OLR response to MEA letter of Medicare Advantage Plus Plan

On July 29, 2021 the MEA sent a letter to the OLR office regarding Medicare Advantage Plus Plan. The original letter can be found here.

Below is the response to our inquiry.

Commissioner Campion asked me to respond to the questions posed in your letter of July 29, 2021 regarding the NYC Medicare Advantage Plus Program. Answers are [italicized] below. There is also an FAQ page and other information on the OLR website. Feel free to reach out to me with any other questions. 

1. How much will it cost for me to remain in GHI/Empire Senior Care? HIP/VIP? 

The rates for all the pay up programs are not yet finalized but will be published in the Enrollment Guide which will be mailed in late August. When they are available, we will add them to the FAQs on the OLR website.

2. How much will it cost for both my spouse and me to remain in GHI/Empire Senior Care? HIP/VIP?

See #1 above. 

3. If I remain in Medicare/GHI Senior Care or HIP/VIP, will I remain eligible for both Medicare Part B Reimbursement and IRMAA? 

Yes. As long as you remain in a City retiree program, you will be eligible for Part B reimbursement and IRMAA payments. 

4. If I remain in Medicare/GHI Senior Care or HIP/VIP, will I remain eligible for all current Management Benefits Fund programs? 


5. 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? 

The Retiree Drug Rider available from Emblem Health will cost $122 per month. It is the same rider for Senior Care and the MAP. As part of the NYC MAP, you must obtain your Part D drug coverage from this plan. 

6. 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 copayments or reduced? Will Emblem Health honor their current approvals for these medicines or will these prescriptions require new approvals by Emblem Health? 

The Drug Plan is not changing.

7. Can you provide more detailed information comparing the Part D Prescription Drug Rider under both plans? 

The Drug Plan is not changing. 

8. If I accept the new NYC Medicare Advantage Plus plan what changes, if any, will happen to my current Management Benefits Fund (MBF) coverage. 

The MBF plan is not changing. 

9. 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? 

Open enrollment will be annually in the Fall for a January 1 start date. Retirees can switch annually.

10. 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.

Any doctor who accepts Medicare patients is required to accept the Medicare payment as payment in full, so there should be no balance billing. There is a concierge call center to assist of any payment issues arise.

11. 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? 

The NYC MAP plan will cover emergency services outside the US.  Retirees who live outside the US cannot enroll in the NYC MAP plan.

12. How will members without computers be able to navigate NYC MAP?

Navigating the NYC MAP is no different than any of the current plans. All requirements of the program can be handled by the call center as well as online. Computers are not required to navigate the plan. 

13. What is the procedure to opt out between September 1 – October 15?

There will be an enrollment guide mailed in late August with complete instructions. Retirees will need to affirmatively opt out of the program and authorize payment of a pay up program. They can do this by mail or online.

14. 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?

Providers outside the NYC area will be included as part of the comprehensive provider campaign. The campaign will include articles in provider newsletters, posting on the provider portal page, telephonic outreach and mailings. 

15. 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?

Yes. Retirees can access the provider finder tool at  https://www.empireblue.com/find-care.  Retirees can also call the NYC Medicare Advantage Plus call center for information. 

16. Are there other nationwide Group Medicare PPOs that exist so we can review their performance?

The City and the MLC went through a detailed RFP process and interviewed four national plans as finalists to compare their performance and ultimately selected this program. 

17. Please provide more details on LiveHealth.

Members can see a board certified doctor or licensed therapist through live video on their smartphone, tablet or computer. More details will be provided in the enrollment guide to be mailed in late August.