Since Jan. 1, 2012, all Medicare-eligible retirees enrolled in the School Employees’ Health Benefits Program (SEHBP) are automatically enrolled in the state-selected Medicare prescription plan, which is currently OptumRx. This program includes the Medicare-eligible retiree to be enrolled automatically in Medicare Part D. 

While there is no standard Medicare Part D cost associated with the program, enrollees whose incomes exceed the legislated threshold amounts—$88,001 in 2019 for a beneficiary filing an individual income tax return or married and filing a separate return, and $176,001 for a beneficiary filing a joint tax return—will pay a monthly, income-related payment. Please see the chart below for specifics.

The Social Security Administration uses the income reported two years ago to determine the Part D beneficiary’s payment. In other words, the income reported on a beneficiary’s 2019 tax return is used to determine whether the beneficiary must pay a monthly, income-related payment in 2021. Beneficiaries whose incomes decreased significantly in the past two years may request that the information from more recent years be used to calculate the payment.

For those members receiving post-retirement medical benefits paid for by the state of New Jersey, the monthly, income-related payment for both them and their dependents is reimbursed at the end of the year in which the payment is paid, only after the proper paperwork is filed with the New Jersey Division of Pensions and Benefits. Notice on how to file for any income-related adjustment reimbursement is sent to retirees, as well as will be posted on the Division of Pensions and Benefits website by early February.

If you have questions about your Medicare Part D monthly income-related payment, call 800-MEDICARE (800-633-4227). Any questions regarding the reimbursement process should be directed to the New Jersey Division of Pensions and Benefits at 609-292-7524.

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