The Municipal Labor Committee (MLC) and the city have been working to negotiate a
unique custom-made large group Medicare Advantage plan that would provide the
same — or ideally increase — member benefits currently covered by the GHI Senior
Care plan. The NYC Medicare Advantage Plus Plan is a result of the work done by the
Your Rights Your Benefits Your Union MLC. The MLC met all its goals by maintaining all of retirees' current, premium-free benefits while adding additional enhancements.
What is the start date for the NYC Medicare Advantage Plus Plan to take effect?
The start date is Jan. 1, 2022.
How does the new plan work?
The NYC Medicare Advantage Plus Plan replaces both traditional Medicare and a
Medicare Supplement plan with a single integrated program administered by an
insurer approved by Medicare. Through a contract with Medicare, the NYC Medicare
Advantage Plus Plan provides all health care services previously covered by original
Medicare and supplemented by the Senior Care program. The Plan must follow
Medicare rules and provides all benefits provided by Medicare.
What new enhancements does this plan have?
This program has a new annual out-of-pocket maximum of $1,470 that will protect
members from catastrophic claims (prescription drug and diagnostic copayments
are not part of this maximum out-of-pocket).
How does the prescription drug benefit differ from GHI Senior Care?
In this new plan, prescription benefits offered through the optional drug rider are
the same but with a lower monthly cost. There is no change in the drug
formulary or copayment structure.
Will I be able to continue seeing my doctors and visiting the same hospitals?
Yes. The NYC Medicare Advantage Plus Plan is a Group Medicare PPO that does
not restrict access to providers. This program will provide access to all doctors that
take Medicare coverage, approximately 850,000 providers nationwide. About
640,000 Medicare providers are currently in the Empire/Emblem Alliance
networks and are contractually bound to see NYC Medicare Advantage Plus
members. Providers that are not contracted with the plan would bill the NYC
Medicare Advantage Plus Plan to get reimbursed, as they do for traditional
Medicare. It doesn't make a difference if that provider is in the insurer's network or
not. As long as the provider takes payment from Medicare, they can bill the NYC
Medicare Advantage Plus Plan and be paid the same amount as traditional Medicare
pays. Only providers who opt-out of the whole Medicare program would not be
covered. This includes all the hospitals in the NYC area, almost all hospitals
nationally, and 99.5% of all doctors.
How will I be enrolled in the new plan? What do I have to do?
If you are a retiree covered by a city Medicare health plan, you will be automatically
enrolled in the new plan for Jan. 1, 2022. You don't need to do anything. However,
you must be enrolled in Medicare Part A and Medicare Part B and continue to pay
your Medicare Part B premiums.
Is the NYC Medicare Advantage Plus plan still premium-free?
Yes. The NYC Medicare Advantage Plus Plan replaces the current GHI/EBCBS Senior
Care program, which is a supplement to traditional Medicare, is the program that is
premium-free to all Medicare-eligible retirees. All other plans will still be available as
a pay-up option. Retirees that choose to stay on their current plan will now pay the
additional premium difference.
Are copayments increasing under this plan?
There will be new $15 copayments for seeing specialists, having diagnostic
procedures, and visiting urgent care facilities. The GHI Senior Care program will also
be adopting these new copayments effective Jan. 1, 2022. Note: The GHI Senior Care
program will be adopting a $15 primary care physician (PCP) copayment on Jan. 1,
2022; the new NYC Medicare Advantage Plus Plan will retain a $0 copayment to see a
primary care physician.
