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An overview of the proposed Aetna plan

Retired Teachers Chapter News

The following email was sent on Thursday, March 2, 2023 to all members of the Retired Teachers Chapter from UFT President Michael Mulgrew and Retired Teachers Chapter Leader Tom Murphy. 

It has been a long road of intense, hard-fought negotiations. We have said from the beginning that any new premium-free health plan must be as good as or better than GHI Senior Care, and this has helped us at the negotiating table ensure that the plan would be customized to address what our members need. With those criteria and parameters in place, today Aetna gave the city and the Municipal Labor Committee (MLC) a comprehensive overview of its proposed new premium-free plan for all Medicare-eligible New York City retirees.

Our commitment to you includes keeping track of every aspect of the plan going forward and making adjustments and improvements as needed. In our negotiations with the company, we insisted on a strong accountability system that establishes guardrails to ensure Aetna fulfills all of its commitments. We were able to secure systems for monitoring and evaluating Aetna’s performance, and we also developed procedures for addressing member concerns. We are committed to ensuring our members continue to get the services they need and deserve.

We are aware of and monitoring ongoing lawsuits on health care, but our responsibility to our members was to negotiate a customized plan that would fully meet their needs since the city was continuing to move forward with a Medicare Advantage plan. The 100-plus unions in the MLC will vote on the proposed plan next week. If the plan is approved, it is scheduled to take effect on Sept. 1, 2023.

Keeping your doctors

The proposed plan is a Preferred Provider Organization (PPO) plan built specifically to give members maximum choice when it comes to selecting their health care providers. Our retirees will have access to Aetna’s network of more than 1.2 million providers and 4,900 hospitals nationwide. Most importantly, this proposed plan allows you to continue to see the doctors you know and trust. 

At this moment, we know that 96% of doctors who take GHI Senior Care are already either in Aetna’s network or accept payment from Aetna. Even if the doctor or the hospital you use is not in Aetna’s network, because this is a PPO plan any doctor or hospital you use that accepts Medicare will be reimbursed at the Medicare allowable rate, just like they are today, if they bill Aetna directly. You will pay the same cost, in or out of the network, and referrals are not required to see a specialist. Both Memorial Sloan Kettering and the Hospital for Special Surgery are in Aetna’s hospital network.

If we move forward, Aetna plans to take the time leading up to the plan’s start date to work with the remaining health care providers to get them to join or set up billing with Aetna so that there is no confusion come September. 

Prior authorization

We heard you loud and clear about your concerns about prior authorization. The MLC fought hard on this issue and ultimately Aetna agreed to significantly reduce the number of services requiring prior authorizations with this new plan. Services not requiring prior authorization include MRIs, CT scans, PET scans, sleep study, radiation therapy, pain management and diagnostic cardiology. Emergency services will never require prior authorizations.

Only a limited list of services requiring prior authorization remain, such as acute long-term care, acute hospital inpatient care (not ER), acute physical rehabilitation, admission to a skilled nursing facility and home care services. 

More information will be provided shortly in a subsequent email.

New benefits

This new plan provides more services than GHI Senior Care was able to offer us and at less cost to you. Here are highlights of the plan benefits:

  • A lower annual deductible than GHI Senior Care (waived in 2023).
  • An annual out-of-pocket maximum — the most you have to pay for covered services (including deductibles and copays but not prescription drugs) — of $1,500. Once you reach that maximum, you will not have any more out-of-pocket costs for the year.
  • No copays for many common services including primary care visits, radiation therapy, ambulances, durable medical equipment and Medicare Part B generic drugs.
  • No copays for routine hearing and vision exams
  • New services at no cost including:
    • Hearing aid reimbursement
    • Transportation to doctor's appointments
    • Delivered meals post-hospital stay
    • An over-the-counter allowance for wellness products

See the comparison chart

No disruption in your care or medication supply

Aetna has committed to us that there will be no interruption in your ongoing or complex care that goes beyond September 2023.

Aetna will also ensure a seamless transition from ExpressScripts to its Medicare Rx administered by SilverScript. Members currently enrolled in GHI Senior Care will be enrolled in the Aetna plan on Sept. 1, 2023, but the switch to Aetna's prescription drug plan will not take place until Jan. 1, 2024. Members in other city plans will completely transition on Sept. 1, 2023.

Aetna also has a dedicated hotline ready to assist with any questions you may have. You will be able to go to your own pharmacy, set up mail-order deliveries or go to one of Aetna’s 65,000 participating retail pharmacies, including CVS, Walgreens, Duane Reade, Rite Aid, Shoprite and many independent pharmacies.