IRMAA
The IRMAA Form for 2024 is now available to download here.
Informational Update Vol 16 #5
1. 2024 IRMAA Application
In early April, I wrote (Info Vol 16 #3) how to determine if you are eligible for the 2024 IRMAA reimbursement. In short, if your monthly 2024 Medicare Part B premium contained a surcharge, called IRMAA, then you are eligible and should read further.
The 2024 IRMAA application is now available. You can download the form from the CSA Welfare Fund website, www.csawf.org and the Office of Labor Relations website, www.OLR.org, This application may also be used to apply for years 2022 & 2023.
Please make sure to include the following with your 2024 IRMAA reimbursement request:
1) A completed reimbursement request application. Be sure to check off 2024 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) The November 2023 Social Security Benefits letter. This is the annual letter that tells you how much Social Security you will be receiving the following year (in this case 2024) & your Medicare Part B & D premiums.
3) The 2024 Social Security 1099 letter.
You can submit your documents directly to OLR either by mail or electronically through Leapfile. The mailing address, or how to upload electronically is on OLR’s website. If you choose, you can also submit them to Susan Barone, our Welfare Fund Administrator whose office will review and upload your documents to OLR. You can do this electronically by scanning your documents and sending them to SBarone@csawf.org, or mailing them to the: CSA Welfare Fund Office, 40 Rector St., New York, NY 10006.
Please note that if you went on Medicare during 2024, you are entitled to a pro-rated 2024 IRMAA reimbursement. Additionally, if you never applied for IRMAA reimbursement for 2022 and/or 2023, you may use the same 2024 IRMAA application, however, check the year you are applying and submit each year’s request in a separate package.
For example, if you are applying for 2022, 2023 & 2024 IRMAA reimbursement, submit 3 separate packages. Each package will contain 3 documents; an application, appropriate SSA benefit letter (for 2022, the November, 2021 letter and for 2023 the November 2022 letter), and appropriate SS 1099 letter (for 2022, the 2022 SS 1099 letter and for 2023, the 2023 SS 1099 letter.
2. Durable Medical Equipment (DME)
Unfortunately, as we age into our senior years, the need for Durable Medical Equipment (DME) increases. The good news is that Medicare provides coverage for this equipment provided your doctor says it is medically necessary. DME include, but is not limited to, such items as wheelchairs, walkers, hospital beds, oxygen equipment, and CPAP machines – devices intended for repeated use and serve a medical purpose,
How to get Coverage
To get coverage, your doctor must write a prescription, saying that the DME is medically necessary. Once approved, Medicare will generally cover 80% the DME provided you use a Medicare-approved supplier. Your secondary will pick up the other 20%.
Keep in mind that some DME is rented rather purchased. Additionally, Medicare approval may be necessary before certain items are supplied.
3. Question of the Month
Q. I recently received a bill of $67 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 your 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 have already used up your deductible. Consequently, you do not owe the $84 and the doctor will have to re-file the bill with Medicare. Motto: Keep track of your deductibles (as well as copays).
Norm Sherman
Florida CSA Retiree Chapter Liaison & Outreach Coordinator
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NY Court of Appeals Rules that NYC Cannot Defund Retiree Healthcare
December 17, 2024
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THE NEWS, PRESS RELEASE FOR IMMEDIATE RELEASE:
CONTACT: Savannah Larson
NY Court of Appeals Rules that NYC Cannot Defund Retiree HealthcareToday’s Ruling Requires the City to Pay the Entire Cost of Retirees’ Preferred Health Insurance
NEW YORK, December 17, 2024 —
Today, the New York Court of Appeals, the state’s highest court, issued a historic decision in favor of 250,000 Medicare-eligible retired New York City workers and their dependents. The Court held that the City must continue to pay the entire cost of any health insurance plan a retiree chooses, thus preserving retirees’ right to City-funded Medicare supplemental insurance.Rejecting the City’s argument that the City can cease funding retirees’ health insurance, the Court unanimously held that “the City must pay—up to the statutory cap—for each health insurance plan that it offers employees and retirees.” The decision is available here.In 2021, the City announced that it would stop paying for retirees’ Medicare supplemental insurance and automatically switch them into a federally funded—and far inferior—type of insurance called Medicare Advantage.
Unlike Medicare supplemental insurance, Medicare Advantage plans limit access to medical providers and regularly deny coverage for necessary care. Under the leadership of Marianne Pizzitola and the NYC Organization of Public Service Retirees, retirees banded together and sued to protect their right to Medicare supplemental insurance.This is another resounding victory for the NYC Organization of Public Service Retirees (one of the lead plaintiffs in the case) and the entire retiree community. In the past three years, they have brought three separate lawsuits regarding their healthcare rights and have obtained landmark victories in each case at both the trial and appellate levels.
Marianne Pizzitola, President of the NYC Organization of Public Service Retirees, states, “The City’s plan to defund retiree healthcare has now been analyzed by 13 different judges across all three levels of the state court system. Every single judge—all 13 of them—have concluded that the City’s plan is unlawful. We once again call on the City and the Municipal Labor Committee to end their ruthless and unlawful campaign to deprive retired municipal workers of the healthcare benefits they earned.”
Jake Gardener, a partner at Walden Macht Haran & Williams LLP, counsel to the retirees, says, “We are grateful to the Court of Appeals for affirming the healthcare rights of hundreds of thousands of elderly and disabled retired City workers. Because of today’s decision, countless senior citizens and disabled first responders will be able to continue receiving the medical care they desperately need and to which they are entitled.”
Steve Cohen, a partner at Pollock Cohen LLP, which also represents the retirees, states, “We are thrilled that the Court of Appeals agrees that City retirees deserve what they were promised: payment for the health plan of their choice.”
Medicare Part B Premium and Deductible
Medicare Part B covers physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A. Each year, the Medicare Part B premium, deductible, and coinsurance rates are determined according to provisions of the Social Security Act. The standard monthly premium for Medicare Part B enrollees will be $185.00 for 2025, an increase of $10.30 from $174.70 in 2024. The annual deductible for all Medicare Part B beneficiaries will be $257 in 2025.
GHI Senior Care members are responsible for the $50.00 annual deductible as well.
Prescription Co-Pay Reimbursements for Pre Medicare-Retirees
If you are not yet on Medicare, and you are a GHI or HMO retiree, one of the benefits is prescription co pay reimbursements. You can log onto the Express Scripts website, log onto your secure site and download all prescriptions filled for the calendar year 2024. Even if you filled them at your local pharmacy, Express Scripts has a record. Make a copy and submit it to the CSA Retiree Welfare Fund. After $100 deductible, the Welfare Fund will reimburse 80% of your co pays with an annual maximum of $10,000. The Retiree Chapter will then reimburse another 20%, with a maximum of $2000.
Turning 65
If you or your partner/spouse are turning 65 this year and are retired, the city requires you to sign up for Medicare Part A and Part B. Once you are on Medicare, the world of medicine opens to you as about 94% of all medical providers in America accept Medicare. Medicare will become your primary provider, covering 80% and your city coverage (Medigap or secondary coverage) covers the remaining 20%. Prescription coverage with Express Scripts remains the same. If you are still working for the DOE when you turn 65, you may apply for Part A, as that is free, if you have worked 10 years paying into social security.
If you are collecting social security, approximately 90 days prior to your turning 65, social security will generally send you your A and B card asking if you wish to keep part B. If you have not received a card, you need to log onto SSA.gov and register for Medicare Part A and B only. You can also visit your local social security office and register there. If you delay in enrolling, generally 90days after you have turned 65, you may be assessed a penalty.
Once you get your card, you need to make a copy and submit it to the NYC office of Labor Relations. They are located at 22 Cordtlandt St, 12th floor, NY, NY, 10007, and their phone number is 212-513-0470.
The Welfare Fund encourages members to reach the Fund office when applying for Medicare to ensure that proper communication is made between the member and Office of Labor Relations. Please call the Fund office at (212) 962-6061 or email the Fund’s administrator, Susan Barone (sbarone@csawf.org) for assistance.
Elections
CSA’s Retiree Chapter Executive Board is in the midst of its election for Executive Board members. Ballots have already gone out. You are asked to vote for no more than 20candidates out of a field of 32 retirees vying for a seat. The RC Executive Board makes policy for the Retiree Chapter following its constitution and CSA’s constitution as well. The voting is being conducted by the AMERICAN ARBITRATION ASSOCIATION. Your ballot must be received by the American Arbitration Association by close of business on Monday, January 27, 2025, in order to be counted. If you have not received your ballot, please call the AAA at 212 484-4136.
