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 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
2019 IRMAA Application
NYS Absentee Ballot Application
Updates from Norm Sherman
Informational Update Vol 11 #8 September 16, 2020
1. Medicare Covers Acupuncture for Back Pain for 2021
Effective January 1, 2021, Medicare will cover up to 12 acupuncture visits in a 90 day period for chronic lower back pain providing:
· The pain is lasting 12 weeks or longer
· The pain is not related to spreading cancer, inflammatory or infectious disease
· The pain is not associated with pregnancy or surgery
Medicare will also cover an extra 8 sessions if your doctor indicates that your chronic back pain shows improvement. If the doctor indicates there is no improvement or your condition is getting worse, then Medicare will not cover the additional sessions. Medicare covers no more than 20 treatments yearly. These treatments may only be used for chronic lower back pain.
Once you have exhausted your allotted 20 treatments, you can turn to the CSA Retiree Welfare Fund and CSA Retiree Chapter for additional coverage.
CSA Retiree Welfare Fund – You are allowed a maximum of 36 visits a year. The maximum allowable charge is $100 per visit. After an annual $100 deductible you will be reimbursed 80% of the cost.
CSA Retiree Chapter – You will get an additional 20% reimbursement of whatever the Fund reimburses you. You do not have to apply for it as the process is a seamless operation. The reimbursement should come about 2 weeks after the Fund reimbursement.
2. Change in Prescription Drug Benefit
One of the most important features under the Affordable Care Act (ACA) is the requirement that health plans cover certain medications & supplements that are considered preventative at no cost to eligible people. From the outset of ACA, the U.S. Preventive Services Task Force (USPSTF) determined the list of drugs, both prescription and over-the-counter (OTC), that fall under this category. The list, which is quite extensive, includes such drugs as Tamiflu, contraceptives, pre-natal vitamins and statins.
Effective July 1, 2020, your health plan covered at no cost to you one specific dosage of Truvada – 200-300 milligrams – since it was now considered a Pre-Exposure Prophylactic medication (PreP), which is a preventative for people who are very high risk of getting HIV. No longer do you need to get the drug through the Welfare Fund.
If you are not on Medicare, there will be no copay. If you are Medicare-eligible, you will continue to pay the 25% copay.
3. Flu Vaccine
With the 2020 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 45% 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 type of herd immunity.
4. 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. 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.
Informational Update Vol 11 #7 August 25, 2020
1. Contact Tracing
It is hard to believe, but almost ½ year has passed since the country closed down because of the coronavirus. Our lives since have changed dramatically in many ways. One of those ways has been new words and terms added to our everyday vocabulary, such as contact tracing.
What is contact tracing? According to Webster’s dictionary, contact tracing is “the practice of identifying and monitoring individuals who may have had contact with an infectious person as a means of controlling the spread of a communicable disease. “ Contact tracers are like detectives in their attempt to find all the people who might have been in contact with someone who tested positive for COVID-19. Their purpose is to try to slow down the spread of the disease.
If you have been in close contact with someone who has tested positive for COVID-19, a contact tracer or public health worker may call you.
If that happens, be aware of the following:
· You will be told that you may have been exposed to someone with COVID-19. The caller will ask who you have been in contact with and your recent whereabouts. You should answer those questions as all the information you give, including your name, is strictly confidential and may help stem the spread of the disease. The caller’s only interest is to track down all people who have been in contact with a person who tested positive for COVID-19 and warn them of their possible exposure.
· You may be asked to self-quarantine for 14 days. This means you stay home, maintain social distancing from all those in the household, and monitor your health.
· You may be asked to watch for symptoms of COVID-19. Let your doctor know if you get symptoms and, if your condition gets worse, get medical help.
Of course, you always have to watch out for COVID-19 scammers. A legitimate tracer or health worker will never ask you for:
§ Your Social Security Number
§ Bank Account Information
§ Salary Information
§ Credit Card Numbers
If someone asks for this information, hang up immediately, and report it to Medicare at 1-800-MEDICARE.
2. Medicare/Emblem Health Glitch
Over the past several days, I have gotten calls concerning a glitch in the way Medicare/EmblemHealth are handling claims.
In June 2020, EmblemHealth issued a new medical card that had a new ID medical number. The card went into effect July 1, 2020. Your job was to give your doctors the new ID card when you first visited their offices after July 1st.
There is apparently a breakdown in the way Medicare and EmblemHealth communicate with each other regarding the new EmblemHealth medical card.
In the past, doctors would send a request for payment for services rendered to a Medicare eligible member directly to Medicare. After Medicare would determine what portion of the payment was allowable and pay about 80% of that portion, it would then send the request for payment to EmblemHealth (or whoever was the secondary provider) to pay the remaining portion, which is about 20% of the request.
This process worked well for years. Somehow, it broke down after the new cards went into effect. Medicare, instead of sending the request to EmblemHealth, sent it to Blue Cross, Blue Shield. Because this provider handles hospital claims, it obviously did not cover the remaining amount of the doctor’s request for payment.
This problem is systemic as it has affected many retired CSA Medicare-eligible members. CSA Retiree Welfare Fund Administrator Doug Hathaway has been in contact with Medicare and EmblemHealth, and was informed that they are aware of the problem and are working on correcting it.
Understand, CSA did not cause this problem. This is strictly a matter for Medicare/EmblemHealth to resolve. Doug will continue to monitor the situation until that happens to everybody’s satisfaction.
What should I do now?
If you haven’t already done so, give your doctors your new EmblemHealth Medical cards so they can record your new Medical ID number.
If you are experiencing above-mentioned problem, call Medicare and EmblemHealth to inform them of your situation. The more people call, the more pressure these two organizations will feel to resolve the problem as quickly as possible.
Do I have to pay the amount the claim says I owe?
No! All you received is a claim, not a bill. Should you get an actual bill, contact the CSA Retiree Welfare Fund or CSA Retiree Chapter.
3. Question of the Month
Q. I am a retired 85 year old retired CSA supervisor. TRS sent me a letter asking me if I am still alive. Is this some sort of scam?
A. No! TRS has been asking this question of our very elderly retired CSA supervisors. Answer the letter. If you don’t, TRS might stop your pension, and it could take up to 4 months for it to resume. If you cannot get your response notarized as instructed, TRS will accept your family doctor’s verification.
Informational Update Vol 11 #6 July 27, 2020
1. Medical Conditions and COVID-19
As you probably are aware, people of any age, but especially senior citizens, who are seriously compromised with certain medical conditions, such as heart disease, diabetes or chronic obstructive pulmonary disease (COPD), are very susceptible to getting the COVID-19 disease.
Medicare strongly recommends that if you have increased risk to COVID-19, you must take certain protections. These are some of them:
· Do not forget to take your medicines and treatment plans as directed by your doctor.
· If you are not feeling well, CALL your doctor. Do not delay in getting emergency medical attention if it becomes necessary.
· If you must go out in public, wear a mask and keep socially distanced.
Keep in mind that Medicare covers the following related to COVID-19:
§ Telehealth and virtual visits as long as it isn’t related to a medical visit within the previous 7 days or doesn’t lead to a medical visit in the next 24 hours (or soonest appointment available).
§ COVID-19 Lab tests.
§ FDA-authorized COVID-19 antibody tests if you had, or were suspected of having, COVID-19.
§ COVID-19 hospitalizations. This includes if you were ready to be discharged from a hospital but need to stay because you contracted COVID-19.
§ Although there is no approved vaccine, it will be covered when it becomes available.
COVID-19 has provided a whole new fertile ground for scammers. Because people, especially those at risk, can be distracted by the disease, scammers have jumped in to try to get your personal information. As always, guard your Medicare card and check your Medicare Claims Summary forms for errors or possible fraud. Do not respond to anyone who alleges there is something wrong with your Medicare card and needs certain information. Just, hang up. Remember, Medicare does not call, they write.
2. Home Health Aide
One of the most frequently used CSA Retiree Welfare Fund benefits is the Home Health Aide. Home health aides are invaluable for people who become incapacitated as a result of injury or illness. The aide will assist the person take care of his/her personal needs, such as, eating, bathing, toileting, dressing, etc.
How Does the Benefit Work?
After an annual $100 deductible, the CSA Welfare Fund will reimburse you 80% of your cost up to the $10,000 annual maximum, lifetime $30,000. In addition, the CSA Retiree Chapter will reimburse you in a separate check an additional 20% of what the Fund reimburses you.
For example, if at the start of the year, you used an aide and it cost you $300, the Fund would reimburse you, after a $100 deductible, $160 (80% of $200). The Retiree Chapter would then give an additional $32 (20% of $160). Your total reimbursement would be $160 + $32 or $192. If you needed an aide again during the same year, there would be no deductible so you would be reimbursed 80% of the full amount.
If you maximized the annual benefit each year that you use it, the $30,000 lifetime benefit would be depleted after 3 years. However, you can spread the use of the benefit over more than 3 years by not using up the full annual benefit. For example, suppose you collect only $5,000 of the benefit in a given year. The $5,000 left will then roll over so that you now have $25,000 left in the lifetime benefit, which will require more than 2 years to deplete.
How do You File a Claim?
To file a claim, submit the following to the CSA Retiree Welfare Fund (nothing is needed for the CSA Retiree Chapter)
· A doctor’s prescription showing the need for the aide.
· Proof the aide is certified.
· A log of the date and hours the aide provided service.
· Proof of payment. You will need a copy of a credit card or check payment. Cash payment is not acceptable.
· A completed Home Health Aide form. You can obtain a blank form from the CSA Welfare Fund.
Within about 2-3 weeks after you receive the Fund reimbursement, you should receive the Chapter reimbursement.
3. Question of the Month
Q. I am a retired CSA supervisor and just went on Medicare. Are the cost of drugs still reimbursable?
A. Unfortunately, they no longer are reimbursable until your out-of-pocket drug expenses reach $6,350. 80% of all drug expenses beyond that amount are reimbursable with a maximum reimbursement of $5,000
Informational Update Vol 11 #4 May 29, 2020
1. “No RMD Payment in 2020”
Recently, the Teachers’ Retirement System sent a letter to retired members who were eligible to receive Required Minimum Distributions (RMD) from their Tax-Deferred Annuity (TDA) Program account in 2020. The letter stated that as a result of recent federal legislation, known as the CARES Act, RMD’s for 2020 were being suspended, and the amount that you were entitled to was not eligible for direct rollover. To emphasize this, the words, “NO RMD PAYMENT IN 2020,” were typed in bold in the upper right-hand corner of the letter.
Almost immediately upon receiving the letter, our members started calling me with myriad questions. They were excellent questions that I thought I should share the answers to in this article. But before I do, a little background…
On Friday, December 20, 2019, the federal government signed into law, effective January 1, 2020, the Setting Every Community Up for Retirement Enhancement Act (Secure Act). This law made drastic changes to long-term retirement savings and affected all Americans at every age.
Prior to the law, you needed to take an RMD in the year you turned 70½. Now, under the Secure Act, that number changed to 72 if you did not reach 70½ before January 1, 2020.
However, under the Cares Act, RMD’s were suspended for 2020.
As a result, your TDA has another year (as of now, RMD’s will take place in 2021) to recoup losses due to a downturn in the stock market. The law also gives you a tax break of not being taxed on a mandatory withdrawal, or being put into a higher tax-bracket.
I can say much more about RMD’s and the two laws mentioned above, but before I run out of space, let’s turn to the questions.
1) Q: What is meant by a direct rollover?
A: A direct rollover is an electronic transfer of your retirement funds from one retirement account (e.g., your TDA) into another qualified account (such as an IRA). Generally, you can do that with your TDA Funds at any time. However, your RMD, as indicated in the letter, is not eligible for a direct rollover.
2) Q: Can I still withdraw my RMD?
A. Yes, however, you will have to pay taxes on the RMD that may put you in a higher tax bracket. Further, if your TDA is in fixed, it gets 8¼% interest. If you really need your RMD for expenses, you might be better off taking the money out from another source if you can, and not lose such high interest.
3) Q: Will I pay double RMD in 2021?
A: No. Your 2021 RMD will be based on the amount of your TDA as of December 31, 2020.
4) Q: Will the 2020 RMD continue to get interest if I do not withdraw it from my fixed TDA account?
2. Exceptions to Signing Up for Medicare When Turning 65
Last month I wrote about having to sign up for Medicare when you enter your enrollment period as you turn 65. If you don’t, 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. This article is about some of those exceptions.
You are 65 and still working
You do not need to sign up for Medicare if you have coverage under a group health plan through an employer who has a minimum of 20 employees. If the employer has fewer than 20 employees, you need to sign up for Medicare Parts A & B, which then becomes your primary health insurance.
You are 65 and your spouse is working
You do not need to sign up for Medicare if your spouse has coverage under a group health plan through an employer who has a minimum of 20 employees (if fewer, need to sign up) and your wife’s plan covers you.
Though you do not need to apply for Medicare if you fall in either of the two categories, it would be advantageous for you to apply for Medicare Part A since it won’t cost you anything and it will become your secondary insurance. If and when you lose the employer’s health plan coverage, you will get an eight month special enrollment period to sign up for Medicare. This period will start the month after you lose the coverage.
3. Question of the Month –
Q. On April 17, I received a Part B standard amount check for $1,626. Am I eligible for the 2019 differential?
A. No, you received the full reimbursement. If you went on Medicare after January 1, 2016, your reimbursement was based on a monthly premium of $135.50 and you received the full reimbursement. However, those members who went on Medicare prior to that date, had their reimbursement based on a monthly premium of $109.30. This group received $1,308. Those members who are eligible for IRMAA reimbursement, will have the difference included in their IRMAA checks, providing they apply for IRMAA. Those who are not eligible will have to apply for the difference using the differential application that can be downloaded from the CSA Welfare Fund website, www.csawf.org.
Informational Update Vol 11 #3 May 1, 2020
As the COVID-19 pandemic continues to wreak havoc throughout the world, I hope this update finds you well and safe…Here is some important information…
1. 2019 Medicare Part B Reimbursement
You should have automatically (no application necessary) received the 2019 standard Medicare Part B reimbursement on April 17, 2020. If you have direct-deposit, the check was either directly deposited in the same bank account as your pension, or, if you do not use direct deposit, mailed to your home. This payment is separate from your pension payment.
If you went on Medicare Part B prior to January 1, 2016, you received $1,308 for the full year ($109 monthly). However, you paid $135.50 per month or $1,626 for the full year. Consequently, you are entitled to an additional Part B reimbursement, known as the Part B Reimbursement Differential. The amount of the reimbursement is $318 (($135.50-$109) x 12) for which you have to apply.
If you enrolled during the calendar year 2016 or later, you received the correct amount of $135.50 per month or $1,626 for the full year (pro-rated if you were not on 2019 Medicare for the full year) and need not take further action.
How to Apply for the Medicare Part B Differential Reimbursement
If you are eligible for 2019 IRMAA (monthly Part B premium was more than $135.50 in 2019) and have filed for 2019 IRMAA, DO NOTHING. Your IRMAA reimbursement scheduled for October 2020 should automatically include the differential. If you have not yet filed for 2019 IRMAA please do so NOW by filling out the 2019 IRMAA application (application can be downloaded from the CSA Welfare Fund website, www.csawf.org) and submit it along with the required documents to the CSA Retiree Welfare Fund, which will verify the correctness of your application & documents
2) If you DID NOT QUALIFY FOR 2019 IRMAA, you must complete the Reimbursement Differential form and submit it along with the required document to the CSA Retiree Welfare Fund.
· 2019 SSA – 1099 if you are ON Social Security
· Other proof of payment such as CMS-500 Notice of Medicare Payment or bank statements if you are NOT on Social Security
Please note your spouse/domestic partner/Medicare-eligible dependent is entitled to these reimbursements as well.
2. Signing Up for Medicare
I often receive calls from members approaching Medicare eligibility – 65 years of age - 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 are automatically enrolled in Medicare Part A & B effective the month you turn 65. Social Security will send you a Medicare card and an informational letter 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.
§ If you are NOT on Social Security, you will have to sign up for Medicare by calling SSA or visiting your local SSA office. You can also sign up online at www.socialsecurity.gov/medicareonly/. If you don’t sign up for Medicare during your initial enrollment period, which begins 3 months before the month of 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 (I will discuss exceptions in future updates).
When you go on Medicare, you will have to pay a premium for Medicare Part B, which the Office of Labor Relations (OLR) will reimburse you. To be able to do that, OLR will require a copy of your Medicare card. The CSA Welfare Fund makes that requirement easy for you to carry out. Just mail a copy of the Medicare card to the CSA Welfare Fund, 40 Rector St., 12th floor. New York, NY 10006. The Fund will send a copy to OLR. They will also send a copy to your Medicare supplemental health plan (Part B pays about 80% of the cost, the supplemental plan pays the rest) to notify them of the changes in your health coverage. You are now set.
3. Question of the Month
Q. How do I know I am eligible for 2019 IRMAA reimbursement?
A. There are several ways, but perhaps the simplest one is to look at your 2019 SSA-1099 letter which you need to file your 2019 tax return. If that amount is greater than $1,626, you ARE eligible and need to file a 2019 IRMAA application.
Informational Update V 11 #2 dated March 21, 2020
1. Medicare Part D Drug Costs
The GHI enhanced Medicare Part D drug plan consists of Tier I. II & III. If you noticed a change in your prescription costs in January it may be the result of starting again in Tier I on January 1, 2020, no matter what tier you ended in on December 31, 2019. In Tier 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 $4,020 (up from $3820 in 2019) at some point in 2020, you enter Tier 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 Tiers I & II exceed $6,350 (up from $5,100 in 2019) you enter Tier III, or the catastrophic coverage. In this Tier your co-payment continues as it was in 2019 at 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 Tier 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 request.
2. “Valentine’s Gift
Retired CSA administrators or supervisors who are Medicare eligible and have the GHI Enhanced Plan D plan should have received their “Valentine’s” gift of $480 for 2018 this past February. 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. The amount was sent as a check.
Those who were eligible for reimbursement, but were not on Medicare for the full year, should have received a pro-rated check. The pro-rata is $40 a month for every month on Medicare.
Eligible Retired CSA members who have not received a check should contact the CSA Retiree Welfare Fund, 212-962-6061. Remember, 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 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. Medicare Coverage Re: Coronavirus
The COVID-19 (also called coronavirus) is one of the most insidious and dangerous disease’s ever. As you know it has created a world-wide pandemic that has shuttered many countries, with the number of COVID-19 cases & death tolls steadily rising. According to the Centers for Disease Control and Prevention (CDC), the most vulnerable population to the virus are older adults and people with serious chronic medical problems like heart disease
The good news is that Medicare covers medically necessary items and services related to COVI-19 providing the doctor accepts Medicare. These items include the following:
1. Coronavirus testing – This is considered a clinical lab test and is covered under Medicare Part B. There is no deductible involved.
2. Coronavirus vaccine – There is no vaccine for the virus. Once one is developed and becomes available, it will be covered by Medicare Part D. All Part D plans will be required to cover the vaccine.
3. Skilled Nursing Facility (SNF) – Medicare Part A generally covers SNF if someone comes directly from a hospital after being a patient for 3 days in a row. Under the coronavirus emergency, this qualifier is being waived if someone:
· Needs to be transferred to a SNF due to nursing home evacuations or make room at local hospitals.
· Needs SNF services due to the current Public Health emergency.
4. Telehealth services – This is a full doctor’s visit at home via a telephone call or video technology. Medicare has expanded its coverage during the public health emergency to include mental health counseling, preventative health screenings & other medical services. Telehealth services can be offered by doctors, nurse practitioners, clinical psychologist, and licensed social workers.
We are living under very trying conditions during this public emergency crises. Practice social distancing and other CDC guidelines to protect your safety and health.
Informational Update Vol 11 #1 (February 10, 2020)
1. 2019 Medicare Part B Deductible & Premiums –
As you start to visit your Medicare doctors in 2020, you will have to pay deductibles again as they reset January 1. The deductible for Medicare increased $13.00 from $185 to $198. (GHI remains at $50). The portion of the $198 deductible that you pay when you visit a doctor will depend on the doctor’s services; most likely it will be less than the full amount. The amount that is left will be paid at a future doctor visit or visits
This year standard Medicare Part B premium increased $9.10 from $135.50 to $144.60. If your monthly taxable income is greater than certain threshold amounts, you will pay, in addition to the standard Medicare Part B premium, a surcharge known as the income-related monthly adjusted amount or IRMAA.
The good news is that BOTH the standard and IRMAA amounts are still reimbursable. The Office of Labor Relations (OLR) automatically reimburses the standard amount, however, you must apply for the IRMAA reimbursement.
How do You Apply for 2019 IRMAA
If you are eligible for 2019 IRMAA reimbursement, the application is now available on the CSA Welfare Fund website, www.csawf.org. Please note that you must check which year you are applying for reimbursement. (You can apply separately for 2017 or 2018 IRMAA reimbursements if you never did so and were eligible.) Also, it is critical that you sign the application or else it will not be accepted.
How do I Know if I am Eligible for 2019 IRMAA?
There are basically 2 ways to determine IRMAA eligibility:
Your 2019 Part B premium was greater than $135.60.
Your 2017 taxable income (2019 Part B premium is based on this amount) was greater than $85,000 if you file individually or $170,000 if you file jointly.
Documents Needed Along With Application:
There are two (2) documents that must be included with the application you are submitting for reimbursement. These documents are:
1) The letter Social Security (SSA) sent you, dated November 2018, indicating how much your Medicare Part B premium was going to be in 2019. (Do not confuse this letter with the one you received this past November, which indicated your 2020 Medicare Part B premium.)
2) The SSA-1099 letter you should have received in January 2020, indicating the total amount you paid for your Medicare Part B premium.
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 submit 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 on your application (one application for both of you) and submit it along with your proper documents as well as your spouse’s or significant other’s proper documents. This procedure is to be followed whether or not your spouse or significant other is a city retiree.
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.
Who Gets the IRMAA Application?
Send your application to the CSA Welfare Fund. 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 all goes well, you should receive it in October 2020
1) Do not submit 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 10 # 8 December 30, 2019
1. 2020 Social Security Letter – If you are eligible for Medicare, you should have received a letter from Social Security (known as the SSA letter) by now indicating your 2020 Social Security benefit amount before and after deductions. The benefit amount was based on your income in 2018. Other factors that determined this amount included 1) a 1.6 percent COLA increase before deductions, 2) an INCREASE in the deductions for the standard amount and income-related monthly adjustment amount (IRMAA) for Medicare Part B, and 3) a DECREASE in the deductions for Medicare Part D IRMAA.
As you know, IRMAA eligibility is based on your taxable income and whether you filed individually, or jointly as a couple. The income that was used to determine eligibility for 2020 Part B & Part D IRMAA was your 2018 taxable income. If you filed individually and your income was greater than $87,000 (up $2,000 from 2019), or jointly and your income was greater than $174,000 (up $4,000 from 2019), you are eligible.
Please note the first page of the SSA letter contains 4 bullets. The first one shows how much your SS benefit for 2020 is before deductions, providing you are collecting Social Security. The second shows the 2020 deductions for Medicare Part B for the standard amount and for IRMAA (if not eligible for 2020 IRMAA, IRMAA deduction should be 0).
The 2020 Part B standard amount & IRMAA deductions are both reimbursable. You will receive the standard amount automatically, probably sometime in April 2021; you must apply for the IRMAA reimbursement. The application should be available in January 2021.
The 3rd bullet shows the 2020 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 2020, keep your 2020 SSA letter in a safe place. You will need to include it in the application package when you file for 2020 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 2020 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, www.SSA.com. 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. 10 #7 November 2019
1. 2018 Medicare Part B Differential Reimbursement.
In April 2019, the NYC Office of Labor Relations automatically (no application necessary) reimbursed both you, as a Medicare retiree, and your Medicare eligible spouse/legal partner the 2018 Medicare Part B standard premium. The amount of the reimbursement ($1,308) was based on a monthly payment of $109. However, most retirees paid $134 and, therefore, were still owed ($134 - $109) x 12 or $300. This amount is known as the Differential Reimbursement.
On October 17, 2019, you and your Medicare eligible spouse/legal partner should have received your 2018 IRMAA reimbursement as well as the Differential Reimbursement providing you were eligible for IRMAA reimbursement 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 2018 IRMAA reimbursement but have NOT yet applied, you can still do so. Just file a 2018 IRMAA application, which can be downloaded from the CSA Welfare Fund website, www.csawf.org and include with it a copy of the November 2017 SSA letter and 2018 SSA-1099 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.
How Do I Know If I Am Eligible For 2018 IRMAA Reimbursement?
You are eligible for 2018 IRMAA reimbursement if your Nov’17 SSA letter, which indicated your monthly 2018 Medicare Part B premium, was GREATER than $134. If you cannot find that letter, look at your Nov’18 SSA-1099. If the amount was GREATER than $1608, you are eligible. Finally, if you cannot find either document, look at your taxable income for 2016, the year in which your 2018 Medicare Part B premium was based on. If the amount was GREATER than $85,000 (filing taxes individually) or $170,000 (filing taxes jointly), you are eligible.
How Do I Collect the Differential Reimbursement If I Am Not Eligible For 2018 IRMAA?
If you and your Medicare eligible spouse/legal partner are NOT eligible for 2018 IRMAA reimbursement but paid less than $134 monthly for Medicare Part B, you should have completed a 2018 Differential application to collect the Differential Reimbursement. If you have not done so, it is not too late. Just file the application, which also can be downloaded from the CSA Welfare Fund website, www.csawf.org, and include with it a copy of the 2018 SSA-1099 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. Medicare Advantage Plans
I am sure you have received lots of information in the mail and on TV about Medicare Advantage Plans. Some plans offer unique benefits such as free preventive dental and eye exams, prescription eyeglass coverage, and hearing exam and hearing aid coverage. While it sounds wonderful, it is important to understand that Medicare Advantage plans have both pros and cons.
What is a Medicare Advantage Plan?
A Medicare Advantage plan is a private plan that contracts with the federal government to provide minimally the same benefits offered by Medicare, but may operate with a different set of rules, costs and restrictions. Some of the most common plans are Health Maintenance Organizations (HMOs – must use a doctor in the HMO) and Preferred Provider Organizations (PPOs – can use any doctor that honors the plan’s coverage)
The Open Enrollment Period - also known as the Annual Election Period - runs from Oct 15 to Dec 7. During this period, you can switch from Original Medicare to a Medicare Advantage Plan or vice versa, or you can switch from one Medicare Advantage Plan to another.
Should I Change My Original Medicare Plan to an Advantage Plan?
Most CSA Medicare eligible retirees have Original Medicare. If you do, the CSA Welfare Fund recommends you keep it with GHI as your supplement. Original Medicare offers you more flexibility than an Advantage Plan. For example, it allows you to see any doctor of your choice and does not require a referral to see a specialist.
Another negative feature of an Advantage plan is that you no longer will be eligible for Part B Medicare premium reimbursement.
If for some reason, however, you still want to change to an Advantage Plan, I strongly urge you first speak to Doug Hathaway, CSA Welfare Fund Administrator. You will not regret it.
Informational Update Vol 10 #6 -- September 17. 2019
1. 2018 IRMAA (Income-Related Monthly Adjustment Amount
For those who applied for 2018 IRMAA reimbursement in a timely fashion, you should have received a letter from the Office of Labor Relations this past August stating that OLR has received and processed your application, and that you will receive the IRMAA reimbursement sometime in October 2019.
Your reimbursement will be deposited electronically if your pension is deposited electronically or sent to you by physical check if that is how you receive your pension.
If you did not receive this letter, you may have submitted your application late. The application will eventually be processed and payment issued accordingly. If you applied for your Medicare eligible partner/spouse as well as yourself, you received only one letter of acknowledgement.
How Do I Know If I Am Eligible For 2018 IRMAA Reimbursement?
Eligibility for 2018 IRMAA reimbursement is based on what your Medicare Part B premium was in 2016. The premium was listed on the Social Security Administration (SSA) letter you had received in November 2017. If the amount was GREATER than the standard amount of $134 (In some cases the standard amount might have been $109), you are eligible and should have applied for reimbursement.
If you did not apply for 2018 IRMAA reimbursement and are eligible, it is not too late to apply. You can download an application from the CSA Welfare Fund website, www.csawf.org. Be sure to include with the application a copy of the November 2017 SSA letter and the 2018 SSA-1099 Benefit Statement, if you collect social security. If you do not, as of yet collect social security, include proof of payment – either copies of your credit card statement or and/or copies of your cancelled checks.
You can send the completed application and documents to either the CSA Welfare Fund, CSA Retiree Welfare Fund, 40 Rector St., 12th Floor, New York, NY 1006 or the Office of Labor Relations, 22 Cortlandt St., 12th Floor, New York, NY 10007. Send the materials 1st class, receipt requested.
2. CSA Welfare Retiree Fund Optical and Hearing Aid Benefits
Are you looking to buy new glasses or hearing aids? Before you do, keep in mind that you have excellent Optical and Hearing Aid benefits.
Optical Benefits – You are entitled to an optical benefit every 12 months. The CSA Welfare Fund reimburses $100 while the CSA Retiree Chapter reimburses an additional $65, for a total of $165. To receive the optical benefit, do the following:
· Obtain an optical voucher. You can request the voucher from the CSA Welfare Fund website (click on the link, “Request a Voucher”), or call the Fund, 212-962-6061.
· Go to an optical store of your choice. No longer are there participating optical centers.
· Sign and date the voucher and return it to the CSA Retiree Fund along with proof of payment and a copy of the itemized bill for your glasses or contact lenses.
Remember, the voucher is only good for 60 days from the time of the request. If it is not used within that period and you still need a voucher, you must return the unused one in exchange for a new voucher.
After the Fund reimburses you $100, you will automatically receive a $65 check from the Retiree Chapter about 2 weeks later. You do not have to apply for the Chapter reimbursement.
Hearing Aide Benefits – The CSA Welfare Fund will reimburse you up to $800 for hearing aids every 36 months. In a seamless operation, the CSA Retiree Chapter will also reimburse you up to $800 every 3 years. You will not have to apply for the reimbursement, it will come to you automatically about 2 weeks after you receive your reimbursement from the Fund.
In order for the Fund to reimburse you, you will need to get a voucher by requesting it from the website or calling the Fund. The voucher is used the same way as the optical voucher: sign and date it and submit it along with proof of payment and an itemized bill to the Fund. If you use a participating hearing aid center, the Fund will pay them up to $800, otherwise they will reimburse you.
Question of the Month
Q: Although I am eligible, I never applied for IRMAA reimbursement. Is it too late to do so?
A: Partially. You can still apply for years 2016, 2017 and 2018. Nothing before those dates. Just check the appropriate box on the application for the year you are applying and be sure to include the proper documentation.
Informational Update Vol 10 #5 July 2019
1. Medicare Coverage Outside of the USA – At this time of the year, many retired people take cruises outside of the USA. If you are, you must consider your medical coverage once you leave the USA.
In MOST cases, Medicare does not cover medical services or health supplies outside of the USA, including using a doctor on a cruise ship. “Outside the USA” means anywhere outside of the 50 states, the District of Columbia, Puerto Rico, the US Virgin Islands, Guam, American Samoa, and the Northern Mariana Islands.
However, Medicare may pay for inpatient hospital, doctor, ambulance or dialysis services in some rare cases.
1. You're in the USA when a medical emergency occurs, and the foreign hospital is closer than the nearest U.S. hospital that can treat your medical condition.
2. You live in the USA, but a foreign hospital is closer to your home than the nearest U.S. hospital, regardless of whether it is an emergency.
In some cases, Medicare may cover some medical situations on-board a ship if you are in territorial waters adjoining the land areas of the USA and no further than 6 hours from the USA.
Medicare does not cover any prescription drugs outside of the USA
Do I Have Any Coverage Other Than Medicare Outside the USA?
Yes, you probably do. If you have GHI as your secondary coverage, it will cover medical expenses as follows:
Ø Blue Shield Blue Cross will cover hospitalization.
Ø Emblem Health (GHI) will cover 100% of the amount it allows (which may not be much) for a medical expense after a $200 deductible.
Procedure for Receiving Reimbursement: You must have an itemized bill in English. The money must be in dollars and cents. Submit the bill along with proof of payment to the CSA Retiree Welfare Fund, 40 Rector St., New York, NY 10006, Attention: Dr. Douglas Hathaway.
Because GHI offers minimal coverage in a foreign country and Medicare virtually none, I highly recommend you obtain travel insurance before traveling abroad.
2. “Hard Caps” vs “Soft Caps” – One of the most confusing improvements in Medicare has been the replacement of the Medicare therapy “hard cap” for physical therapy, speech therapy & occupational therapy with a “soft cap.” In fact, some therapists are unaware of this important change or how it even works, causing great consternation to people who need extensive therapy.
In 1997, Medicare introduced a therapy limit or “hard cap” of $1,500 for out-patient therapy services. When the “hard cap” was reached, therapy was generally no longer covered. If someone needed therapy beyond the “hard cap,” therapists could apply for an exception, but was not always successful. Fortunately, the $1,500 cap got larger and larger over the years and eventually became a “soft cap.”
“Hard Cap” Replaced With “Soft Cap”
In the 2018, Congress repealed the “hard cap” and replaced it with a “soft cap.” That meant it became much easier for someone in need of extended therapy to get approval beyond the Medicare threshold (in 2018 it became $2,010, in 2019 it rose to $2040).
Steps That Need to be Taken to Get Approval for Therapy Services Beyond the Threshold
1.The Doctor must write a letter confirming the patient needs therapy services beyond the threshold by a skilled therapist.
2. The therapist must continue to track the patient’s progress so that he or she can submit a claim (requires special code) for extended therapy services.
In conclusion, if a therapist says you reached the limit in therapy services, remind him or her that Medicare now has a “soft cap.” If approval to get extended therapy hours is not possible, you can always use the CSA Welfare Fund benefit for therapy coverage.
3. Question of the Month – I have used a health aide for the past 5 years and paid him by cash. Only in the last month did I start paying by check. Am I entitled to a reimbursement for the 5 years I was paying by cash?
Answer – Unless you have receipts showing you paid cash to the aide, the cash payments are not reimbursable. The CSA Welfare Fund will not pay out a benefit unless there is evidence of payment. However, paying by check is reimbursable since your bank statement is evidence of payment.
Informational Update Vol 10 #4 May 18,2019
1. 2018 Medicare Part B Differential Reimbursement
You and your Medicare-eligible dependent spouse/legal partner (if any) should have automatically (no application necessary) received the 2018 standard Medicare Part B reimbursement on April 12. This was directly deposited, or if you do not use direct deposit, mailed to your home.
The amount of the reimbursement was either $1,308 or $1,608, depending on when you went on Medicare. If you went on Medicare during or after January 1, 2017 you received the correct amount of $134 per month, $1,608 for the full year (pro-rated if you were not on 2018 Medicare for the full year).
However, if you went on Medicare prior to January 1, 2017, you most likely received $109 monthly, $1,308 for the full year. The amount was incorrect since you probably paid more than $109 for Medicare part B in 2018. Consequently, you would be entitled to an additional Part B reimbursement, known as the Part B Reimbursement Differential. The amount of the Reimbursement Differential probably is $300 (($134-$109) x 12) since most Medicare-eligible members paid $134 monthly for 2018 Medicare Part B.
How to request your 2018 Medicare Part B Reimbursement Differential
This month, the CSA Retiree Welfare Fund mailed a 2018 Medicare Part B Reimbursement Differential form. If you qualify for 2018 IRMAA (monthly Part B premium more than $134 in 2018) and have filed for 2018 IRMAA, DO NOTHING. The differential will be included in your IRMAA reimbursement scheduled for October 2019. If you have not yet filed for IRMAA please do so NOW and submit the required documents to the Retiree Welfare Fund, which will verify the correctness of your application & documents.
If your monthly 2018 Part B premium was greater than $109, but you DID NOT QUALIFY FOR IRMAA, complete the Reimbursement Differential form and submit it along with the proper documents to the Retiree Welfare Fund.
The differential, which in most cases should be $300, will be reimbursed in the first quarter of 2020.
Remember, the differential is only for Medicare-eligible members whose standard reimbursement was $1,308 and paid more than $109 monthly for 2018 Medicare Part B.
2. Question of the Month: Does Medicare Cover Ambulance Services?
Definitely in an emergency when your health is seriously impaired and you cannot be transported safely by any other means but by ambulance, Medicare Part B will also cover ambulance services in certain non- emergency situations.
Part B Coverage of Emergency Ambulance Services
Part B will cover such services provided:
· It is the only safe way to travel to a hospital or skilled nursing facility (SNF)
· The reason for the trip is either to receive a Medicare - approved service or return from receiving service. The transportation must be from Medicare approved locations such as your home to the hospital and back.
· The transportation provider meets Medicare ambulance requirements.
Part B Coverage of Non-Emergency Ambulance Services
Part B will cover such services if the person:
o Is confined to a bed, e.g., cannot get up without help, and unable to sit in a chair or wheel chair.
o Needs essential medical services during the trip that can only be done in an ambulance
Please note that Original Medicare Part B does not cover the ambulette services, wheelchair van, or litter vans.