Health Insurance Subsidy for Members

As a retired member, you may be eligible for a health insurance subsidy.

At age 65, you are required to enroll in Medicare to the fullest extent of your entitlement to continue your participation in the Health Subsidy Program. Members who become eligible for Medicare before turning age 65 must contact the Medical and Dental Benefit Section.

Who is eligible?

You qualify for a health insurance subsidy if you meet the following requirements:

What is the subsidy amount?

Your monthly subsidy depends on whether you are enrolled in Medicare:

  • If you are (1) under age 65 and not enrolled in Medicare or, (2) at least age 65 and enrolled in Medicare Part B only, monthly subsidy maximums are calculated as follows:

 

Formula: YOS x 4% x Maximum Subsidy Amount ($1097.41)= Monthly Subsidy
Example: If you have 20 years of service, $877.93 is your monthly subsidy, which would be applied toward your health premium. (20 YOS x 4% x $1,097.41 = $877.93)

 

  • If you are enrolled in Medicare Parts A and B, subsidy formulas are plan-specific and you are reimbursed the cost of the standard Part B premium. At age 65, if you do not qualify for Medicare Part A (all pensioners will qualify for Medicare Part B), the above formula will be used to calculate your subsidy amount and, additionally, you will not be reimbursed for the cost of the standard Part B premium.  If you are enrolled in Medicare Parts A and B, the following monthly subsidy maximums are in effect beginning January 1, 2012.

 

UNFROZEN SUBSIDY:  Members enrolled in Medicare Parts A and B who either (1) entered DROP or retired prior to July 15, 2011 or, (2) chose to opt-in during the designated period are subject to the updated monthly subsidy maximum of $423.45*.  Please note that this is the maximum single-party subsidy; depending on the years of service, some members may qualify for a higher amount if there are dependents covered under the plan.

*If the retiree had 20 to 25 years of service, the qualified survivor is eligible for 100% of the monthly subsidy maximum as stated.  If the retiree had 15 to 19 years of service, the qualified survivor is eligible for 90% of the monthly subsidy maximum as stated.  If the retiree had 10 to 14 years of service, the qualified survivor is eligible for 75% of the monthly subsidy maximum as stated.

 

FROZEN SUBSIDY:  Members enrolled in Medicare Parts A and B who chose not to opt-in during the designated period and entered DROP or retired on July 15, 2011 and later are frozen at the monthly subsidy maximum of $480.41*, the rate effective July 1, 2011.  Please note that this is the maximum single-party subsidy; depending on the years of service, some members may qualify for a higher amount if there are dependents covered under the plan.

If the plan premium is higher than your eligible subsidy, the difference will be taken in the form of a deduction on your monthly pension payment.  If your eligible subsidy exceeds your plan premium, the unapplied subsidy amount is forfeited.
How do I enroll?

It is not necessary to apply for this benefit. Any eligible retiree or qualified surviving spouse/ domestic partner enrolled in a City-approved health plan will automatically receive this benefit.

However, it is recommended that members contact the Association that is administering their active health plan approximately one year before retirement or exiting from DROP to inquire about any special enrollment requirements prior to making the transition to the Association’s retiree health plan. 

Members must contact the Association administering their active health plan after their retirement or DROP exit date is finalized in order to complete the required paperwork to make the transition to the Association’s retiree health plan.