2022 medicare part b reimbursement differential request form

2019 Medicare Part B Reimbursement

We have been informed that the City of New York Health Benefits Program will distribute the 2019 Medicare Part B reimbursements by the end of April 2020.

Table of Contents Show

2019 Medicare Part B Reimbursement
2019 Medicare Part B Reimbursement Differential
MEDICARE PART B PREMIUM REIMBURSEMENT FOR 2021
How do I know if I am eligible for Part B reimbursement?
What document do I need to submit to receive my correct Part B reimbursement amount?
My spouse (non-LAFPP member) is currently enrolled in Medicare Parts A and B. Does he/she need to submit Medicare Part B premium documentation?
I received a letter stating that I pay a higher Part B premium based on my income level (Income-Related Monthly Adjustment Amount – “IRMAA”). May I submit this letter as proof of my Part B premium?
I receive a monthly Social Security payment, but I did not receive / cannot locate my “New Benefit Amount” Statement from Social Security. What should I do?
When do I need to provide LAFPP documentation of my Part B Premium?
Contact Information

Eligible recipients are as follows:

Retirees and/or their eligible dependent, with a Medicare Part B effective date between 2016 and 2019, will be reimbursed at the rate of $135.50 per month ($1,626 annual total.)

Retirees and/or their eligible dependent, with a Medicare Part B effective date prior to 2016, will be reimbursed at the rate of $109.00 per month ($1,308 annual total.)

2019 Medicare Part B Reimbursement Differential

As you may know, you and/or your dependent may be eligible for an additional reimbursement of up to $300, known as the “Reimbursement Differential”, if you and/or your dependent meet any of the following criteria:

Your Medicare Part B, and/or your dependent’s Medicare Part B, effective date is prior to 2016 and you and/or your dependent’s 2019 monthly Medicare Part B premium was between $110.00 and $135.50.
You and/or your dependent did not receive Social Security benefits and were billed directly for Medicare Part B premiums.
You and/or your dependent were newly enrolled in Medicare Part B in 2019 and did not receive the higher reimbursement because you and/or your dependent is a member of TIAA (CUNY), Brooklyn Public Library, Queens Public Library or are a Line of Duty Survivor.

Please note, if you have applied, or intend to apply for IRMAA reimbursement for 2019, you should not submit for the “Reimbursement Differential”, as we are informed that the additional differential payment will automatically be issued to you, separate from your IRMAA payment.

Download a copy of the 2019 Medicare Part B Reimbursement Differential Request Form. Please review it carefully. If you believe you and/or your dependent may be eligible for the reimbursement differential, please complete and return the form according to the instructions provided.

MEDICARE PART B PREMIUM REIMBURSEMENT FOR 2021

SPECIAL NOTICE: This article only applies to retired members of the Los Angeles Fire & Police Pension Plan

The Centers for Medicare and Medicaid Services (CMS) has increased the standard Medicare Part B monthly premium to $148.50 effective January 1, 2021; however, you may pay a different amount determined by CMS.

If you are a new Medicare Part B enrollee in 2021, you will be reimbursed the standard monthly premium of $148.50 and do not need to provide additional documentation.
If you received a Medicare Part B reimbursement of $144.60 on your pension check in 2020, you do not need to provide documentation and your Part B reimbursement will automatically increase to $148.50 for 2021.
If you received less than a $144.60 Medicare Part B reimbursement on your pension check in 2020, LAFPP will notify you by email or mail with instructions on how to update your Part B premium amount on record.

To update your Part B reimbursement for the 2021 calendar year, please submit a copy of your:

Social Security New Benefit Amount statement for 2021; or
Next Medicare monthly or quarterly billing statement (if you do not receive Social Security benefits)

To update your Part B reimbursement for premiums paid during the 2020 calendar year, please submit a copy of your:

Social Security Form 1099 for 2020; or
First Medicare monthly or quarterly billing statement for 2020

Please send all documents to LAFPP’s Medical and Dental Benefits Section via:

Email to: ;
Fax to: (213) 628-7782; or
Mail to: Department of Fire and Police Pensions, Attn: Medical & Dental Benefits, 701 E. 3rd Street, Suite 200, Los Angeles, CA 90013

Due to the anticipated high volume of submissions, it may take at least three months to process your Part B documentation and update your reimbursement amount on your LAFPP pension payment.

As a reminder, Part B reimbursement only applies to Retirees or Qualified Survivors who are eligible for an LAFPP health subsidy and are enrolled in both Medicare Parts A and B. Any additional Part B penalties or fees charged by CMS are not eligible for reimbursement.

Frequently Asked Questions

How do I know if I am eligible for Part B reimbursement?

You must be a retired member or qualified survivor who is receiving a pension and is eligible for a health subsidy, and enrolled in both Medicare Parts A and B.

What document do I need to submit to receive my correct Part B reimbursement amount?

You must submit a copy of your Social Security benefits verification statement (your “New Benefit Amount”) or a copy of a 2021 Centers for Medicare and Medicaid Services (CMS) billing statement.

My spouse (non-LAFPP member) is currently enrolled in Medicare Parts A and B. Does he/she need to submit Medicare Part B premium documentation?

No. Only the retired member or Qualified Survivor enrolled in Parts A and B is eligible for Medicare Part B premium reimbursement.

Yes. You may submit a copy of the first page of your IRMAA letter if it contains your name, address and 2021 monthly Medicare Part B premium deduction. LAFPP does not reimburse IRMAA fees, so your Part B reimbursement will not exceed the 2021 standard monthly premium of $148.50.

You may call or visit your local Social Security Administration (SSA) office. You may also access proof of your 2021 Medicare Part B basic premium online at the SSA website: www.ssa.gov/myaccount. You may be required to create or register your SSA account. Please note that once you have an online account, your SSA notifications will be emailed to you.

When do I need to provide LAFPP documentation of my Part B Premium?

You may submit your documentation at any time during 2021 and receive a retroactive reimbursement for up to twelve (12) pension roll months from the date your submission is received.

Contact Information

If you have additional questions about your Medicare Part B reimbursement, please contact the Medical and Dental Benefits Section at (213) 279-3115, toll free at (844) 88-LAFPP ext. 93115, or via email to .