The City of New York and its unions have negotiated reimbursement in full for all premiums Medicare eligible participants and their eligible dependents pay for Medicare Part B, including the IRMAA amounts based upon income.
When first turning 65 years old, participants or dependents must submit a copy of their Medicare card, showing the Part A and Part B effective dates, to the City Office of Labor Relations. The Medicare Card Transmittal form, listed below, must be submitted along with the card. This is a one-time action, and, once completed, the standard amount paid for Medicare Part B is reimbursed the following April ( for example, 2020 payments were reimbursed in April 2021)
If a participant and/or dependent pays more than the standard amount, as described in the annual Social Security Award Letter, you must apply for the overpayment. The City posts a reimbursement request form which must be completed and submitted with the letter showing the amount to be paid and proof it was paid ( SSA-1099 form if collecting Social Security benefits, copy of monthly billing statement and proof of payment if not collecting Social Security benefits ).
For 2017 through 2019 some members who turned 65 before January 1, 2017 and did not qualify for IRMAA reimbursement were initially under-reimbursed. For those who were under reimbursed they can apply for the “Differential” reimbursement ( the amount of the underpayment) using the appropriate reimbursement request form.
The 2017, 2018, and 2019 forms are listed below. AS new years are made available they will be posted here and members will be notified.
As a courtesy to CSA participants and their families, Medicare cards and IRMAA and Differential request applications may be submitted tot he Fund for review. Once the submissions are correct the Fund will deliver them to the City of New York.
Medicare Card Transmittal Form
IRMAA Reimbursement Applications
New York City 2022 IRMAA Reimbursement Form
New York City 2021 IRMAA Reimbursement Form
New York City 2020 IRMAA Reimbursement Form
New York City 2019 IRMAA Reimbursement Form
New York City 2018 IRMAA Reimbursement Form
New York City 2017 IRMAA Reimbursement Form
Differential Reimbursement Applications
New York City 2019 Part B Differential Form
New York City 2018 Part B Differential Form
New York City 2017 Part B Differential Form
