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NYC Medicare Advantage Plus Plan update

New York Teacher
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Editor’s Note: After the New York Teacher went to press on Dec.13, a New York State judge issued his long-awaited ruling on the NYC Medicare Advantage Plus Plan. The new plan will not take effect until April 1, 2022, to ensure that members and health care providers have enough time to be made aware of the plan, how it works and all it has to offer. The UFT pressed for city retirees to have more flexibility in decision-making, and the judge granted that request. The opt-out period for the plan’s April 1 start date will end on March 31, 2022, but there will be a continuing opt-in and opt-out period through June 30, 2022.


Under the supervision of a state court judge, the city and the health care administrators of the NYC Medicare Advantage Plus Plan have been working hard to improve the flow of information to Medicare-eligible city retirees and medical providers about the new plan’s procedures and benefits.

Since the judge had not yet issued his order by Dec. 13, the NYC Medicare Advantage Plus Plan will not take effect in January as originally planned.

Due to the ongoing litigation, the UFT strongly voiced its opinion — and the judge agreed — that the New York City Medicare Advantage Plus Plan should not take effect until an orderly transition and continuity of services for retirees can be guaranteed.

The latest updates:

No multiple deductibles: Any payment toward deductibles that city retirees make in January while in their current plan will count toward the annual deductible in the new NYC Medicare Advantage Plus Plan once it takes effect.

The opt-out period continues: Retirees may opt out of the new plan or opt back into it at any time.

Retirees will be able to try out the new plan: The UFT pressed for and obtain assurance that retirees will be able to opt in or out of the NYC Medicare Advantage Plus Plan in the first part of 2022 after it takes effect. No one will be locked into a choice for a full year.

All Medicare-eligible municipal retirees will remain in their current health plans until a start date is set for the new plan. No rate increases will go into effect for GHI Senior Care until the NYC Medicare Advantage Plus Plan is in operation, but the new GHI Senior Care doctor copay of $15, which is not associated with the new plan, will take effect on Jan. 1 (that increase was postponed from Jan. 1, 2021).

All supplemental health care coverage will also remain unchanged.

Key elements of the new plan:

No premium: Because the NYC Medicare Advantage Plus Plan is part of the government’s Medicare Part C program, it will not charge a monthly premium. There is a $125 monthly charge for the drug benefit rider.

Not your typical Medicare Advantage plan: The Medicare Advantage Plus Plan is a totally new large-group Preferred Provider Organization (PPO) provided exclusively to retired city employees by Empire BlueCross BlueShield and EmblemHealth. Access to all doctors who accept Medicare: If your doctors accept Medicare, you will be able to see them through the new plan, which represents about 850,000 providers nationwide. It doesn’t matter if the doctor is in network or out of network — the copayment is the same for you.

A cap on out-of-pocket costs: The NYC Medicare Advantage Plus Plan has a cap on most covered out-of-pocket expenses of $1,470 a year. All other plans, including GHI Senior Care, have no annual out-of-pocket maximum.

Almost all hospitals are in network: All New York City hospitals, except for Maimonides (contract pending), are in the plan. All New Jersey hospitals and 90% of Florida hospitals are in network, too.

No prior authorizations in an emergency: Prior authorization is required only for certain procedures, but not in emergency situations.

If you are unsure whether your doctor is part of the NYC Medicare Advantage Plus Plan, speak to the doctor’s billing department or the office that handles insurance. Ask if the doctor participates in the Empire Blue or Emblem Medicare networks. If the answer is yes, then the doctor accepts NYC Medicare Advantage Plus.