NYC Medicare Advantage Plus Plan
The NYC Medicare Advantage Plus Plan (PPO) includes many health resources and benefits that Original Medicare does not offer, like:
• Flu and pneumonia vaccines, and most health screenings
• Inpatient hospital care and ambulance services
• Emergency and urgent care
• Skilled nursing facility benefits
• Complex radiology services and radiation therapy
• Diagnostic procedures and testing services received in doctor’s office
• Lab services and outpatient X-rays
• Home health agency care
• Routine hearing exams and hearing aid coverage
• Outpatient surgery and rehabilitation
• Non-emergency transportation
• Diabetes services and supplies
• Healthy meals
• Healthy pantry
• Durable medical equipment and related supplies
• Prosthetic devices
• Wearable health and fitness tracker
• 24/7 NurseLine
• SilverSnakers fitness program
• Medicare Community Resource Support
• Doctors available anytime, anywhere with LiveHealth Online
• Foreign travel emergency and urgently needed services
What is the new NYC Medicare Advantage Plus Plan ("The Plan")?
A unique, customized Medicare Advantage plan to provide better benefits for NYC retirees at lower costs. District Council 37 played a major role in crafting this plan and believes it is better than what was previously offered.
When does the NYC Medicare Advantage Plus Plan go into effect? January 1, 2022.
How does The Plan work?
The Plan replaces both traditional Medicare and a Medicare Supplement plan with a single, integrated program administered by a Medicare-approved insurer. The Plan provides all health care services previously covered by Medicare and supplemented by the Senior Care plan. It adds important new benefits not covered by the current Senior Care plan, including: • Transportation costs for 24 one-way trips per year to doctors’ offices; • Home meal delivery for patients after being discharged from the hospital; • A fitness program & wellness rewards program; • $0 copay telemedicine with LiveHealth platform.
Is The Plan still premium-free? Yes. Yes. The NYC Medicare Advantage Plus Plan replaces the current GHI/EBCBS and DC 37 Med Team Senior Care program, which is a supplement to traditional Medicare, so the new Plan remains premium-free to all Medicare-eligible retirees.
All other retiree health care plans remain available as premium-share options. Retirees who choose not to go into the Medicare Advantage Plus Plan will have to pay the additional premium difference.
Can I go to my current doctors and hospitals?
Yes. Retirees can go to any doctor or hospital that accepts Medicare. Providers not contracted with The Plan will bill The Plan for reimbursements. It does not make a difference if a provider is in the insurer’s network. As long as the provider takes payment from Medicare, they may bill the NYC Medicare Advantage Plus Plan and be paid the same amount as Medicare. This includes all hospitals in the NYC area, including Memorial Sloan-Kettering (MSK) and The Hospital for Special Surgery (HSS), almost all hospitals nationally, and 99.5% of all doctors.
What if the provider I see does not agree to accept payment from The Plan?
In the rare instance where a provider accepts Medicare and tells a retiree he will not accept payment from The Plan, the retiree must first contact The Plan’s concierge service. The Plan will make sure the provider understands it is the same payment schedule and billing protocol and answer other questions. If the provider still refuses, the member can pay the provider and then submit claims to The Plan for reimbursement. As long as the service is a Medicare-covered benefit and the Medicare fee schedule is followed, the member is only responsible for copays/co-insurance as defined by The Plan.
Who will provide the NYC Medicare Advantage Plus Plan?
An alliance between Empire BlueCross BlueShield and EmblemHealth will provide the program.
What do I have to do?
If you are covered by a City retiree health plan, you will be automatically enrolled on January 1, 2022. However, you must be enrolled in Medicare Part A and Medicare Part B and continue to pay your Medicare Part B premiums.
Can I choose another plan or is the NYC Medicare Advantage Plus Plan my only choice?
You may choose to remain in your current plan by “opting out” of the NYC Medicare Advantage Plus Plan before Nov. 1, 2021. By opting out, you will be responsible for the premium share difference between the NYC Medicare Advantage Plus Plan and your selected plan’s cost. If you opt out, you will receive a confirmation letter after November 1.
Will this year be the only time I can opt in or out?
No. Every fall you will have the option to make changes to your coverage just like you do with the current system.
Will my co-pays remain the same?
The NYC Medicare Advantage Plus Plan will have $0 copays for primary care physician visits. Effective January 1, 2022, there will be $15 copays implemented for the Senior Care Plan, including primary care physician and specialist visits, and diagnostic tests, among other new copays.
Will the City reimburse my Medicare Part B premium?
Yes. The current reimbursement process for Medicare Part B premiums will continue.
In the Medicare Advantage Plus Plan, do I need a referral to see a specialist? No.
Do any services require preauthorization?
es, some medical procedures do require preauthorization. When you see an in-network provider, the doctor and the insurer will handle the preauthorization. When seeing out-of-network doctors, while prior authorizations are not required, we recommend you ask your provider to request a prior authorization to confirm that the services they are providing will be considered medically necessary and covered.
What if I live out of state?
The NYC Medicare Advantage Plus Plan includes a national network of doctors and hospitals. It covers retirees in any state in which they work or reside and when they travel. To be eligible, members must live within the 50 states or any U.S. territory, including Puerto Rico.
Will this new NYC Medicare Advantage Plus Plan impact or change my DC 37 Health & Security Plan prescription drug benefit?
No. Your DC 37 Health & Security Plan prescription drug benefit plan remains the same and will not be impacted by this new Plan. Since you receive your retiree prescription drug coverage through the DC 37 Health & Security Plan (Aetna/SilverScript), there is no need to purchase the Medicare Part D prescription drug rider through The Plan.
What if the retiree or spouse/legal partner is under 65?
The retiree and spouse must choose an insurer that offers an over 65 option and an under 65 option. The over 65 members will be automatically enrolled in The Plan and the under-65 members in the Empire GHI/CBP plan, both at no cost to the retiree. For example, if the retiree chooses to pay monthly to remain in the HIP VIP plan, the under 65 spouse or legal partner will be enrolled in the HIP HMO for non-Medicare eligible participants at no cost. If the retiree chooses to pay monthly to remain in another plan, the under-65 spouse will pay up to remain with the same insurer.
If I have surgery scheduled for Jan. 3, 2022, with my current carrier, what should I do?
The Plan’s clinical transition team will work with you and your doctor to ensure continuity of care.
What happens if I go to the hospital in December and I’m not discharged until January?
The insurer that was in place at the time of the inpatient admission will be responsible for the entire inpatient stay.
Where can I call for more information about the NYC Medicare Advantage Plus Plan?
We have established a special call center for the NYC Medicare Advantage Plus Plan to answer all of your questions — 1.833.325.1190. Hours of operation are Monday-Friday, 8 a.m. to 9 p.m. EST, except holidays. You should have received extensive materials explaining the plan and the enrollment process. If you have not, please call 1.833.325.1190.
For more about the NYC Medicare Advantage Plus Plan, visit: on.nyc.gov/2XdyVkH