Benefits Available to City Retirees

Retirees pay the same percentage of health and life insurance premiums as active employees. Premiums are withheld from your monthly retirement or pension check, and we collect them one month in advance. For example, June deductions pay for coverage in July.

Retiree health insurance coverage follows the same rules as coverage for active employees. Retirees can newly enroll in or change plans during the annual enrollment period each spring for coverage that begins on July 1. Retirees can also enroll any time during the year year due to a loss of coverage.

Retirees can add or remove dependents due to a qualifying life event, including a:

• a marriage or birth
• a spouse or dependent losing their coverage, or
• a spouse or dependent gaining coverage elsewhere. You need to drop them from your plan within 30 days of them getting new coverage.

You can update your address by completing the Change of Address form and submitting it to the health benefits office within 30 days of your move.

If you move out of your plan service area, this is considered a qualifying event, and you can enroll in a different plan within 30 days. For questions about the plan service areas, please call Health Benefits at 617-635-4570.

Upon a retiree's death, their surviving spouse may continue coverage at the same cost as when the retiree was alive. Please also keep in mind:

• Choosing Option A, B, or C for your pension allowance does not affect your surviving spouse’s eligibility for continued health insurance. But, if you choose Option A or B, they your spouse must pay premiums to the City.
• If you choose Option C for your pension allowance, we will take monthly deductions from your surviving spouse’s pension check.
• Surviving spouses are no longer eligible for health insurance if they remarry.

Effective July 1, 2011, Massachusetts law mandated that all cities and towns require retirees age 65 and older to apply for Medicare Parts A and B. If eligible, these retirees must also transfer to a Medicare plan to continue their health insurance coverage.

This includes:

• retirees
• the spouses of retirees
• Medicare eligible dependent children (if they are disabled), and
• surviving spouses.

If you are eligible to receive Medicate Part A for free, you must enroll in both Medicare Parts A and B.

You could be eligible for Medicare Part A for free if:

• you worked 40 credits into Social Security
• you have a current spouse, former spouse, or a deceased spouse who worked 40 credits into Social Security
• you paid the Medicare tax (employees hired after July 1, 1986 have paid the Medicare tax), or
• you have Military service that counts toward eligibility.

This list is not comprehensive. Even if you think you are not eligible for Medicare, you must go through the process of applying through Social Security.

Every year in July, the City refunds 50 percent of the amount you paid for your Medicare Part B premium. The refund is issued in your July retirement check for the previous calendar year.

• For example, the refund issued in July 2016 is for premiums paid from January through December 2015.
• The City will automatically refund you based on the standard monthly premium amount.
• If you paid more than the standard premium, you must submit proof of your extra payment no later than April 30th of each year. Proof of payment may be the Social Security 1099 or a letter on Social Security letterhead stating how much you paid.

> Read more information about Medicare Part B Refund

> Download the Medicare Part B IRMAA Refund Request Form

If you are ineligible for Medicare (Part A is not free), you must provide proof. We need a copy of a letter on Social Security letterhead stating that you are not eligible for Medicare Part A for free. You may remain enrolled in a non-Medicare plan.

Family Exemption

If you are covering two or more family members (a spouse and dependents) who are not eligible for Medicare, you may continue coverage in your non-Medicare family plan.

'One Over, One Under'

If you retire and are not eligible for Medicare, but your spouse is eligible:

• your spouse must enroll in a Medicare plan, and
• you must enroll in individual coverage in a non-Medicare plan.

If you retire and are eligible for Medicare, but your spouse is not eligible:

• you must enroll in a Medicare plan, and
• your spouse must enroll in individual coverage in a non-Medicare plan.

Advanced Imaging:

Diagnostic imaging procedures including magnetic resonance imaging (MRI), computed tomography (CT), and nuclear medicine imaging procedures, such as positron emission tomography (PET).

Annual Enrollment:

The yearly period when employees/retirees can enroll in and change health insurance plans and coverage without a qualifying life event.

Copayment:

A fixed amount you pay for each covered health care service, in addition to your premium and any deductible.

Deductible:

A fixed amount an employee pays for certain services before the insurer begins to pay for those services.  Members pay in full for certain services until reaching the annual maximum deductible amount.

Inpatient Hospital:

Care that you receive when admitted (acute, medical rehabilitation, skilled nursing care). Excludes mental health and substance use disorder.

Outpatient Hospital:

Care that you receive without being admitted or for a stay of less than 24 hours.

Premium Share:

The percent of premium you pay for health insurance every month (from paycheck or pension). The employer pays the remaining percentage.

Primary Care Physician (PCP):

A physician who directly provides or coordinates a range of health care services for a patient.

Specialist:

A physician who focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent, or treat certain types of symptoms and conditions.