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NYC Medicare Advantage Plus Plan highlights

New York Teacher

More than 7,500 UFT retirees joined a webinar presentation on the NYC Medicare Advantage Plus Plan on Oct. 1. The presentation, organized by the Retired Teachers Chapter, was a refresher for some, an introduction for others and a chance for questions to be answered.

Kim Parker of Empire BlueCross/BlueShield and the account executive for the New York City Medicare Advantage Plus Plan, went over the details of the new plan into which all Medicare-eligible city retirees will be automatically enrolled on Jan. 1, 2022. The opt-out period ended on Oct. 31, but those who missed the deadline can choose to opt out next fall (effective Jan. 1, 2023). Parker announced during the webinar that Memorial Sloan Kettering Cancer Center has confirmed its participation in the plan.

Here are some other highlights:

Do not confuse the NYC Medicare Advantage Plus Plan with Medicare Advantage.

Medicare Advantage is available to any individual. The NYC Medicare Advantage Plus Plan is a customized PPO (Preferred Provider Organization) administered jointly by Empire BlueCross BlueShield and EmblemHealth. It is only available to retired New York City employees and is a premium-free plan.

Which health care providers are in the plan?

The plan will provide access to all medical providers who take Medicare coverage, about 850,000 providers nationwide.

Is prior authorization needed?

Some medical procedures will require preauthorization — similar to what is required for in-service city employees. When you see an in-network provider, the doctor and the insurer will handle the preauthorization. When you see an out-of-network doctor, a preauthorization is not formally required, but you should ask your provider to request preauthorization to confirm the services they are providing will be considered medically necessary and eligible for coverage under the plan.

Does the prescription plan change?

In the new plan, prescription benefits are the same as those in the GHI Senior Care program, but at a lower monthly cost. There is no change in the drug formulary or copayment structure.

Is there out-of-state access?

The plan is a national program that covers New York City retirees who live in any of the 50 states or a U.S. territory, including Puerto Rico.

Free benefits of the NYC Medicare Advantage Plus Plan:

  • An annual wellness visit when you see a doctor who accepts Medicare.
  • LiveHealth Online, which allows you to visit with a doctor, therapist or psychologist through live video on your smartphone, tablet or computer with a webcam.
  • A 24/7 NurseLine that puts you in touch with a registered nurse any time of the day or night.
  • Aspire Health, a community-based program providing support by a team of doctors, nurse practitioners, nurses and social workers to patients facing serious illness and their families.
  • SilverSneakers membership to thousands of participating gym and fitness center locations, plus online videos for at-home workouts.

For more information on the new plan, see the Medicare Advantage Plus FAQ and these updates.