July 29, 2021
Commissioner Renee Campion
Office of Labor Relations
22 Cortland Street
New York, NY 10007
Re: FAQ’s About the NYC Medicare Advantage Plus Plan
Dear Commissioner Campion:
Thank you for posting the updated Frequently Asked Questions About the NYC Medicare Advantage Plus Plan on the OLR website on July 26, 2021. MEA posted the information onto our website and across our social media platforms. Several retirees have sent us questions that we are unable to answer without your written responses.
Please let us know your answers to the following questions:
- How much will it cost for me to remain in GHI/Empire Senior Care? HIP/VIP?
- How much will it cost for both my spouse and me to remain in GHI/Empire Senior Care? HIP/VIP?
- If I remain in Medicare/GHI Senior Care or HIP/VIP, will I remain eligible for both Medicare Part B Reimbursement and IRMAA?
- If I remain in Medicare/GHI Senior Care or HIP/VIP, will I remain eligible for all current Management Benefits Fund programs?
- If I remain in Medicare/GHI Senior Care or HIP/VIP, how much will my Medicare Part D cost? If I transfer to the NYC MAP plan, how much will my Medicare Part D cost?
- With the conversion from Medicare / GHI Senior Care or NHIP/VIP to the NYC Medicare Advantage Plus Plan, how will special approved Non-Formulary Prescription Drugs be treated for Part D? Will the co-payments be the same as the existing co-payments or reduced? Will Emblem Health honor their current approvals for these medicines or will these prescriptions require new approvals by Emblem Health?
- Can you provide more detailed information comparing the Part D Prescription Drug Rider under both plans?
- If I accept the new NYC Medicare Advantage Plus plan what changes, if any, will happen to my current Management Benefits Fund (MBF) coverage.
- How often can I transfer from Medicare/GHI senior care to the NYC MAP plan? How often can I transfer back from the NYC MAP plan to Medicare/GHI Senior Care or HIP/VIP?
- If the member pays the doctor the amount s/he is billing and the member submits it to the NYC MAP, the plan may only reimburse the Medicare rate, would I therefore have to pay the difference? If so, this is a prime example of balance billing which should not occur.
- I can use my Medicare/GHI Senior care outside of the United States; will I be able to use the NYC MAP plan outside of the US?
- How will members without computers be able to navigate NYC MAP?
- What is the procedure to opt out between September 1 – October 15?
- How will NYC MAP inform the providers outside the NYC area but within the 50 states, District of Columbia, or any US territory (including Puerto Rico) prior to January 1, 2022, of the new plan to ensure the doctors and hospitals will accept payment directly or indirectly and to encourage their participation?
- Can I access the data base of the 640,000 participating providers so I can determine if my providers are participating? Are participating providers the same as in-network providers?
- Are there other nationwide Group Medicare PPOs that exist so we can review their performance?
- Please provide more details on LiveHealth.
We look forward to the in-person meetings and webinars in September and remain available to facilitate meetings with the MEA Retirees Chapter during that period.
For further information and clarification, please contact our MEA Executive Director Alice Wong at info@nycmea.org or 212.964.0035.
Thank you for your prompt response and stay well.
Sincerely,
Shelly Shulman
President of the Board