Medicare for New York State retirees with NYSHIP

How NYSHIP and Medicare fit together

While you're working, NYSHIP is your primary coverage and Medicare, if you have it, is secondary. That flips in retirement: once you're retired and eligible for Medicare, Medicare pays first and NYSHIP pays second. For Empire Plan members that means Original Medicare covers the bulk of hospital and medical costs, and the Empire Plan picks up most of Medicare's deductibles and coinsurance when you use its participating providers. For NYSHIP HMO members, the HMO generally provides its own Medicare Advantage plan instead.

The arrangement depends on you actually being enrolled in Medicare Parts A and B when Medicare becomes primary. NYSHIP's rule is blunt: if you're not enrolled, your coverage is drastically reduced or cancelled, because NYSHIP pays only what it would have paid after Medicare.

What to do at 65

1. Three months before your 65th birthday, enrol in Parts A and B through Social Security. Do this even though Part B has a premium; see reimbursement below. If you're still working at 65, the timing is different, and the working past 65 guide applies, but plan the Part B start for the month you retire.
2. Send your Medicare card to your benefits administrator (the Employee Benefits Division for state retirees) so NYSHIP records you as Medicare-primary and starts reimbursement.
3. Do nothing about Part D. Empire Plan members are enrolled automatically in Empire Plan Medicare Rx, a Part D plan with coverage broader than a standard plan. It arrives with its own card.
4. Ignore the October mail. Advantage plans with $0 premiums and Part D plans with low premiums are aimed at people who need them. You don't, and joining one can undo steps 2 and 3.

The money: Part B and IRMAA reimbursement

• Part B premium. NYSHIP reimburses the standard Part B premium for each Medicare-primary person under your enrollment, you and a covered spouse, typically added to your pension payment. For 2026 that's $202.90 a month each.
• Part B IRMAA. If your income two years ago put you in a surcharge bracket (over $109,000 single or $218,000 joint on the 2024 return, for 2026), the extra Part B amount is reimbursed too, but only when you apply each year with the Social Security letter showing the surcharge. Many retirees never apply and leave real money behind. The IRMAA guide explains the brackets and appeals.
• Part D IRMAA is charged by Medicare on top of Empire Plan Medicare Rx and is not reimbursed.

Where I fit in

For an Empire Plan retiree there's usually nothing to sell, and I'll say so. What I can do is confirm which NYSHIP option you're in, explain how it coordinates with Medicare, make sure the Part B and IRMAA reimbursements are in place, help with the IRMAA application or an appeal after retirement income drops, and look at the rest of the household: a spouse without NYSHIP coverage, or a Medicare decision for a parent. For NYSHIP HMO members, I'll walk through what the HMO's Medicare Advantage plan does and doesn't cover. No fee for any of it. Request a call.

For the official rules, your benefits administrator and the Department of Civil Service's Medicare and NYSHIP pages are the authority, and they change from time to time; this guide summarises them as of September 2026.

I do not offer every plan available in your area. Any information I provide is limited to the plans I do offer in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your State Health Insurance Assistance Program for information on all of your options. Not connected with or endorsed by the U.S. government, the Social Security Administration or the federal Medicare program.