Medicare for Empire Plan (NYSHIP) retirees
The Capital Region is full of retired state, SUNY and public-authority employees whose health coverage comes through NYSHIP. That coverage is unusually good in retirement, and unusually easy to damage: every fall the mailbox fills with Medicare plans that, for a NYSHIP retiree, are at best unnecessary and at worst a way to lose the Empire Plan. Here is how it actually fits together.
At 65, enroll in Medicare Parts A and B: NYSHIP requires it, reimburses your standard Part B premium ($202.90 a month in 2026) through your pension, and reimburses Part B IRMAA on annual application. Keep the Empire Plan's own Medicare Rx drug coverage. Don't join an outside Medicare Advantage or Part D plan; it adds nothing you lack and can break your NYSHIP coverage. A Medigap policy almost never makes sense either, because the Empire Plan already pays most of what Medigap would.
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 canceled, because NYSHIP pays only what it would have paid after Medicare.
What to do at 65
- Three months before your 65th birthday, enroll 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.
- 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.
- 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.
- 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: the IRMAA Reimbursement Application goes to the Employee Benefits Division's IRMAA Unit in Albany with your SSA-1099 (or your Medicare premium bills) as proof, and the check comes from the State Comptroller, usually 90 to 120 days later. You have three years after the tax filing deadline for a year to claim it. 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.
"It was free, so I signed up"
A retiree enrolls in a $0-premium Medicare Advantage plan at a seminar. Medicare permits one Part D enrollment, so the Advantage plan's drug coverage replaces Empire Plan Medicare Rx. Prescriptions that were covered are suddenly not, and untangling it takes months. If anyone offers you a plan and you have NYSHIP, the answer is "let me check with my benefits office first."
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 summarizes them as of September 2026.
By county: Albany · Saratoga · Schenectady · Rensselaer · Warren · Washington · Montgomery · Fulton · Columbia · Greene · Schoharie · Otsego · Herkimer · Hamilton · Essex · Ulster · Dutchess. Town pages: every town, grouped by county. Anywhere else in New York.
- Medicare and NYSHIP (NYS Department of Civil Service) — Parts A and B requirement, Empire Plan Medicare Rx, HMOs
- Medicare: Empire Plan retirees (NYS Department of Civil Service) — Part B and IRMAA reimbursement; do not join non-NYSHIP plans
- IRMAA reimbursement, Empire Plan retirees (NYS Department of Civil Service) — annual application with proof of payment (SSA-1099, CMS-500); IRMAA Unit, Employee Benefits Division, Albany, by mail or secure fax; State Comptroller check in 90 to 120 days; three-year deadline; no Part D IRMAA or penalties; read October 16, 2026
- Retired member FAQs (NYSTRS) — NYSTRS does not administer retiree health insurance; contact your former employer about health benefits and Medicare reimbursement; read October 16, 2026
- Medicare costs 2026 (medicare.gov)
We do not offer every plan available in your area. Currently we represent 10 organizations which offer 81 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. 1-800-MEDICARE (TTY 1-877-486-2048) is available 24 hours a day, 7 days a week. Insurers' legal names and home offices: carriers page.
Common questions
Short answers to what people ask before they call.
Still have a question? Call (518) 902-8822 or book a call.
I'm retired with NYSHIP and turning 65. Do I need Medicare?
Yes, both Parts A and B, effective the month Medicare becomes primary. NYSHIP requires it. If you're not enrolled in Part B when Medicare becomes primary, NYSHIP pays as though you were, which leaves you responsible for what Medicare would have paid. Contact Social Security about three months before your 65th birthday.
Does NYSHIP pay my Part B premium?
NYSHIP reimburses the standard Part B premium, $202.90 a month in 2026, for each Medicare-primary person covered under your enrollment, usually through your pension check. If you pay the income-related surcharge (IRMAA) on Part B, that is reimbursed too, but only on annual application with proof from Social Security. Part D IRMAA is not reimbursed.
How do I get my Part B IRMAA reimbursed by NYSHIP?
Apply every year; it is not automatic. Send the Department of Civil Service's Medicare Part B IRMAA Reimbursement Application, with proof of what you paid (your SSA-1099, or the Medicare premium bills if you pay Medicare directly), to the Employee Benefits Division's IRMAA Unit in Albany by mail or secure fax. Approved claims are paid by a check from the Office of the State Comptroller, usually within 90 to 120 days of a complete application, and the deadline is three years after that year's tax filing deadline. NYSHIP has no authority to reimburse Part D IRMAA, and it doesn't reimburse late-enrollment penalties.
I retired from a school district and get a NYSTRS pension. Does any of this apply to me?
Only if your district's retiree coverage is NYSHIP. NYSTRS pays your pension but says it does not administer retiree health insurance, and it sends retirees to their former employer for health benefits and any Medicare reimbursement. Whether you retired from Shenendehowa, North Colonie or another Capital Region district, ask the district's benefits or business office which plan you're in and what it requires at 65 before you sign up for anything else.
Should I join a Medicare Advantage or Part D plan I saw advertised?
If you're in the Empire Plan, no. Empire Plan Medicare Rx, a Part D plan built for NYSHIP, is included automatically once Medicare is primary, and Medicare allows only one Part D enrollment. Joining an outside Part D or Advantage plan with drug coverage can cancel your Empire Plan Medicare Rx and disrupt your NYSHIP coverage. Civil Service's own guidance is not to sign up for any non-NYSHIP Advantage or Part D plan.
I'm in a NYSHIP HMO rather than the Empire Plan. Is it different?
Yes. NYSHIP HMOs generally move their Medicare-eligible members into the HMO's own Medicare Advantage plan automatically. That's still NYSHIP coverage, still with Part B reimbursement, but it is a Medicare Advantage plan with a network. Check the HMO's materials, and talk to me or to your benefits office before doing anything else.
Should I buy a Medigap plan on top of NYSHIP?
Almost never. The Empire Plan already pays most of Medicare's deductibles and coinsurance when you use its network, which is what a Medigap plan would do. Paying a second premium for overlapping coverage rarely makes sense. The exceptions are rare enough that they're worth a phone call rather than a rule.
Retiring from state service?
Bring your NYSHIP notices. I'll show what Medicare adds, what it costs, and what you shouldn't buy.