Department of Civil Service
New York State Health Insurance Program: Coordination of Medicare Coverage for Spouses and Dependents
The Department of Civil Service administers health insurance programs for State and local
government employees and their spouses and dependents. The primary such program is the
Empire Plan, which provides services costing more than $1.6 billion a year.
Medicare is a federal health insurance program for disabled people and people aged 65 or
older. When Empire Plan enrollees, including covered spouses and dependents, become
eligible for Medicare, their medical expenses should generally be paid by Medicare. We
examined the hospitalization and major medical claims paid during 1995 by the Empire Plan
on behalf of covered spouses and dependents who were eligible for Medicare and estimated
that about $739,000 of these claims should have been paid by Medicare. We also identified
about $28,000 in claims that could have been paid by Medicare, but were not, because of
errors in records maintained by the Department of Civil Service. We recommend that these
payments be recovered from the appropriate parties. We also recommend that improvements
be made in the Empire Plan's procedures for identifying covered spouses and dependents who
are eligible for Medicare.
For a complete copy of Report 96-S-62 click here.
For a copy of the associated follow-up report click here.
For a copy of the 90-day response click here.