FAQ: Proposed Medicare Advantage Plan

Frequently Asked Questions About the Proposed Medicare Advantage (MA) Plan. For a full list of questionnaire and reference chart, link here. Source: PCS CUNY

Q: Will all doctors accept the new Medicare Advantage Plan?
A: All physicians who accept Medicare must continue to accept Medicare B coverage under the MA plan.

Q: Will the other Medicare Advantage plans that are currently in force remain or will they be replaced by the new Medicare Advantage plan?
A: The City has not yet determined whether it will offer the Medicare Advantage as the only plan option or offer both a Medicare Advantage and the option to purchase GHI SeniorCare.

Q: Will there be two MA plan options?
A: The possibility of two plan options is slim because all of the vendors have said they cannot guarantee the savings if members are allowed to pick from a variety of health care plans.

Q: What is the cost to the City for the current health insurance program for retirees?
A: The approximate current medical and hospital projected savings for all New York City ‘s retired Medicare eligible participants and their spouses is approximately $500 to $600 million. We assume a Medicare Advantage plan will reduce the City’s spend materially through efficiencies and moving to a single program.

Q: Will the new MA plan be accepted anywhere in the US?
A: Yes, you are covered anywhere in the US or US territories as long as the urgent care physician and/or hospital accepts Medicare.

Q: I have GHI Emblem health for myself and my husband. My monthly cost is $2.00 for me and $2.25 for my husband. What will the monthly cost for the new MA plan be for me and for my husband?
A: The monthly cost you are referring to is the cost of the optional 365-day hospital rider. There is no cost for current GHI SeniorCare coverage. There will be no cost for any MA plan currently being considered. All plans will include the 365-day hospital coverage at no additional charge.

Q: My primary care physician does not accept Medicare. I am currently reimbursed according to Medicare rates but pay extra to see him. Will this remain the same or will I not be reimbursed according to the Medicare schedule?
A: If your primary care provider accepts Medicare but does not accept Medicare Assignment of Benefits (in which Medicare pays physicians directly), you will still be able to see the physician under the MA plans.

Q: Will the $50 deductible, no-copay feature still be available under the Medicare Advantage plan?
A: All of the plans being considered must meet the same coverage as the GHI SeniorCare Plan now offered. GHI SeniorCare currently has an annual deductible of $248 per participant, plus a $25 deductible for ambulance, durable medical equipment, and private duty nursing after the Medicare Part B deductible has been reached.

Q: My wife is under 65, is on the Affordable Care Act, and has supplemental coverage under my Empire Blue Cross plan. Will I know for sure whether she will be covered as well under the Medicare Advantage plan being proposed before I have to decide whether to join city’s Medicare Advantage plan?
A: Spouses over 65 are eligible for coverage under the proposed MA plans. Spouses and/or dependents under 65 will also be covered, but details are pending the selection of the vendor.

Q: If I choose to remain with traditional Medicare, do you have a ballpark figure on how much I would have to pay for me and my wife if I wanted to retain the supplemental plan I have now?
A: The option of purchasing the current GHI SeniorCare program has not yet been decided and will depend on which vendor is selected.

Q: What will the timing be for the transition from traditional Medicare to Medicare Advantage?
A: No vendor has been selected yet so the timing of the transition is still being decided.

Q: Can such a large-scale conversion occur by July 1?
A: At this point none of the bidders can meet a July 1, 2021, implementation.

Q: How can continuing participation by Medicare doctors and other providers in the new Advantage plans be demonstrated and assured?
A: The only requirement is that a doctor must be a participating Medicare provider. Currently 97% of all doctors accept Medicare patients.