City unions approve Aetna's new premium‑free plan
The Municipal Labor Committee, the umbrella organization representing 100-plus city labor unions, voted today to approve the new plan, which will be called the City of New York Aetna Medicare Advantage PPO plan. We said all along that any new premium-free health plan for Medicare-eligible city retirees must be as good as or better than GHI Senior Care. After months of intense, hard-fought negotiations with Aetna, we are proud to announce that the MLC achieved that goal with the creation of a fully customized Medicare Advantage plan that meets our retirees’ health care needs.
As it was just ratified, Aetna needs a few weeks to do its extensive outreach to doctors, including all those who take GHI Senior Care, to educate them about the new plan. Please wait until the end of March to call your doctor to ask if they take the plan.
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 establishing a strong system for monitoring Aetna’s performance and ensuring the company fulfills all of its commitments.
We understand that the idea of navigating a new health care plan can be daunting. We are here to support you during this transition.
When will the new plan take effect? What steps do you need to take?
The new plan is scheduled to take effect on Sept. 1, 2023. All Medicare-eligible city retirees and their eligible dependents, except those retirees enrolled in the HIP VIP Premier Medicare Plan, will be automatically enrolled in the Aetna Medicare Advantage PPO plan on Sept. 1, 2023. Before that date, you will continue to receive health care coverage from your current city health plan.
What about prescription drugs?
Aetna will also ensure a seamless transition from your current prescription plan to its Medicare Rx administered by SilverScript. If you have the Prescription Drug Rider through GHI Senior Care, you will continue with your prescription drug plan through Express Scripts until Dec. 31, 2023. You will switch to the Aetna Medicare Rx administered by SilverScript on Jan. 1, 2024.
If you are enrolled in any other plan through the City of New York and purchase the prescription drug rider through that plan, or if you currently purchase and are enrolled in an individual prescription drug plan (Part D) in the open market, you will make the transition to the SilverScript prescription plan on Sept. 1, 2023, at the same time you are enrolled in the new Aetna Medicare Advantage PPO plan.
Beginning on Sept. 1, 2023, the cost of the Aetna optional prescription drug rider will be $103.50 monthly. The cost of the rider increases to $135.50 in 2024.
Are there any other health care plans available to Medicare-eligible city retirees?
To continue receiving premium-free health care from the City of New York after Sept. 1, 2023, you must be in this new City of New York Aetna Medicare Advantage PPO plan or the HIP VIP Premier Medicare plan, which is available only to city retirees in the New York City metro area.
In his ruling in the Medicare Advantage litigation, Judge Lyle Frank interpreted the city’s current administrative code to require that any health plans the city offers retirees be premium-free, eliminating the option of pay-up plans. The UFT urged the City Council to amend the administrative code so that other health care plans like GHI Senior Care could continue to be available as pay-up plans, but the City Council did not amend the code.
Due to the high cost of providing GHI Senior Care as a premium-free option, the city has said it will no longer provide GHI Senior Care. The two remaining plans, Aetna Medicare Advantage PPO and HIP VIP Premier Medicare, are Medicare Advantage plans which have federal funding that allows the city to keep them as premium-free options.
Can I opt out of the Aetna plan?
If you do not want to be automatically enrolled in the City of New York Aetna Medicare Advantage PPO plan, you must opt out of the plan between May 1 and June 30, 2023. If you opt out of the Aetna plan, your only option to remain covered through the City of New York is to enroll in the HIP VIP Premier Medicare plan, which is available only to city retirees in the New York City metropolitan area.
Besides these two premium-free city health plans, your only other option is to opt out of City of New York health benefits to maintain traditional Medicare. If you opt out of the City of New York Health Benefits Program, your dependents will also lose their city health coverage and you will not be eligible for the city's annual Medicare Part B premium and/or IRMAA reimbursements (if applicable). If you go with traditional Medicare, you will be subject to Medicare deductibles and coinsurance, and if you wish to maintain prescription drug coverage, you will need to find a Medicare Part D drug plan. If you go this route, we strongly recommend you purchase a Medigap insurance plan to supplement traditional Medicare.
If you opt out or waive coverage but later change your mind, you will be eligible to enroll in either plan during the city’s annual retiree transfer period, which occurs every November. You can also enroll outside the transfer period if you have a qualifying event or use your once-in-a-lifetime option that the city offers.
More information about the Aetna plan
Between now and Sept. 1, Aetna and the city will be sending extensive information about the new plan and how it works to all Medicare-eligible retirees and their doctors. We have set up an information hub on the UFT website where you can find all the relevant information, too. Aetna will also be holding dozens of in-person and virtual informational sessions about the new plan across the country in the coming months. We strongly recommend that you attend one of those meetings.
Call Aetna’s dedicated phone number for New York City retirees at 855‑648‑0389, 8 a.m. – 9 p.m. ET, Monday–Friday
From the UFT:
Regularly check our Aetna plan info hub on the UFT website, where you can find up-to-date information and resources. Right now, you can read:
- What's covered under the new plan
- Eligibility for you and your dependents
- Checking to see if your doctors are in network and/or willing to bill Aetna (and making sure Aetna reaches out to them if they aren’t set up)
- Filing and appealing claims
- Prior authorization
- Prescription drugs
- Programs and services you might be eligible for