Skip to main content
Full Menu

Answers to concerns about the NYC Medicare Advantage Plus program for retirees

I’ve done my own research on Medicare Advantage and read bad things online about it. Haven’t there been problems with Medicare Advantage plans?

Absolutely. Other individual Medicare Advantage plans have restrictions and leave subscribers with fewer medical options and/or higher costs. While the custom NYC Medicare Advantage Plus Plan bears the same (unfortunate) name, it is designed to eliminate the problems people have experienced with individual Medicare Advantage plans.

A major point of confusion for both our members and their medical providers is the new plan’s name.This plan is nothing like traditional Medicare Advantage plans. This is a custom, large-group version of Medicare Advantage developed for New York City municipal employees ONLY. By using the legal term “Medicare Advantage,” we are able to tap into federal funds that we weren’t eligible for before, which is important because we reduce city health care costs without any reduction in care.

We modeled this custom plan after GHI/Empire Senior Care. The new plan is filled with features that make it the same or better than current GHI/Empire Senior Care. The plan has been created to give you the best care possible and keep you happy and healthy! If retirees are unhappy, the plan's rating will be affected and the plan will be hit with monetary penalties. Nothing like this plan has ever existed before, so anything you read online about other Medicare Advantage plans doesn’t apply.

I called my doctors, and they said they had never heard of this plan so they can’t tell me if they will accept it.

We can’t stress enough: You can continue seeing your current doctors as long as they accept Medicare. 

If your doctor accepts Medicare you can continue to see them, and the doctor will be able to receive 100 percent of the standard Medicare payment for the services the doctor provides. 

Because the plan is brand-new, providers are still being educated about the way it works. Many are not aware that it’s a plan that will make sure providers receive the full Medicare payment for their services. This lack of awareness about the new plan will decrease as more providers become informed about the program. If you want, you can give your doctors this Provider Brochure, which shows them how they will be paid. 

How can I check if my doctor is in the plan’s network?

Ninety percent of doctors who accept Medicare are considered “in network” under the new plan, but what’s unique about this new plan is that a doctor doesn’t have to be “in network” for the doctor to receive the full amount of standard Medicare payments. As long as your doctor accepts Medicare, the doctor will get paid 100 percent of the Medicare rate. So you can keep seeing your current doctors.

The Provider Brochure clearly explains to any medical providers who still need assistance how the process for filing claims works to get their full payment for the services they provide you.  

A special website exists where you can search for your current doctor to see if they are in network, but remember, you can see your current doctors whether or not they are in network and they’ll be paid in full by the plan. 

How can I see the differences between GHI/ Empire Senior Care and NYC Medicare Advantage Plus plans?

Look at this side-by-side comparison chart of the GHI/Empire Senior Care plan and the NYC Medicare Advantage Plus plan. You will notice the benefits and copays of this new plan are similar to or better than GHI/Empire Senior Care. (Please note, as the chart indicates, GHI/Empire Senior Care is increasing its rates as of January 2022.)

I need prior authorization for procedures under the new plan. Does this mean I will have to wait for procedures?

The need for prior authorization is indeed a change in the new plan. But prior authorization will be quick because the Center for Medicare/Medicaid Services has very strict timelines that medical providers must adhere to. 

The GHI/Emblem plan for in-service members requires prior authorization, and our in-service members have not had difficulty getting the care they need quickly and easily. 

Also, prior authorization will not be required in emergency situations. 

I had a good thing going. I liked my current health care. Why would you change it? 

Here’s why this change needed to happen: The city’s health care costs have increased dramatically, from $5 billion to $11 billion, over the past decade. This burst in cost meant that municipal retirees would soon be looking at additional out-of-pocket costs and eventually health care premiums that, once in place, will only grow.  We knew we had to do something to ensure we stay premium free for at least the next five years, so we leveraged our bargaining power and got the custom plan we wanted.

I have heard that the city made this change to pay for raises for in-service members. Is that true?

There is no truth to that statement. All the savings from the NYC Medicare Advantage Plus plan will be earmarked for the city’s Health Care Stabilization Fund and will go to support health care services for all our members and continuing protection against rising health care prices. 

I still feel uncomfortable about changing my health plan. 

You can try out the new plan for a year and if you’re dissatisfied, you have the right during the open-transfer period in the fall of 2022 to opt to return to your prior health care plan starting Jan. 1, 2023. 

You will still have the option to opt out and we will let you know the new deadline as soon as we are made aware. If you decide to stick with your current health care plan, you will be responsible for the full premium difference between the NYC Medicare Advantage Plus plan and your plan’s cost.

Anyone who has already opted out and changes their mind or would like more time to make the decision should call the NYC Medicare Advantage Plus plan at 833-325-1190. Retirees can rescind their opt-out over the phone.

Where can I call for more information about the NYC Medicare Advantage Plus Plan? 

There is a special number (833-325-1190) established for the NYC Medicare Advantage Plus Plan to answer all your questions. You can call Mondays through Fridays, 8 a.m. to 9 p.m. Eastern Standard Time, except holidays.

Also check out all the information about the new plan in the Retired Teachers Chapter section of the UFT website.