How does Medicare work?

Your coverage and costs with Medicare vary based on how you decide to assign your Medicare benefits.

If you decide to enroll in original Medicare: You will pay for services as you get them. In general, you will pay a premium for Part B (Medical), an annual deductible for part B, and 20% of the cost of the service. If you add Medicare Part D (Drug costs) you will also pay a premium for that benefit. Please note: If you do not enroll in Part D coverage within 2 months of losing your coverage and then wish to enroll in Part D coverage later, you will likely have to pay a penalty.

If you decide to enroll in a Medicare Advantage Plan (Part C): You can choose from a variety of private insurance providers who will bundle your hospital coverage (Part A), medical benefits (Part B) and may provide additional services including dental, vision, and pharmacy benefits. The coverage and out of pocket costs will vary from provider to provider. If you are a resident of New York City, you can enroll in a Medicare Advantage Plan through MetroPlus.

If you want to continue coverage through the Benefit Funds: You may be eligible to assign your Medicare Part B and Part D benefits to the Industry-Wide Benefit Funds and maintain medical and pharmacy coverage at the health centers. Eligible disabled dependents who have Medicare Part B also have the opportunity to assign their Medicare to maintain health center benefits. This option is only available to individuals who are retiring. If you are over the age of 65 and interested in this option but you are not retiring yet, please be aware that if you enroll in a Medicare Advantage Plan (Part C) with a private insurance company or MetroPlus, you will not be eligible to assign your benefits to the Funds at a later date, unless you are covered by the Funds for 36 consecutive months after returning to work.

 In general, in order to be eligible for Medicare, you must be:

• Age 65 or older
• A U.S. citizen or a permanent legal resident who has lived in the United States for at least five years
• Be receiving Social Security benefits (or be eligible to)

Certain younger individuals with disabilities are also eligible. To read the full list of qualifications, visit Medicare’s website here.

If you want to continue coverage through the Benefit Funds: You must meet the following criteria:

• Be age 65 or older
• Be a “Hotel Industry Retiree” meaning that you must work for a Contributing Employer until you’re eligible for a Pension benefit that will begin with the calendar month after your last day of Covered Employment
• Have been part of the Health Benefits Fund Plan for at least 36 consecutive months prior to your retirement.

Important note: You cannot have a break in coverage. If you are thinking about retiring (but are not retired yet) you should enroll in original Medicare Part B coverage now and purchase COBRA to keep this option to continue coverage through the Benefit Funds open. If you do not wish to have the option to continue to use medical and pharmacy benefits at the health centers when you retire, you only need to purchase Medicare Part B when your coverage ends. You do not need to enroll in COBRA.

Important note: If you enroll in a Medicare Advantage Plan (Part C) with a private insurance company or MetroPlus, you will not be eligible to assign your benefits to the Funds at a later date unless you are covered by the Funds for 36 consecutive months after returning to work.

Your out of pocket premiums and costs will vary based on which Medicare plan you elect.

If you want to enroll in original Medicare: You can apply online or call Social Security at 1-800-772-1213.

If you want to enroll in a Medicare Advantage Plan (Part C): You should speak with the insurance provider of your choice. 

• If you are a resident of New York City, you can enroll in a Medicare Advantage Plan through MetroPlus. You can enroll in person at the Union’s Gertrude Lane Auditorium (305 West 44th Street) and at the Midtown, Brooklyn, Queens, and Harlem Health Centers, 9:00 AM to 5:00 PM, Monday through Friday. You can also apply by phone by calling 855-809-4073 from 9:00 AM – 5:00 PM, Monday through Friday and 9:00 AM – 1:00 PM on Saturdays.
• If you want to enroll with BlueCross BlueShield and live in New York State (outside of New York City), you can view your plan options on Empire BlueCross BlueShield’s website.
• If you want to enroll with BlueCross BlueShield and live in New Jersey, you can view your plan options on Horizon BlueCross BlueShield’s website.

If you wish to enroll in a Medicare Advantage Plan, you will need to enroll within 2 months of losing your coverage, or you will have to wait until the annual Open Enrollment Period to enroll.

In order to be eligible to enroll in a Medicare Advantage Plan with MetroPlus or BlueCross BlueShield, you will need to enroll in Medicare Part B with the Social Security Administration first.

If you want to continue coverage through the Benefit Funds: Call the Benefit Funds at (212)-586-6400.

How does receiving payment for your PTO and continuing your coverage affect your deadlines to enroll in Medicare?

If you have decided to continue your coverage with the Health Benefits Fund for a limited period of time by receiving payment for your paid time off, your 8-month Special Enrollment Period to enroll in original Medicare without paying a penalty will begin AFTER you lose coverage with the Health Benefit Funds.

For example, if you receive payment for your PTO and extend your coverage until February 28, 2021, your 8-month window to enroll in Medicare will begin on March 1, 2021, rather than January 1, 2021.