Department of Civil Service

New York State Health Insurance Program: Coordination of Medicare Coverage

The Department of Civil Service administers health insurance programs for State and local government employees and their dependents. The primary such program is the Empire Plan, which provides services costing more than $1.4 billion a year. Medicare is a Federal health insurance program for disabled people and people aged 65 or older. When Empire Plan enrollees become eligible for Medicare, their medical expenses should generally be paid by Medicare. We reviewed the hospitalization and major medical claims paid over a one-year period by the Empire Plan to people aged 65 or older and estimated that about $3.4 million of these claims should have been paid by Medicare. We recommend that these payments be recovered from Medicare. We also recommend that improvements be made in the Empire Plan's procedures for identifying enrollees who are eligible for Medicare.

For a complete copy of 95-S-92 click here.
For a copy of the associated follow-up report click here.
For a copy of the 90-day response click here.