Key plan details

What you need to know:
Key plan details of the Aetna Medicare Advantage PPO plan

What is the Aetna Medicare Advantage PPO Plan?

The Aetna Medicare Advantage PPO Plan is a premium-free health plan offered by the City of New York for Medicare-eligible city retirees. It replaces both traditional Medicare and a Medicare supplement plan with a single integrated program administered by Aetna. The plan must follow Medicare rules and provide all benefits provided by Medicare as well as supplementary benefits and services.

The Aetna Medicare Advantage plan is a Group Medicare PPO plan, with a robust nationwide network. Unlike an HMO plan or a traditional Medicare Advantage plan, the Aetna Medicare Advantage PPO Plan allows retirees to choose their own healthcare providers and continue to use the doctors and providers you have always seen. Retirees can go to any doctor, hospital, or facility that accepts Medicare.

As a Medicare Advantage plan, it unlocks access to important cost savings and federal subsidies that are essential to maintaining the strength and stability of the Aetna Medicare Advantage PPO plan going forward.

Retiree feedback helped shape the conversations at the bargaining table, and this new plan addresses those concerns head-on with a defined process to address member issues. We were able to secure a formal process to monitor and evaluate Aetna’s performance and promises. If and when we need to hold Aetna accountable, this new plan includes a series of benchmarks and guarantees.

What are the most important things to know about the Aetna Medicare Advantage PPO plan?

• Your plan will continue to be premium-free: Our top priority was not only to protect and preserve your robust health care benefit structure, but also ensure that they remained premium-free. Thanks to careful planning and aggressive negotiations, we were able to achieve that goal.
• You can continue to see your doctors: Under the Aetna Medicare Advantage PPO plan, you can still continue seeing your same doctors and providers. Over 96% of current GHI Senior Care providers already take Aetna – and Aetna is doing outreach to grow that number. Memorial Sloan Kettering and Hospital for Special Services signed contracts with Aetna and are in network. Even out of network, if your doctor accepts Medicare, they can accept the Aetna Medicare Advantage PPO plan. Further, if they accept Medicare but do not accept the Aetna Medicare Advantage PPO plan, we have a process in place that will allow you to still see that doctor.
• Most prior authorizations have been eliminated: One of our main priorities during these negotiations was to address concerns about prior authorizations and as a result, we were able to get the vast majority of prior authorizations removed.
• You won’t see a disruption in your prescription drugs: Aetna will provide guidance and have their care team ready to ensure a seamless transition from Express Scripts to Aetna Medicare Rx by SilverScript. Their focus is to avoid any disruptions in your medication supply. They also have a dedicated customer service department ready to assist with any questions.
• Strong accountability: Robust accountability measures were a central tenet in our negotiations. We were able to secure systems to monitor and evaluate every major aspect of the Aetna Medicare Advantage PPO plan going forward, with the ability to make adjustments and improvements as needed.

When will the Aetna Medicare Advantage PPO plan go into effect?

The Aetna Medicare Advantage PPO plan will go fully into effect on Sept. 1, 2023.

However, while members currently in GHI Senior Care with the Emblem prescription drug optional rider will be enrolled in the Aetna Medicare Advantage PPO as of Sept. 1, 2023 for their medical coverage, their prescription drug coverage will remain with GHI Senior Care’s drug rider until Jan. 1, 2024. On that date, Aetna’s Medicare Rx by SilverScript prescription drug program will go into effect and will begin providing coverage. 

If you are enrolled in any other plan through the City of New York and purchase the prescription drug rider through that plan, or you currently purchase and are enrolled in an individual prescription drug plan (Part D) in the open market, you will be enrolled into the prescription drug rider offered by Aetna Medicare Rx by SilverScript on Sept. 1, 2023. 

How can I learn more about the Aetna Medicare Advantage PPO plan?

Aetna has planned an extensive retiree education program that includes calling, mailing, and emailing every UFT retiree with information about the Aetna Medicare Advantage PPO plan. Aetna will have a team of clinicians to work directly with retirees during the onboarding process.

In addition, both in person and virtual meetings will be held to inform members about this new plan. In person meetings will be held throughout the New York Metro area in all five boroughs, Long Island, New Jersey and bordering suburbs in northern New York, Connecticut and Pennsylvania. Outside the New York area, meetings will be held in several Florida locations, and in the following states: Maryland, Virginia, North Carolina, South Carolina, Georgia, Texas, Arizona, Nevada and California.

Register for a virtual meeting about the Medicare Advantage PPO plan 
Register for an in-person meeting about the Medicare Advantage PPO plan

Your Aetna enrollment card will also include important phone numbers, including a 24-hour nurse hotline. Visit Aetna's website to learn more and view plan documents. 

How is the Aetna Medicare Advantage PPO plan different from a typical Medicare Part C/Medicare Advantage plan?

The city's retiree Aetna Medicare Advantage PPO plan is different from other Medicare Advantage plans offered in the individual market. As a member, you can access any Medicare provider who is willing to accept the Aetna Medicare Advantage PPO plan and you will always pay the in-network cost share. There are no penalties or higher cost shares if you see providers who are outside of the Aetna Medicare network. The plan also travels with you, so it provides coverage wherever you live throughout the country and in U.S. territories.

Are my doctors covered under the Aetna Medicare Advantage PPO plan?

If your doctor accepts Medicare, they will be paid under the Aetna Medicare Advantage PPO plan. Aetna’s nationwide network is robust, with over 1.2 million providers. 96% of doctors who take GHI Senior Care are either in network or accept payment from Aetna, and the company is doing outreach to those who aren’t. The Aetna Medicare Advantage PPO plan gives you the freedom to see any provider who participates in Medicare and accepts payment from Aetna, even if they are not part of the Aetna Medicare network. You will pay the same cost share, in or out of network.

As the plan 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.

Who is eligible for the Aetna Medicare Advantage PPO plan?

Retirees who are eligible for Medicare and their Medicare-eligible dependents. Eligibility must be determined by the city, that includes years of credited service and whether you are covered under another city employee as a dependent.

Do I need a referral to see a specialist?

No, referrals are not required. This plan is a Preferred Provider Organization (PPO) so you can go to any provider who participates in Medicare and accepts the Aetna Medicare Advantage PPO plan. A designated primary care doctor is not required but recommended.

Is there a limit on the number of doctor visits per year?

No.

What if I live outside the New York City area or out of state?

This PPO is a national plan. Aetna currently has over 1.2 million participating providers across the country and in U.S. territories, and is actively recruiting to grow their network further. You can use your benefits nationwide, whether you have different residences at different times of the year or while traveling domestically.

Will I have health care coverage internationally?

The Aetna Medicare Advantage PPO plan will cover urgent and emergency care while you are traveling outside the U.S. You will need to pay for the costs up front and then submit paid receipts to Aetna directly for reimbursement. Aetna reimburses providers at Medicare rates.

I live outside the United States. How will my health care coverage be handled?

City retirees who currently reside outside the United States will be enrolled in the GHI-CBP plan designed for in-service/pre-Medicare retirees. Since retirees living abroad are not eligible for Medicare and do not require Medicare Part B coverage, they will not receive reimbursement for Medicare Part B expenses..

Will the city still reimburse my Medicare Part B premium after I am enrolled in the Aetna Medicare Advantage PPO plan?

Yes, since Aetna Medicare Advantage PPO is a plan offered by the city.

Will the Welfare Fund still reimburse Medicare Part D costs?

Both the UFT Welfare Fund’s optional rider reimbursement and the Medicare Part D Catastrophic reimbursement remain unchanged.

How can I contact Aetna with questions?

Aetna has set up a call center specifically for NYC retirees: (855) 648-0389, 8 a.m. - 9 p.m. ET, Monday - Friday. At retiree onboarding meetings, Aetna representatives will be available to meet privately with members to answer questions and offer support.

How can I contact the UFT with questions?

If your question is not answered in our FAQ, check our Aetna Plan Info Hub. You can also call the UFT's designated Aetna Medicare Advantage PPO hotline at: (646) 878-9717 or reach out to us via email at: HealthBenefitHelp@uftwf.org

What if retirees have specific concerns or want to speak to someone personally?

Aetna representatives will attend retiree informational meetings to talk with members privately, answer their questions and address concerns. Aetna will have a team of clinicians to work directly with retirees during the onboarding process. Aetna will assign a personal case manager to all those currently receiving ongoing medical treatment and will tell members how to request a case management outreach.

If a member ever receives a bill beyond what their copay/cost share states, they should contact Aetna. Your Aetna enrollment card will include important phone numbers, including a 24-hour nurse hotline. This is generally used for more emergent health questions and concerns, such as assisting members by helping them find the most appropriate level of care for their condition.