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Do you know how your health coverage and costs are changing in 2019?

A New Year is upon us. As Retirees we need to constantly pay attention to what changes are being proposed that affect our quality of life, such as what we pay for Medicare and health care.

The Centers for Medicare and Medicaid Services recently announced their cost adjustments for 2019, and you will be happy to know that the standard Medicare Part B monthly premium for most beneficiaries that started in January is $135.50. That’s a modest increase of just $1.50 per month over the 2018 standard premium.


However, a small group of Medicare beneficiaries will actually pay less than $135.50, because the 2.8 percent cost-of-living increase in their Social Security checks will not be large enough to cover the full premium increase.

Thanks to the Social Security Act’s “hold-harmless” provision, Medicare can not pass along to seniors premium increases greater than the dollar increase in their Social Security checks.

In addition, a small group of “high Income” beneficiaries will pay higher Part B premiums because their annual income is above $85,000 as a single person, or $170,000 as a married couple filling jointly. Medicare uses modified adjusted gross income from two years ago to determine your premiums, which means 2019 Part B premiums are determined by 2017 income. For more information visit Medicare.gov or call 800-633-4227.

We also need to be aware of recent changes in our NYSHIP (NYS Health Insurance Program) rates and benefits. Every year in November, December and January we receive important information about health insurance from the NYS Department of Civil Service.

In November, we received NYSHIP’s Health Insurance Choices for 2019, and in December the 2019 Rates and Information flyer. We also received in December “At a Glance,” an Empire Plan guide that briefly describes your 2019 plan benefits. It is Important to read these publications thoroughly, so you know your choices for benefits. For instance, 2019 brought changes in the following:

  • in-network out-of-pocket limit,
  • combined annual deductible,
  • combined annual coinsurance maximum,
  • copayments,
  • Empire Plan Flexible Formulary Drug List,
  • Elimination of the “New to You” Prescription Drug Requirement,
  • phone number for Diabetic Supplies Pharmacy (now 800-321-0591), and
  • skilled nursing facility care.

All of this information and more can be found in the At A Glance booklet. Most notably, we saw increased copayments (now $25 for an office visit), changes in benefits, and a small increase in premiums.

Non-NYSHIP Plans: You also may receive information from Medicare and non-NYSHIP plans in your area describing Medicare options available to you that are not part of NYSHIP, and you may wonder whether you should join one of these plans. Please be careful in considering this.

Keep in mind that:

If you enroll in a non-NYSHIP Medicare Advantage plan, or a Medicare Part D plan that is separate from your NYSHIP coverage, you will automatically be unenrolled from NYSHIP coverage.

Therefore, you will have no medical/surgical, hospital, mental health and substance abuse, or prescription drug coverage under NYSHIP.

You will have only the benefits available to you through the non-NYSHIP plan. This information is on page 3 of Health Insurance Choices for 2019.

Happy 2019! Stay informed, involved and engaged, and continue to be active with PEF Retirees!

Retiring or Retired? Join PEF Retirees now!
Membership equals benefits. Contact PEF Retirees at 800-342-4306, x289. DON’T DROP NYSHIP AT 65!

Table of Contents – February 2019