MEDICARE INFO.

Joined
May 6, 2010
Messages
15,589
PART D....
MEDICARE CHANGES IN THE LAW
President Trump Signed These Medicare Changes into Law. Here?s What to Watch For
The law has already been signed by President Trump, so whether these are good changes or not is moot for the time being
by Philip Moeller - PBS Making Sense - 2/14/18

Seemingly overnight, big changes to Medicare morphed from being an item on various congressional wish lists into reality as part of last week?s budget deal, diverting me on my way to this week?s reader questions.
The Congressional Budget Office?s estimate of the financial impact of the budget deal includes five pages of detailed health care changes, and I suspect there are others that have yet to be reported. However, the law has already been signed by President Trump, so whether these are good changes or not is moot for the time being.
Medicare?s Independent Payment Advisory Board has been killed. It was authorized by the Affordable Care Act to serve as a check on higher Medicare expenses. It was quickly labeled a death panel by opponents and became such a lightning rod that no board members were ever named.
The rules for Medicare?s Part D drug plans were changed. The much-maligned coverage gap (or donut hole) in these plans has been shrinking for years under the Affordable Care Act, and was supposed to end in 2020, at which time consumers in the gap would pay no more than 25 percent of the costs of their drugs. That end date was moved up a year to 2019.
Consumers who have spent a lot on drugs and have entered the so-called catastrophic phase of Part D plans will pay no more than a few dollars for each prescription or, for costly drugs, no more than 5 percent of the cost of the drug. While this percentage will not change, the responsibility for paying the other 95 percent of the cost will be borne even more heavily by the government, and is expected to save pharmaceutical companies billions of dollars. Taxpayers, of course, ultimately will be on the hook for those higher government expenses. It?s a more significant if largely invisible change.
Medicare?s caps on covered expenses for outpatient therapy have been officially repealed. People with persistent therapy needs have bumped against these caps for more than 20 years, and Congress has regularly eased those rules. While claims above current cap levels may be subject to review, people who legitimately need extensive therapy will not have to depend on year-to-year congressional fixes.
Medicare?s high-income premium surcharges will carry even more of a bite for wealthier enrollees. Those making more than $500,000 a year ($750,000 for couples) will pay 85 percent of the actual costs of Part B and D in 2019, up from 80 percent this year. Most Medicare enrollees pay premiums that equal about 25 percent of these costs.
Congress also made numerous and potentially far-reaching changes to the rules for Medicare Advantage plans. That includes allowing such plans to pay for limited long-term care expenses ? something that until now has not been covered by Medicare.
If this wasn?t enough, the Trump administration finally seems ready to make good on its repeated commitment to do something to lower high prescription drug prices for Medicare beneficiaries. The Council of Economic Advisers issued a report late last week laying out many ideas.
The White House reportedly will back a plan to permit those on Medicare to share in substantial discounts that drug manufacturers currently pay to Medicare drug insurers. People with commercial health insurance regularly get manufacturer discounts, which can save them thousands of dollars a year on costly medications. Medicare prohibits such manufacturer discounts, and while pharmaceutical companies do provide hefty discounts to Part D insurers, they are not passed along to consumers.

Part D insurers generally oppose the change, saying that the industry currently uses the discounts to subsidize Part D premiums, and that all consumers would face sharply higher premiums if discounts were shared with the relatively small number of consumers who need expensive medications.
The Trump budget also proposes removing even the 5 percent that people in the catastrophic phase of their drug plan must pay, permitting them to get their drugs for free. While this would be a great deal for the million or so people who spend that much money on prescriptions, other elements of the proposal would raise out-of-pocket spending for other people with Part D plans.
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Joined
Jun 22, 2007
Messages
5,538
For the Senior Citizens of today, Medicare can be very difficult for them to understand (myself included). What is paid for and what is not. Generally, it isn't until they get their bill that they finally realize what they must pay. I am on Medicare myself and I think my monthly out of cost pocket is about $109.00/month. I believe I am enrolled in Part D.

When I was no longer covered under my work contract insurance after retirement, it was suggested to me that I go to a local city run/senior citizens building to talk to an official regarding what is right for me. I needed advice on what supplemental insurance and prescription plan would be best for me. I was joined by another retired member as well, who had the same concerns.

We both met with a woman who specialized in that field. She was GREAT. She advised us to bring in all of our current prescriptions that we take and then she compared everything to get the best deal for each of us. What she found for us was a plan to supplement our Medicare coverage at the best price. She ended up saving us a couple of hundred dollars each and every month.

It didn't cost us ONE PENNY for her expert advise. The guy who sent us there was also a retired member we worked with, who had very high medical expenses himself being treated for cancer. 

What I say here might be a little off topic. But I just wanted to pass on some advice that not only helped me, but others as well.
 
Joined
Dec 7, 2007
Messages
1,557
My friend's monthly Social Security benefit went up by 2% and the Medicare deduction from his monthly Social Security increased by over 20 per cent. 
 
Joined
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Messages
15,589
RECD THIS FYI TODAY..... QUOTE...

mail
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RETIRED LIEUTENANTS ASSOCIATION NYPD

a few notes
all NY City Medicare retires covered by the NY City Office of Labor relations in 2020 should have received their 2020 reimbursement in April 2021.

All NY City Medicare retires covered by the NY City Office of Labor relations
in 2019 should have received any shortage from their 2019 reimbursement in
March 2021.
Please read everything and check your bank statements before submitting any forms as most pre 2016 Medicare enrollees received the full 2020 reimbursement in April 2021.
An update on Medicare Reimbursements from the NYC Office of Labor Relations (OLR) website health-retiree-responsibilities (nyc.gov)


Medicare Part B Reimbursements
Medicare Part B 2020 Reimbursement
Medicare Part B 2020 reimbursements were issued in April 2021. Please check your bank account/statement (or the mail, if you are receiving a physical check) for your payment.
· If you already submitted your Medicare Part A & B card to the Health Benefits Program, this payment is automatic and you will receive it annually
.
Medicare Part B 2019 Differential Reimbursement
Medicare Part B 2019 differential reimbursements were issued in March 2021. Please check your bank account/statement (or the mail, if you are receiving a physical check) for your payment.
· For those retirees/eligible dependents who are not eligible for IRMAA, Medicare Part B 2019 differential payments up to $318 will be issued once the Medicare Part B and IRMAA payments are processed in calendar year 2020.
· Those retirees/eligible dependents who are eligible for 2019 Medicare Part B differential reimbursements must submit the Medicare Part B 2019 Reimbursement Differential Request Form, along with required documentation.
· Please submit this form, along with all required documents, electronically to: https://nycemployeebenefits.leapfile.net

IRMAA 2020 Reimbursement
IRMAA 2020 reimbursements will be issued in October 2021.
· If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement will be deposited directly into your bank account. This is separate from your pension payment. If you don’t have EFT or direct deposit, you should receive a check in the mail.
· Please submit the IRMAA 2020 Reimbursement Application, along with all required documents, electronically to: https://nycemployeebenefits.leapfile.net
IRMAA 2019 Reimbursement
IRMAA 2019 reimbursements were issued during October and November 2020. Please check your bank account/statement (or the mail, if you are receiving a physical check) for your payment.
· If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement was deposited directly into your bank account. This is separate from your pension payment. If you don’t have EFT or direct deposit, you should have received a check in the mail.
· If you did not receive your IRMAA reimbursement by December 1, 2020 or if you did receive the reimbursement and you believe the amount is incorrect, you must resubmit the IRMAA 2019 Reimbursement Application.
· Please submit this application, along with all required documents, electronically to: https://nycemployeebenefits.leapfile.net

IRMAA 2019 Differential Reimbursement
IRMAA 2019 Differential payments were issued at the end of November 2020.
· For those retirees/eligible dependents of a retiree with a Medicare Part B effective date prior to 2016, they received an additional amount up to $318.
The Medicare Part B Reimbursement Program video provides information about the different types of Medicare Part B reimbursements that the City provides, as well as information to help you to see whether you qualify to receive these payments, and how to apply.
Play the video
Please note that if you were Medicare-eligible prior to 2016, you must complete the Medicare Part B Differential Form for 2019 in order to receive the Medicare Part B differential payment. The payment is based on the amount that you paid in 2019.
If you are applying for IRMAA, you will be receiving the differential payment once IRMAA 2019 payments are processed in October 2020.
If you were enrolled in Medicare Part B effective after 2016, then you are already receiving the full payment and do not need to complete the Medicare Part B Differential Form.
Learn more


Health Benefits Forms & Downloads from OLR
Health Benefits Summary Plan Description (SPD)
Health Benefits Application/Change Form (Not for use by NYCAPS Agencies)
Health Plan Rate Chart for Retirees
Retiree Change of Address Form
COBRA Form, Notice of Rights and COBRA Rates - March 2021
COBRA Form, Notice of Rights and COBRA Rates - January 2021
Young Adult Option Through Age 29 (NYS Law Chapter 240) - March 2021
Young Adult Option Through Age 29 (NYS Law Chapter 240) - January 2021
Domestic Partner Enrollment Information
Medicare Part B Reimbursement
Medicare Part B Reimbursement Q&A
Medicare Part B Reimbursement Program Application
2020 Medicare Part B Reimbursement Differential Request Form - Information available May 2021
2019 Medicare Part B Reimbursement Differential Request Form
2018 Medicare Part B Reimbursement Differential Request Form
2017 Medicare Part B Reimbursement Differential Request Form
IRMAA Medicare Part B Reimbursement
IRMAA Medicare Part B Reimbursement Application (for 2020, 2019, 2018)
IRMAA Medicare Part B Reimbursement Application (for 2017)
Creditable Coverage Notice (Employees Age 65 or Over)
Form 1054 (For Use By Authorized Personnel Only)
Health Insurance Marketplace (Exchange) Notice
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UNQUOTE.
Retired Lieutenants Association NYPD | 266-19 Hillside Avenue, Floral Park, NY 11004​
 
Joined
Jan 11, 2016
Messages
2,228
RECD THIS FYI TODAY..... QUOTE...

mail

RETIRED LIEUTENANTS ASSOCIATION NYPD





All NY City Medicare retires covered by the NY City Office of Labor relations
in 2019 should have received any shortage from their 2019 reimbursement in
March 2021.



An update on Medicare Reimbursements from the NYC Office of Labor Relations (OLR) website health-retiree-responsibilities (nyc.gov)


Medicare Part B Reimbursements
Medicare Part B 2020 Reimbursement
Medicare Part B 2020 reimbursements were issued in April 2021. Please check your bank account/statement (or the mail, if you are receiving a physical check) for your payment.
· If you already submitted your Medicare Part A & B card to the Health Benefits Program, this payment is automatic and you will receive it annually
.
Medicare Part B 2019 Differential Reimbursement
Medicare Part B 2019 differential reimbursements were issued in March 2021. Please check your bank account/statement (or the mail, if you are receiving a physical check) for your payment.
· For those retirees/eligible dependents who are not eligible for IRMAA, Medicare Part B 2019 differential payments up to $318 will be issued once the Medicare Part B and IRMAA payments are processed in calendar year 2020.
· Those retirees/eligible dependents who are eligible for 2019 Medicare Part B differential reimbursements must submit the Medicare Part B 2019 Reimbursement Differential Request Form, along with required documentation.
· Please submit this form, along with all required documents, electronically to: https://nycemployeebenefits.leapfile.net

IRMAA 2020 Reimbursement
IRMAA 2020 reimbursements will be issued in October 2021.
· If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement will be deposited directly into your bank account. This is separate from your pension payment. If you don’t have EFT or direct deposit, you should receive a check in the mail.
· Please submit the IRMAA 2020 Reimbursement Application, along with all required documents, electronically to: https://nycemployeebenefits.leapfile.net
IRMAA 2019 Reimbursement
IRMAA 2019 reimbursements were issued during October and November 2020. Please check your bank account/statement (or the mail, if you are receiving a physical check) for your payment.
· If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement was deposited directly into your bank account. This is separate from your pension payment. If you don’t have EFT or direct deposit, you should have received a check in the mail.
· If you did not receive your IRMAA reimbursement by December 1, 2020 or if you did receive the reimbursement and you believe the amount is incorrect, you must resubmit the IRMAA 2019 Reimbursement Application.
· Please submit this application, along with all required documents, electronically to: https://nycemployeebenefits.leapfile.net

IRMAA 2019 Differential Reimbursement
IRMAA 2019 Differential payments were issued at the end of November 2020.
· For those retirees/eligible dependents of a retiree with a Medicare Part B effective date prior to 2016, they received an additional amount up to $318.
The Medicare Part B Reimbursement Program video provides information about the different types of Medicare Part B reimbursements that the City provides, as well as information to help you to see whether you qualify to receive these payments, and how to apply.
Play the video
Please note that if you were Medicare-eligible prior to 2016, you must complete the Medicare Part B Differential Form for 2019 in order to receive the Medicare Part B differential payment. The payment is based on the amount that you paid in 2019.
If you are applying for IRMAA, you will be receiving the differential payment once IRMAA 2019 payments are processed in October 2020.
If you were enrolled in Medicare Part B effective after 2016, then you are already receiving the full payment and do not need to complete the Medicare Part B Differential Form.
Learn more


Health Benefits Forms & Downloads from OLR
Health Benefits Summary Plan Description (SPD)
Health Benefits Application/Change Form (Not for use by NYCAPS Agencies)
Health Plan Rate Chart for Retirees
Retiree Change of Address Form
COBRA Form, Notice of Rights and COBRA Rates - March 2021
COBRA Form, Notice of Rights and COBRA Rates - January 2021
Young Adult Option Through Age 29 (NYS Law Chapter 240) - March 2021
Young Adult Option Through Age 29 (NYS Law Chapter 240) - January 2021
Domestic Partner Enrollment Information
Medicare Part B Reimbursement
Medicare Part B Reimbursement Q&A
Medicare Part B Reimbursement Program Application
2020 Medicare Part B Reimbursement Differential Request Form - Information available May 2021
2019 Medicare Part B Reimbursement Differential Request Form
2018 Medicare Part B Reimbursement Differential Request Form
2017 Medicare Part B Reimbursement Differential Request Form
IRMAA Medicare Part B Reimbursement
IRMAA Medicare Part B Reimbursement Application (for 2020, 2019, 2018)
IRMAA Medicare Part B Reimbursement Application (for 2017)
Creditable Coverage Notice (Employees Age 65 or Over)
Form 1054 (For Use By Authorized Personnel Only)
Health Insurance Marketplace (Exchange) Notice
UNQUOTE.
Retired Lieutenants Association NYPD | 266-19 Hillside Avenue, Floral Park, NY 11004​
Great info pass a long.
 
Joined
May 6, 2010
Messages
15,589

Recd. from a good source....
" Mayor Adams will be under a Plan for retired NY State Governmental Officials
as a former State Senator in Albany therefore he doesn't really care about the decreased medical benefits for NYC Retirees ."
 
Joined
May 6, 2010
Messages
15,589

RETIRED LIEUTENANTS ASSOCIATION NYPD

Health plan hit

City retirees risk loss of care in switch: feds

BY CHRIS SOMMERFELDT NEW YORK DAILY NEWS Retired city government workers could be at risk of losing out on “medically necessary care” if they enroll in a health insurance plan favored by Mayor Adams’ administration, according to a federal study released Thursday.

The federal study, conducted by the inspector general’s office for the Department of Health and Human Services, reviewed thousands of medical claims denied by Medicare Advantage plans, which are privately administered and have become increasingly common in the U.S. in recent years.

About 13% of the claims rejected by the Advantage plans on preauthorization grounds would’ve been covered under traditional, federally administered Medicare, the Health and Human Services IG found. The IG also discovered that 18% of the rejected claims were inappropriately denied for payment after the fact.

“Denying requests that meet Medicare coverage rules may prevent or delay beneficiaries from receiving medically necessary care,” the report stated, adding that among the improperly rejected services were MRI scans and stays at inpatient rehabilitation facilities.

In light of its findings, the IG recommended that Congress consider strengthening enforcement against and oversight of private providers that administer Advantage plans.

The study comes as Adams’ administration continues to fight in court in hopes of transferring the city’s roughly 250,000 retired municipal workers onto an Advantage plan administered by a coalition of private health insurance companies known as Alliance.

Adams’ administration has argued that the Alliance plan would save local taxpayers hundreds of millions of dollars per year, as the private-public insurance structure would allow the city to contribute a smaller chunk of funding than under the traditional Medicare plan most municipal retirees currently benefit from.

The NYC Organization of Public Service Retirees, which is made up of retired cops, firefighters and other city workers, sued last year to block former Mayor Bill de Blasio’s administration from first rolling out the Advantage plan, arguing that it would water down their health coverage.

The group also contended that the city would break the law by attempting to slap a $191 monthly penalty on any retiree who opted out of the Advantage plan in order to keep their current Medicare coverage.

A Manhattan Supreme Court justice sided with the retirees last month, ruling that the city could not implement the plan because the proposed financial penalty violated longstanding local administrative laws.

But Adams’ administration is appealing that ruling, saying it hopes to roll out the plan as first envisioned in order to secure the sizable taxpayer savings. Adams and several of the city’s largest unions have consistently argued that the Advantage plan would provide retirees with adequate health care coverage.

Despite the HHS study, Adams spokesman Jonah Allon said late Thursday that the administration “continues to believe that the Medicare Advantage Plan is in the best interests of retirees and the city.”

”The implementation is currently on hold pending the outcome of the appeal. We look forward to presenting our arguments in court,” Allon added.

Marianne Pizzitola, a retired FDNY emergency medical specialist and president of the NYC Organization of Public Service Retirees, said the HHS study corroborates what her group has been arguing in court.

“We’ve been saying from the get-go that this plan would downgrade our benefits because [Alliance’s] goal is their bottom line, not our care, and now we’ve been vindicated,” she said. “It would be great if the mayor actually read the report and said, ‘Ah s--t, let’s fix this in other way.’ That would be the responsible thing to do.”

https://www.nydailynews.com/news/politics/new-york-elections-government/ny-nyc-retirees-medicare-advantage-plan-hhs-study-denial-of-care-20220428-agjnk33tdnfipg764rpbjh572u-story.html
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Joined
May 6, 2010
Messages
15,589
RETIRED LIEUTENANTS ASSOCIATION NYPD


for retirees on Medicare and on the NYC OLR health plan

The NYC Office of Labor Relations (OLR) has made the IRMAA form for 2021 available at IRMAA INFORMATION INSTRUCTION FORM (nyc.gov)
IRMAA 2021 annual reimbursements will be issued in October 2022.
Medicare-eligible retirees and their Medicare-eligible dependents can submit an IRMAA application if they paid above the standard amount of $148.50 per month. If you did not pay more than the standard amount then you are not eligible for IRMAA.
If you are currently receiving your pension check through Electronic Fund Transfer (EFT) or direct deposit, your reimbursement will be deposited directly into your bank account. This is separate from your pension payment. If you don’t have EFT or direct deposit, you should receive a check in the mail.
IRMAA 2021 Reimbursement Application will be available in May 2022

For More information see the OLR website at health-retiree-medb-irmaa (nyc.gov)




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Retired Lieutenants Association NYPD | 266-19 Hillside Avenue, Floral Park, NY 11004
 
Joined
May 6, 2010
Messages
15,589
RETIRED LIEUTENANTS ASSOCIATION NYPD
Dear RLA Members,

To those of you who are on or going on Medicare and have NYC health plans as your secondary insurance, the Retired Lieutenants Association just got the following information from the Municipal Labor Committee and want to pass this information on to you.

It appears one half of the Alliance making up the Medicare Advantage Plus Plan has pulled out of the agreement. Anthem (Empire BCBS) has withdrawn from the Alliance with Emblem Health GHI SeniorCare.

At this time we do not know what this means for the pending appeal. Without a plan, the City does not appear to have anything to appeal.

While this is great news, it seems like they are trying to put another MAP together to replace the one which just fell apart. Standby for developing information. As always, we will let you know anything as soon as we find out.

Keep up the fight!!!

Fraternally,
Michelle Schaefer
President RLA


https://www.empireblue.com/press/newyork/nyc-ma-update/

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Joined
May 6, 2010
Messages
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The fight is not over yet however Thank You to those spearheading this & to those who have contributed $ to keep things running.
 
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