage of Medicare-eligible people will actually pay less than the standard amount under a “hold harmless provision.“ which prevents their Social Security benefit payment from decreasing because of an increase in their Medicare Part B premium. Those in this category will pay either the same premium as they did in 2021 or a little less.


There also are Medicare-eligible people who will pay more than the standard amount. For those whose Medicare Adjusted 2020 taxable income was greater than $91,000 if they filed individually or $182,000 if they filed jointly, they will pay a surcharge known as the income-related monthly adjusted amount or IRMAA in addition to the standard amount. The extra amount that they will pay varies depending on how much taxable income they had received in 2020.


The good news is that BOTH the 2022 standard and IRMAA amounts are still reimbursable. While the Office of Labor Relations (OLR) reimburse the standard amount automatically, they require an application for the IRMAA reimbursement. At this time, the date of the 2022 application is unknown.


In October 2021, the OLR sent out 2020 IRMAA reimbursement checks to Medicare-eligible members who filed a 2020 a timely fashion. Those who are eligible for 2020 IRMAA reimbursement and never filed an application, can still file one. Applications are available on the CSA Welfare Fund website,


Those who are eligible for 2021 IRMAA reimbursement should have received their 2021 1099 SSA letter. (If you have not yet received the letter you can download it from the website, after January 31st) Once the 2021 application becomes available, they will be able to apply for the 2021 IRMAA reimbursement.  Below is a primer on how to do it.


How do You Apply for 2021 IRMAA


If you are eligible for 2021 IRMAA reimbursement, you will need to file an application. If things stay the same as last year, the application should be available in April’22 or May ’22 and you will be able to download it from the CSA Welfare Fund website


Assuming the 2021 application is similar to the 2020 application, there will be 3 boxes, one for 2019, 2020, & 2021. Check the 2021 box. (You can apply separately, or together with the 2021 application, for 2019 or 2020 IRMAA reimbursements if you never did so and were eligible.)


Sign the application. This is a critical step. Applications will not be accepted without signature.


How do I Know if I am Eligible for 2021 IRMAA?


There are 2 ways to determine 2021 IRMAA eligibility:

  • Your 2019 Part B premium was greater than $135.50.

  • Your 2019 taxable income (2021 Part B premium was based on this amount) was greater than $88,000 if you filed individually or $176,000 if you filed jointly.

Documents Needed to Send Along With Application:


There are two (2) documents that you must include with the application. These documents are:

1) The letter Social Security (SSA) sent you, dated November 2020, indicating how much your Medicare Part B premium was going to be in 2021. (Do not confuse this letter with the one you received this past November, which indicated your 2022 Medicare Part B premium. Put that away in a safe place.


2) The SSA-1099 letter you should be receiving in January 2022, indicating the total amount you paid for your 2021 Medicare Part B premium.


Please Note:


         1.  If your spouse or significant other is 1) Medicare eligible, and 2) a city retiree who has his/her own medical coverage, he/she must fill out and sign a separate application and send it along with the proper                              documents.            

         2. If your spouse or significant other is 1) Medicare eligible, and 2) is your dependent, complete the Eligible Dependent Information section of the application (one application for both of you) and send it along with yours as well as your spouse’s or significant other’s proper documents.

         3. If you or your Medicare-eligible spouse are not yet receiving Social Security, you will not receive a 1099 form. Instead, you will have to send a copy of each month’s SSA billing statement for Medicare Part B and proof of payment for the IRMAA premium (copy of check, credit card statement, or bank statement). If you are providing a credit card or bank information black out the account information before submitting the information.


Where Should I Send the Completed IRMAA Application & Documents?


Send your completed application to the CSA Welfare Fund, 40 Rector St, 12th Floor, New York, NY 10006. The Fund will check your application to determine that you submitted the correct documents. They also will scan your documents (in case the city loses your submission) to their archives, and, log and submit them to OLR.   


When Will I Receive My IRMAA Reimbursement?


If things are the same as last year, you should receive it in October 2022



1) Do not send original documents. Only copies.

2) Make a copy of your submission(s) and put it in a safe place.  

 2. Question of the Month

              Q.  Is a Medicare-eligible member covered for emergency ambulance service to the hospital?

              A. Medicare plus the secondary insurance overs ground ambulance transportation when you need to be transported to a hospital, critical access hospital, or skilled nursing facility for medically necessary services, and transportation in any other vehicle could endanger your health.  

Informational Update Vol 12 # 12   January 4, 2021

1. NYC Medicare Advantage Plan –  By now, many of you are aware that the judge dealing with the new NYC Medicare Advantage Plus Plan issued a ruling which did the following:

·        Changed the start date of the new NYC Medicare Advantage Plus Plan to April 1, 2022. The previous start date was January 1, 2022.

·        Extended the Opt-Out date to March 31, 2022. The previous opt-out date was October 31, 2021. If you already opted out, you do not have to do anything.

·        Opened a window from April 1, 2022 to June 30, 2022 to tryout the new NYC Medicare Advantage Plan Plus. If you initially decided to go into this new plan and do not like it during this 3 month period, you can opt out up to June 30; you will be able to return to your old plan. If you opted out initially and now wish to try it out, you may enroll in the new plan from April 1, 2022 to June 30, 2022.

         Below is some other important information about the new NYC Medicare Advantage Plus Plan that you should know. :

  • On Jan 1, those members in Senior Care will be paying a Part B deductible of $233 (up $30 from last year) and $50 for GHI – Emblem Health for a total of $283. Any deductible paid between Jan 1 and April 1, will be carried over to the NYC Medicare Advantage Plus Plan for those enrolling in the new plan

  • Starting Jan 1, there will be a co-pay of $15 for all medical services under Senior Care. Those members who will go into the new plan on April 1, 2022, will continue to pay the $15 co-pay, except for a family doctor.

  • The Office of Labor Relations (OLR) has put out a publication giving you in-depth information and updates about the new NYC Medicare Advantage Plus Plan. You can download this publication from either the OLR website,, or the CSA Retiree Welfare Fund Website,

  • You should have received in September an Enrollment Guide by snail mail or email. You can now download an updated Guide from either the OLR website or the CSA Retiree Fund Website.

  • One of the unique facets of the new plan is you can go to either an in-network provider or out-of-network provider providing the providers take Medicare. Your only payments are deductibles and $15 co-pays. All the out-of-network doctor has to do to get payment for Medicare covered services is bill the plan directly


  4. Question of the Month


Q. I did not receive my SSA letter listing my 2021 Social Security benefits and deductions. How can I get a copy?    

A. There are two ways: 1) you can call Social Security or visit your local Social Security office and request the SSA letter. Have a previous SSA letter or facsimile of the letter available with you so that you can clearly describe to the SSA agent what you want, OR 2) download a copy from the SSA website, This will require your having an online SSA account, which, if you don’t have one, you can open one on the SSA website by just following the prompts.

Informational Update  Vol. 12  #11      December 7, 2021

1.   2022 Social Security Letter – If you are eligible for Medicare, you should have received a letter from Social Security in November giving you your 2022 Social Security benefit amount before and after deductions.

Due to a rise in the cost of living, your Social Security benefit amount will increase 5.9% starting January 1, 2022. Social Security deducts from this amount your Medicare Part B (medical) premium & your IRMAA Medicare Part D (drugs).premium.

Medicare Part B Premium

Your Medicare Part B premium is divided into 2 parts: the standard amount & IRMAA (Income-Related Monthly Adjustment Amounts). Everyone who is Medicare-eligible pays the same standard amount. For 2022, the standard amount is $170.10 per month, up $21.50 from $148.60, in 2021.

The Income-Related Monthly Adjustment Amounts (IRMAA) is a monthly surcharge that is deducted ONLY from those Medicare-eligible members whose taxable income (based on your 2020 income tax return) surpasses a certain threshold. In 2022 the threshold is $91,000 if you filed individually (up $3,000 from 2021) and $182,000 if you filed jointly (up $6,000 from 2021). The SSA letter contains a chart indicating various income thresholds and the monthly amounts of the Part B surcharge.


Medicare Part D Premium


Medicare Part D is your drug plan. Your premium is also divided into 2 parts: the High Option Rider and IRMAA. The High Option Rider, which most of you bought when you were active supervisors, is currently $150 a month and is deducted from your pension check.  

If you are eligible, you will also pay IRMAA Medicare Part D. The amount is based on your 2020 income tax return. The SSA letter contains a chart indicating various income thresholds and the monthly amounts of the Part D surcharge.


How Much You Will Get


Please note the first page of the SSA letter contains 4 bullets. The first one shows how much your SS benefit for 2022 is before deductions, providing you are collecting Social Security.  The second shows the 2022 deductions for Medicare Part B for the standard amount and for IRMAA (if not eligible for 2022 IRMAA, IRMAA deduction should be 0).

The good news is that the 2022 Part B standard amount & IRMAA deductions are both reimbursable. You will receive the standard amount automatically, probably sometime in April 2023. IRMAA reimbursement is not automatic; you must apply for it.  The application is generally available when you receive your standard reimbursement.

The 3rd bullet shows the 2022 deduction for Part D IRMAA. If you have an IRMAA deduction for Part B then you will also have one for Part D. Please note that Part D IRMAA is NOT reimbursable.

The 4th bullet lists your SSA benefit amount after all deductions. 

If you are eligible for IRMAA in 2022, keep your 2022 SSA letter in a safe place. You will need to include it, along with your 2022 SSA-1099 letter, in the application package when you file for 2022 Part B IRMAA.

2.   Payment of Medicare Part B Premium – Most Medicare members have their Part B premium electronically deducted from their Social Security Check. However, if you are NOT collecting Social Security (you may be waiting until you are old enough to receive full payment) you will receive a bill called “Notice of Medicare Premium Payment Due” (CMS-500). You can pay this bill by 1) using your bank’s online bill payment service, 2) signing up for Medicare Easy Pay, a free service that automatically deducts the premium payments from your savings or checking account each month, or 3) paying by check, money order or credit card. Check or money order is sent to:

Medicare Premium Collection Center

P.O. Box 790355

St. Louis, MO 63179-0355

If you use a credit card you will have to complete the bottom portion of the Medicare bill, sign it and send it to the above address.

3. Questions of the Month

Q. I did not receive my SSA letter listing my 2022 Social Security benefits and deductions. How can I get a copy?    

A. There are 3 ways: 1) you can call Social Security at 1-800-772-1213 2) visit your local Social Security office and request the SSA letter. Have a previous SSA letter or facsimile of the letter available with you so that you can clearly describe to the SSA agent what you want, OR 2) download a copy from the SSA website, This will require your having an online SSA account, which, if you don’t have one, you can open one on the SSA website by just following the prompts.


Informational Update Vol. 12 #10   November 4. 2021


1. 2020 IRMAA Reimbursement.

If you are on Medicare, you and your Medicare-eligible spouse/legal partner should have received your 2020 IRMAA reimbursement on October 15, 2021, providing you were eligible for it and filed an application in a timely fashion. The Office of Labor Relations direct deposited the reimbursement check if that is the way you receive your pension or sent you the reimbursement check directly if that is your mode of payment.  

If you are eligible for 2020 IRMAA reimbursement but have NOT yet applied, you can still do so. Just submit a completed 2020 IRMAA form to the CSA Welfare Fund Office, 40 Rector St., 12th Floor, New York, and N.Y. 10006. You can download the form from the CSA Welfare Fund website, Be sure to include with the form a copy of the November 2019 SSA and 2020 SSA-1099 letters if you collect Social Security. If you do not collect Social Security, you must include proof of payment for the Medicare Part B premium. Credit card statements or copies of canceled checks are acceptable proof.

2. What is the Impact of the NYC Medicare Advantage plus Plan?


As many of you know by now, a state judge has issued a temporary restraining order extending the opt-out of the NYC Medicare Advantage plus Plan (MAPP) beyond the October 31 deadline to give you and medical providers more time to learn about the provisions of the new plan. No new deadline date has been set.


The judge did reject the claims of Aetna & United Health that the bidding process was faulty and dismissed their lawsuit that made those claims.


He also ordered that those affected by the City’s plan to have public workers change to MAPP, maintain their current health plan until the judge approves a newly revised plan that resolves the current roll-out deficiencies.


Simply put, the judge did not scrap MAPP, just its implementation. When that gets resolved a new deadline date will be set.


What does all of this mean to you? Only that the plan is on hold and you stay with your current plan (in most cases, Original Medicare & Senior Care). This is true whether or not you have already opted out. When a new plan is approved and a deadline date is set, then you can decide whether to go into the new plan or opt-out.


3. Question of the Month


Q.  I am a non-Medicare retiree. I understand that I am entitled to a reimbursement for my drug co-pays. Is that so?


A.  Yes it is. After an annual $100 deductible, the CSA Retiree Welfare Fund will reimburse you 80% of the cost up to a max of $10,000. Even better, the CSA Retiree Chapter will reimburse you an additional 20% of the Fund’s reimbursement. Please submit your claim after you receive the last quarter’s (Oct, Nov, Dec) printout, which must be included with your claim.  Filing it quarterly or monthly puts an undue strain on the Welfare Fund. Please note that you do not have to submit a claim to the Retiree Chapter as you will automatically receive the 20% payment about 2 weeks after you receive the Fund’s payment

Informational Update Vol 12 #9     September 27, 2021


1. Traditional Medicare vs the new MAP

The most frequently asked question I have received over the past month is “What health plan should I take, the traditional Medicare plan or the new NYC Medicare Advantage Plus Plan?” And my answer has always been the same: I cannot answer that question because there is no right or wrong choice. It is a personal choice that should take into consideration 4 factors.

First, does the new plan offer you the same coverage as the traditional Medicare plan? Absolutely, and more. The following are some of the “extras” that are covered by the new MAP plan, but not by the traditional one:

  1. Transportation to the Doctor

  2. Hearing Aids

  3. Dental Work

  4. House Call Program

  5. Prepared Meals

  6. Fitness Tracker Device & Silver Sneakers


Second, your financial situation; can you afford the additional costs under the traditional Medicare Plan? Under the new MAP plan, there is no premium, no copay when you visit a Primary Care Physician (PCP), and a cap of $1,470 on out-of-pocket (OOP) expenses, which include the $253 deductible. Under the traditional Medicare plan you have to $191.57 per person per month (not reimbursable), a $15 copay when you visit the PCP, and no cap on OOP expenses.


Third, your tolerance for stress. Because the MAP plan is new, it may have some “growing pains.”  Think of it as moving into a brand new house. After living there for a week, you discover some floor tiles are cracked. What do you do? You report the problem to the builder and he sends a repairman to replace the tiles. Problem solved. Now consider when you go to a Medicare doctor. In most, if not all, cases the doctor will accept the new plan. However, suppose he/she does not. What do you do? You call the plan’s concierge who will attempt to convince the doctor to accept the plan. If the doctor still refuses, then you pay him/her and submit the claim to the plan for reimbursement (providing the service is a Medicare covered benefit). Problem solved. In short, the new plan may incur some problems moving forward until all the kinks are ironed out. This could cause some stress which you normally don’t experience under traditional Medicare. 


Fourth, once I make a choice will I have an opportunity to change my mind?  Absolutely! You will have an opportunity to opt-in or opt-out toward the end of every year.


So, review these 4 factors first and then select the health plan that best suits your personality. Whatever plan you choose, you will not make a mistake.


2. Flu Vaccine

With the 2021 flu season quickly approaching, you need to take your flu shot. Taking the shot this year is especially important as the public health officials continue to grapple with the COVID-19 pandemic.  While the flu is not as dangerous as coronavirus, it does kill thousands of people each year. Amazingly, only 51.8% of Americans were vaccinated last year.

Not everyone can get the flu shot for medical reasons; everyone should consult with their doctor before taking the shot.

Keep in mind that vaccinated people cuts down on the transmission of the flu from one person to another, creating a form of herd immunity.

3. Question of the Month

Q. I am the spouse of a retired CSA member and just paid a $300 deductible for a recent hospitalization. Is there coverage for the $300?

A. I hope you are feeling well…Yes, there is. Submit the invoice and proof of payment to the CSA Retiree Welfare Fund. After an annual $100 deductible under the Fund’s Supplemental Medical Program, you will get back 80% of $200 ($300-$100) or $160. Moreover, the CSA Retiree Chapter will reimburse you seamlessly (you do not have to apply) an additional 20% of $160 or $32. Total reimbursement: $192.

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