Senior Citizen Health Program benefits
What is the Senior Citizen Health Program, and do I qualify?
It’s Health Plan coverage for seniors designed to supplement Medicare coverage. Benefits for all Medicare-covered services are coordinated with Medicare’s primary coverage. The Senior Citizen Health Program also covers services Medicare doesn’t, such as prescriptions, preventive dental care, wellness services and private duty nursing.
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What is a Base Year?
The 12-month period of December 1 through November 30. The amount of the
Regular Annuity under the Retirement Plan is based on your AFTRA-covered earnings in Base Years in which you earn a Pension Credit. Covered earnings during Base Years also determine performers' eligibility for the Senior Citizen Health Program, as described below.
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How do I know if I’m eligible for the Senior Citizen Health Program?
The Senior Citizen Health Program is available to those:
- Who are age 65 or older, and
- Whose covered earnings during the previous four calendar quarters are too low to qualify them for active coverage under the AFTRA Health Plan, and
- Who meet the covered earnings requirements for individual coverage:
- If you are age 65 and have 15 or more Qualifying Years, or
- If you were 60 or older on Jan. 1, 2003 and have 10 or more Qualifying Years. - Who meet the covered earnings requirements for family coverage:
- If you have 20 or more qualifying years, 15 of which are Family Qualifying Years
- If you were at least age 60 as of Jan. 1, 2003 and had at least 15 Qualifying Years,
10 of which are Family Qualifying Years.
| Base Year | Annual Covered Earnings Required for a Qualifying Year (Individual Coverage) | Annual Covered Earnings Required for a Qualifying Year (Family Coverage) |
1986 and before
| $2,000 | $2,000 |
1987
| $2,500 | $2,500 |
| 1988 – 1989 | $3,500 | $3,500 |
| 1990 – 1991 | $5,000 | $5,000 |
1992 – 1993
| $7,500 | $7,500 |
| 1994 – 2001 | $7,500 | $15,000 |
2002
| $7,500
| $20,000
|
2003 to present
| $10,000
| $30,000
|
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Can my Health Plan premiums be deducted from my pension payment?
If you participate in either the Senior Citizen Health Program or active active coverage under the Health Plan, you can have your premiums automatically deducted from your monthly pension check (if your pension amount is sufficient). To request automatic deduction, submit the
Health Fund Premium Deduction Form.
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Can I cover my dependents under the Senior Citizen Health Program?
Yes. Both individual and family coverage options are available under the Senior Citizen Health Program. If your earnings qualify you for individual Senior Program coverage (but not family coverage), you may pay an additional buy-up premium to purchase coverage for one or more dependents.
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I don’t understand all of the different “parts” of Medicare. What do they mean, and how do they work with AFTRA H&R coverage?
- Medicare Part A provides hospital coverage, subject to an annual deductible. Everyone eligible for Medicare can receive Part A coverage at no charge.
- Medicare Part B provides coverage for outpatient services like doctor’s visits. Medicare-eligible people may choose enroll and pay premiums for Part B.
- Medicare Part C is the Medicare Advantage (MA) program, administered by many private carriers. Only those in certain areas may join MA plans, and those who do waive their regular Medicare benefits. Some MA plans have premiums and others don’t, and coverage differs under each plan.
- Medicare Part D is the Medicare Prescription Drug Program, administered nationwide by many private carriers. Part D plans provide different levels of prescription coverage at different costs.
The Senior Citizen Health Program coordinates benefits with Medicare Part A and Part B. The Senior Program provides coverage secondary to Medicare. Since Medicare is primary, before the Senior Program pays benefits, you must meet the non-network deductible.
The Senior Citizen Health Program provides benefits comparable to Medicare Parts C and D. If you enroll in a Medicare Advantage (Part C) plan, you won’t be eligible for the Senior Program. If you enroll in a Medicare prescription drug plan (Part D), the Senior Program can’t provide secondary prescription coverage.
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