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, www.csawf.org, 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 # 11  November 29, 2022

1. 2023 Social Security LetterIf you are eligible for Medicare, you should have received a letter from Social Security this past week informing you of your 2023 Social Security benefit amount before and after deductions.

Due to a rise in the cost of living, your Social Security benefit amount will increase 8.7% starting January 1, 2023. Social Security deducts from this amount your Medicare Part B (medical) premium & your IRMAA Medicare Part D (drugs).premium, and, if you want it deducted, taxes.

 

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 2023, the standard amount is $164.90.per month, down $5.20 from $170.10 in 2022.

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 2021 income tax return) surpasses a certain threshold. In 2023 the threshold is $97,000 if you filed individually (up $6,000 from 2022) and $194,000 if you filed jointly (up $12,000 from 2022). The SSA letter contains a chart indicating various income thresholds and the monthly amounts of the surcharge

Medicare Part D Premium

If you have a Medicare Part D drug plan through the union, you must have a High Option Rider. You either purchased this rider as an active employee or purchased it after you retired. The High Option Rider is currently $125 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 2021 income tax return. The SSA letter contains a chart indicating various income thresholds and the monthly amounts of the 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 2023 is before deductions, providing you are collecting Social Security. The second shows the 2023 deductions for Medicare Part B for the standard amount and for IRMAA (if not eligible for 2023 IRMAA, IRMAA deduction should be 0).

The good news is that the 2023 Part B standard amount & IRMAA deductions are both reimbursable. You will receive the standard amount automatically, probably sometime in April 2024. 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 2023 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 2023, keep your 2023 SSA letter in a safe place. You will need to include it, along with your 2023 SSA1099 letter, in the application package when you file for 2023 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:

  • using your bank’s online bill payment service,

  • signing up for Medicare Easy Pay, a free service that automatically deducts the premium payments from your savings or checking account each month, or

  • paying by check, money order or credit card or debit card. If you are paying by credit card or debit card, you must complete of sign the coupon at the bottom of the Medicare bill. Use the return envelope to send your Medicare payment along with your Medicare payment coupon to:

Medicare Premium Collection Center

P.O. Box 790355

St. Louis, MO 63179-0355 

 

Questions of the Month

Q. I did not receive my SSA letter listing my 2023 Social Security benefits and deductions. How can I get a copy?

A. There are 3 ways:

  • You can call Social Security at 1-800-772-1213.

  • 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

  • Download a copy from the SSA website, www.SSA.gov. 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. 13 #1 October 19,2022

 

1. 2021 IRMAA Reimbursement

If you are on Medicare, you and your Medicare-eligible spouse/legal partner should have received your 2021 IRMAA reimbursement on October 14, 2022, 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 2021 IRMAA reimbursement but have NOT yet applied, you can still do so. Just submit a completed 2021 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, www.csawf.org. Be sure to include with the form a copy of the November 2020 SSA, and 2021 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. 2023 Emblem Health Plan D Documents

Emblem Health recently sent a letter about your 2023 drug Plan D documents. These documents include the following:

  •  Evidence of Coverage (EOC)

  •  Formulary – list of prescription drugs covered by the plan

  •  Provider and Pharmacy Directory

All 3 of these documents can be found on the Emblem Health website at www.emblemhealth.com/medicare. If you still wish to have a hard copy, call Emblem Health at 800-585-5786 (TTY: 711). Their hours are 8 a.m. to 8 p.m. 7 days a week.

If you haven’t done so, I strongly suggest you open an Emblem Health account. This will allow you to access a lot of personal information including account details such as your EOBs. To open an account, go to www.my.emblemhealth.com and follow the prompts.

If you have questions about whether a drug is covered or a pharmacy is in the network call Emblem Health at 800-585-5786 (TTY: 711).

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.

Informational Update Vol 13 #9  October 4, 2022

1. Impact of Court Ruling Regarding Medicare Eligible Beneficiaries Right to Appeal “Observation Status” Reclassifications

In January’22, the U.S. Court of Appeals for the Second Circuit upheld a ruling that allowed Medicare beneficiaries who are admitted to a hospital as “in-patients” and subsequently reclassified as “outpatients” receiving “observation services” the right to appeal the reclassification. What impact does this ruling have on our Medicare eligible retirees? A big one as the decision allows this group to get post-hospital coverage, if necessary, for a skilled nursing facility which otherwise would be unaffordable. What is a Skilled Nursing Facility? Often, individuals confuse a nursing home with a skilled nursing facility (SNF) because of their similarities. In fact, many times the terms are used interchangeably. To be clear, a SNF provides more “skilled” medical expertise and services than a nursing home. Basically, a SNF provides rehabilitation services to help injured, sick or disabled individuals get back on their feet. Generally, hospitals make the arrangements to transfer a Medicare eligible patient to a SNF after an acute hospital stay, such as surgery. To qualify for such a transfer, i.e. Medicare covers the SNF stay, the patient must be in the hospital for a minimum of 3 consecutive days. Normally, the patient would go home after his/her stay in the SNF. However, there may be situations where the patient needs to be readmitted to the hospital and then again to the SNF for more skilled care. What is the coverage for staying at an SNF?  Days 1-20: $0 (covered by Medicare)  Days 21-100: $0. (covered by Blue Cross Blue Shield)  Days 101 and beyond: You pay all costs.

2. Careington -

Careington is a nation-wide dental plan that is now part of the SIDS program. It is intended to save additional money for SIDS members who live in an area where there aren’t participating SIDS dentists. Here is how it works:  Go to a Careington dentist of your choice. You can find a list of Careington dentists by going on the website www.asonet.com. This will require that you open an account. Once you have an account, follow the prompts to open the directory. The Careington dentists are listed in red.  The dentist should charge you the Careington discount price for the service.  The dentist will submit the claim (charge) to SIDS.  You will be responsible for the difference between what SIDS reimburses for the claim and Careington’s discount charge. For example, suppose you need a crown and Careington's charge is $750 (a crown is normally over $1,000). SIDS will pay $500 to the provider and you will be responsible for the difference, or $250.

3. Question of the Month

Q. As a dependent surviving spouse, I was told I am entitled to reimbursement of my prescription co-pays. Please explain.

A. When your CSA member spouse passed away, your CSA Retiree Welfare Fund benefits continued for five years from the date of the member’s death, or if you remarry, or if your dependent status terminates, at no cost to you. One of the benefits you are entitled to is a prescription drug benefit providing you are covered by a city plan through COBRA or your own health plan with a prescription drug plan. The benefit works as follows: After a $100 deductible, you are entitled to 80% of the cost up to a maximum of $5,000 for the year. The CSA Retiree Chapter also reimburses 20% of the Fund reimbursement. For example, if your drug claim is $2,000, the Fund will reimburse you $1,520. About 2 to 3 weeks after receiving your reimbursement, the Retiree Chapter will reimburse you an additional 20% of $1,520 or $304. Your total reimbursement is $1,824. This is a seamless operation so you do not have to file a claim with the Retiree Chapter.

Informational Update Vol 13 #8  August 28, 2022

1. CSA Welfare Fund Stop-Loss Benefit

One of the most important, and perhaps least understood, CSA Retiree Welfare Fund & CSA Retiree Chapter health benefits is the Stop-Loss. This benefit is intended mainly for non-eligible Medicare members who cannot find medical services covered by the Basic NYC Health Plan. These services include office visits and lab charges. The benefit limits these members’ out-of-pocket (OOP) medical expenses in the following way:

 

First, after an annual $1,000 deductible, you are reimbursed 80% of the next $1250 in total expenses. Thereafter, you receive 100% of your remaining out-of-pocket expenses up to $50,000 annually/$250,000 lifetime. Also, the CSA Retiree Chapter will reimburse you for 20% of the Welfare Fund payment (excluding the deductible). Keep in mind that StopLoss does not cover hospital costs.

As an example, suppose you are a non-eligible Medicare member who is enrolled in Emblem Health but live in an area where there are no participating doctors. Since you have no choice, you go to a nonparticipating doctor. This is your first visit to a doctor this year. After filing a claim for the doctor’s charge with Emblem Health, you are reimbursed a small amount of the bill and are left with a $3,000 OOP expense. You now file a $3,000 claim along with the EOS to the CSA Retiree Welfare Fund. Since this was your first visit to the doctor, there is a $1,000 deductible. The Fund will then reimburse you for 80% of the next $1,250 of the claim, or $1,000 and then 100% of the remaining part of the claim, or $750. Your total reimbursement from the Fund for this claim is $1,000 + $750, or $1,750.

In the above example, you paid only $1,250 ($3,000 - $1,750). And that’s it. No more OOP expenses for the rest of the year since you get 100% back of any further expenses. About 2 weeks after you receive the Fund’s reimbursement of $1,750, the CSA Retiree Chapter will send you a supplementary reimbursement for 20% of $1,750, or $350. Therefore, your total reimbursement for the $3,000 claim is $1,750 + $350 or $2,100.

While this benefit sounds great, and it really is, there are some hitches. First, the out-of-pocket expenses must be reasonable and customary. You will not get back what you think you should if it is not.

Second, if you are on Medicare and choose not to use a Medicare doctor, the allowance will be based on Medicare rates or even less. If there is no Medicare doctor available, then the rate could be much higher. In this instance, I strongly recommend you call the Fund to determine the rate of the reimbursement.

 

2. 2021 IRMAA – Eligible Medicare members who applied for the 2021 IRMAA reimbursement in a timely fashion should have received a letter informing them that the Office of Labor Relations received their application and supporting documentation. The letter also said that the application was processed and that payment will be issued in October 2022. If a member receives his or her NYC pension check electronically, the IRMAA check will be directly deposited into the same bank account as the pension payment. If the member receives a physical pension check, then the IRMAA payment will be issued in the same way.

 

3. Question of the Month

Q. I am a CSA retiree on Medicare and recently had a procedure done in a hospital as an outpatient. The other day I received an $800 bill from the hospital for this procedure. Should I pay it?

A. It depends. If the procedure was not covered, you have no choice but to pay the $800. However, if it is covered, then most likely the hospital was either unaware of your secondary coverage or failed to submit the bill to your secondary carrier. Consequently, call the finance department of the hospital and inform them of your secondary coverage. This should negate your having to pay the bill.

Informational Update Vol 13 #7  August 3, 2022


1. Medicare Coverage Outside the USA – Many of you are beginning totravel again, some taking cruises outside the USA, after being cooped up because of COVID. As a result, I thought it would be prudent to write about your Medicare coverage outside the USA, or the lack thereof.  In MOST cases, Medicare does not cover medical services or health supplies outside the USA, including using a doctor on a cruise ship.  “Outside the USA” means anywhere outside the 50 states, the District ofColumbia, Puerto Rico, the US Virgin Islands, Guam, American Samoa,and the Northern Mariana Islands. However, like most rules there are
exceptions.
There are 3 situations where Medicare may pay for health care services in a hospital outside the USA

  •  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.

  • You’re traveling through Canada without unreasonable delay by the most direct route between Alaska and another state when a medical emergency occurs, and a Canadian hospital is closer than the nearest USA hospital that treat your illness or injury. Medicare will determine whether your route is “without unreasonable delay.”

  • 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
    cruise ship if Medicare does not cover any prescription drugs or dialysis outside the USA.

Remember, Medicare will pay only for Medicare–covered services you get in a foreign hospital.
 

Will Medicare pay for medically necessary health care services I get
on a cruise ship?  Medicare may cover the following on a cruise ship:

  • The doctor is allowed under certain laws to provide medical services on a cruise ship.

  • You are in territorial waters adjoining the land areas of the USA and no further than 6 hours from the USA.  

What do I pay for a Medicare-covered service outside the USA?

More than likely the full amount as if you had no coverage. Remember, the foreign hospital or doctor is not under any obligation to submit your charges to Medicare. However, when you get home, you can then submit an itemized bill to Medicare for your doctor, hospitalization and ambulance services. If you received Medicare-covered services on a cruise ship under a situation as described above, the doctor must file a Medicare claim, which you should also do.

Do I Have Any Coverage Other Than Medicare Outside the USA?

Yes, you probably do. If you have Emblem Health as your secondary coverage, it will cover medical expenses as follows:

  •  Blue Shield Blue Cross will cover hospitalization.

  •  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. Questions of the Month

Q. I have used a certified 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?

A. 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.

Q. I am currently on Medicare and my doctor has started to charge an additional fee on top of my $15 co-pay. Why is that?

A. While I cannot be certain (you should ask the office manager), your doctor may have stopped accepting the Medicare assignment, although he/she still is a participating provider. In this instance, he/she can charge you up to a maximum of 15% more than Medicare pays for the service. For example, suppose a Medicare-approved amount for a check-up is $120. Your doctor, who may no longer take an assignment, can charge 15% more for a total charge of $138 (15% of 120 = 18). The $18 is called an “excess” charge. So, your total-out-of-pocket-expense is $15 (copay) + $18 or $38. Medicare or your secondary DOES NOT cover your $15 co-pay or your “excess” charge of $18.

Informational Update Vol 13 #6   July 8, 2022

      Hi everyone! Hope all is well. Here is some important information:

1. Wellness Visit. As an eligible Medicare person, have you had your annual wellness visit (AWV)? If the answer is no, you are not alone. A study showed that only 1/5 of all eligible Medicare people had such a visit. While some of this is due to patient neglect, the study indicated that only 23% of the medical practices have given an AWV to as little as 1/4 of their eligible patients. Further complicating the problem is a large percentage of the eligible Medicare people are unclear about what an (AWV) entails.

 An AWV is a yearly visit with your Primary Care Physician (PCP) to create or update a personalized medical prevention plan. It is not a full-fledged head-to-toe physical but rather a plan to help prevent illness based on your current health and risk factors.

If you are on Medicare for more than 12 months, you are eligible for an AWV visit free of charge. This means you pay nothing (no deductible or co-pay). At this visit, your PCP will not only develop or update a personalized prevention plan, he or she may also do the following:

  • Give you a health risk assessment. (Your doctor or health professional will ask you to answer some questions before or during your visit, which is called a health risk assessment. Your responses to the questions will help you and your health professional get the most from your yearly “Wellness” visit.)

  • Review of medical and family history  Develop or update a list of current providers and prescriptions.   Check your height, weight, blood pressure, and other routine measurements

  •   Screen for any cognitive impairment, including Alzheimer’s and other forms of dementia

  •   Screen for depression

  •   Provide personalized health advice and referrals to health education and/or preventative counseling           services aimed at promoting wellness

  •   Provide a list of risk factors and treatment options for you.

  •   Provide a screening schedule (like a checklist) for appropriate preventive services

  To get the most out of your AWV visit, you should bring a complete list of your medications (both prescription and non-prescription) along with a list of all your doctors. Also, bring a list of questions you wish to discuss with your doctor. 

2. New CSA Welfare Retiree Fund Benefit. Last month I wrote about the eyeglass benefit in which the Fund reimburses you a max of $100 for new eyeglasses. Starting January 1, 2023, this reimbursement goes up to a max of $150. The CSA Retiree Chapter eyeglass benefit remains the same at $65.

3. Eligible Survivors’ Benefits. For the purposes of this column, an eligible survivor is defined as a dependent spouse/registered partner, or a dependent child under 26 years old, of a member who has passed away. If the child is handicapped and cannot care for himself/herself then there is no age limitation providing the handicap occurred prior to the child’s 19th birthday.

While the passing of a member is a very difficult time for the eligible survivor, the good news is that the CSA Retiree Welfare Fund continues to provide him/her with supplemental medical coverage WITHOUT COST for a period of 5 years from the date of the member’s passing. The coverage includes dental, optical, hearing aid, drugs, and many other medical items. The whole list of benefits can be downloaded from the CSA Welfare Fund website.

Eligible survivors are also entitled to the CSA Retiree Chapter supplemental benefits which enhance the Fund benefits. However, you must join the Chapter, which has a monthly charge.

After 5 years from the member’s passing, the eligible survivor may extend the Fund supplemental benefits as long as he/she likes providing he/she pays a monthly COBRA premium. The survivor can also continue to receive the CSA Retiree supplemental benefits if he or she continues to pay the Chapter dues, which is something I highly recommend.

While the supplemental Welfare Fund coverage is free, the eligible survivor must have a basic city health plan or the equivalent through another health plan to receive  the Fund coverage.

The Fund’s supplemental benefits are considered secondary to any other coverage the eligible survivor may have through an employer or private paid plan. The Fund will coordinate its coverage with the primary coverage.

As indicated above, the eligible survivor’s coverage automatically ends after 5 years unless the coverage is  renewed. It will also end prior to the 5 years if the survivor remarries or if his/her dependent’s status terminates.

   Informational Update Vol 13 #5  June 8, 2022

  1. 2021 IRMAA Application  

The 2021 IRMAA application is now available. There is a link for the form near the top of this page.   You can also download the form from the CSA Welfare Fund website, www.csawf.org. IRMAA forms for the years 2017 through 2020 are also on the website as well as the differential forms for the years 2017 through 2019.

 

Please make sure to include the following in your request for 2021 IRMAA:

  1. A completed reimbursement request application. Be sure to check off 2021 and sign and date the application. If your spouse/domestic partner is your dependent, be sure to complete the Eligible Spouse/Dependent section of the application. If your spouse/domestic partner is also a NYC retiree and has a separate NYC health plan, then she/he has to submit a separate reimbursement request application.

  2. November 2020 Social Security Award letter. This is the annual letter that tells you how much Social Security you will be receiving the following year (in this case 2021) & your Medicare Part B & D premiums.

  3. The 2021 Social Security 1099 letter.  

Please note that if you went on Medicare during 2021, you are entitled to a pro-rated 2021 IRMAA reimbursement.

 

Send the application & documents either electronically to Doug Hathaway (dhathaway@csawf.org) or by snail mail to the CSA Retiree Welfare Fund, 40 Rector St., 12th Floor, New York, NY 10006-1729. If you would like confirmation of receipt & verification of your application and documents, then include a note and your email address in your submission. 

 

As in the past, the CSA Retiree Fund will review your request for completeness and accuracy, and then electronically upload it to the City Office of Labor Relations. If there is an error in the application or in the documents you have submitted, the Fund will inform you of the exact problem so that you can correct it and re-submit the request for reimbursement.

 

     2.  CSA Welfare Retiree Fund & Retiree Chapter Eyeglass Benefits

Perhaps one of the most popular Welfare Fund benefits is the optical benefit for new eyeglasses.

Optical Benefits

Every 12 months you and your spouse/significant other are entitled to be reimbursed for a new pair of glasses. The CSA Retiree Welfare Fund will reimburse you a max of $100 and the CSA Retiree Chapter will reimburse you a max of $65, for a total max of $165. The amounts are paid directly to the participant.

Procedure for Obtaining the Reimbursements 

  •  Obtain an optical voucher. You can request the voucher from the CSA Welfare Fund website, www.CSAWF.org (click on the link, “Request a Voucher”), or call the Fund at 212-962-6061. Be certain to supply the requested information on the request form, and indicate the desired voucher. Indicate on the NOTES section on the form the family member who is receiving the glasses.

  • 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.

The reimbursement is a seamless operation. After you receive a check from the Fund for $100, you will receive a $65 check from the CSA Retiree Chapter about two to three weeks later.

       3. Why Open a Medicare Account?

Once you are on Medicare and have Parts A & B, you can create a Medicare online account. Why do it? Simply, because you can manage your personal healthcare & coverage needs online. For example, you can:

  •  Keep track of your Medicare claims

  •  Keep track of relevant benefit information

  • Review the dates of your most recent flu shots and other preventative services.

  • Print a copy of your official Medicare card 

Is it difficult to open a Medicare account? Not at all. Just go to www.mymedicare.gov and follow the prompts. You will not be sorry.

4. Question of the Month

Q. I recently received a bill of $76 from my doctor who claims that was my deductible. However, I already paid my complete deductible previously. How could that discrepancy happen?

A. At the time you received service from the doctor, you still had not exhausted your deductible and so he charged you accordingly. However, the doctor apparently held on to the bill and by the time you received it, other doctors that you had gone to already used up your deductible. Consequently, you do not owe the $76 and the doctor will have to re-file the bill with Medicare. Motto: Keep track of your deductibles. 

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 www.ssa.gov. 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 www.COVIDtests.gov 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 application.in 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, www.csawf.org.

 

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, www.SSA.gov 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

 

Reminders:

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.  

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