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 ).
The 2023 application is listed below.
As a courtesy to CSA participants and their families, Medicare cards and IRMAA and Differential request applications may be submitted to the Fund for review. If you would like the Fund to review your forms, please email the IRMAA Reimbursement application along with all supporting documentation to Susan Barone, Administrator at sbarone@csawf.org or by mail to The CSA Welfare Fund, Attention Susan Barone, 40 Rector Street, 12th Floor, NY NY 10006.
Medicare Card Transmittal Form
2023 IRMAA Reimbursement Application:
IRMAA INFORMATION INSTRUCTION FORM (nyc.gov)
Please note: Reimbursement requests that do not include both documents for each eligible person for the year(s) indicated above will not be evaluated. Please include the retiree’s name and Social Security number on any eligible dependent’s documentation. Retiree AND eligible Spouse/Dependent – Please enclose all required documentation for each person for which you are applying.
Proof of payment for ALL months of Medicare Part B premiums for each eligible person.
Documentation includes: Copy of Form SSA-1099 Social Security Benefit Statement OR proof of direct payments and billing statements for all premiums paid directly to CMS. Copy of Social Security Administration (SSA) benefit notice stating your Medicare Part B premium including the income-related monthly adjustment amount for the year(s) for which you are applying. Note: If no IRMAA amount is listed on your SSA benefit notice nor included in your Medicare Part B premiums on your Form SSA-1099, you are not eligible for IRMAA reimbursement and you should not complete this form
2023 IRMAA Upload Link to OLR
