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Medicare-eligible retirees and their Medicare-eligible dependents will be reimbursed annually for the standard Medicare Part B amount of $170.10 per month ($170.10 x 12 months = $2,041.20), excluding any penalties and late enrollment fees, and subject to be pro-rated. 2022 Medicare Part B reimbursements were issued in April 2023.
- health-retiree-forms-and-downloads - NYC.gov
Health Benefits Program. 22 Cortlandt Street, 12th Floor....
- New York City Office of Labor Relations Health Benefits ...
Please submit this form, along with all required documents,...
- health-retiree-forms-and-downloads - NYC.gov
The Income-Related Monthly Adjustment Amount (IRMAA) is an additional amount that you are required to pay for your monthly Medicare premiums if you have higher annual earnings. If your income in 2021 was less than or equal to $97,000 as an individual, or less than or equal to $194,000 as a married couple, you did not pay IRMAA in 2023 and the ...
By completing and signing this form, I certify that I was, or my dependent was, required to pay the Medicare Part B Income Related Monthly Adjustment Amount (IRMAA) and no reimbursement was issued to me or my dependent from any other source. Signature: Please submit this form, along with all required documents, electronically to:
Signature: Please submit this form, along with all required documents: Electronically: https://nycemployeebenefits.leapfile.net Mail: NYC Health Benefits Program, ATTN: IRMAA 22 Cortlandt Street, 12th Floor New York, NY 10007 Fax: (212) 306-7373 Date:
IRMAA is an acronym for Medicare’s Income-Related Monthly Adjustment Amount, which is a greater premium Medicare charges for Part B and Part D coverage to individuals with higher incomes. IRMAA is determined based on a retiree’s Modified Adjusted Gross Income (MAGI) and tax filing status. Social Security uses the most recent tax return ...
