July 27, 2021
Re: Important information on NYC’s change to a Medicare Advantage Plus program
Dear PSC Retirees,
On Wednesday, July 14, the Municipal Labor Committee (MLC), the group of unions that represents New York City employees in health insurance negotiations, voted to approve changing the administration of the Medicare benefits of city retirees, including all CUNY retirees, from the federal government to a customized Medicare Advantage Plus program administered by the “Alliance,” a partnership of Empire BlueCross BlueShield and Emblem Health. The transition will take effect on January 1, 2022.
PSC voted and advocated against this change, along with the unions representing doctors and nurses. In addition to our concerns about moving to private administration of Medicare benefits, we believed the process was not transparent and no decision should have been made until more information was available to the PSC, our members, and other MLC unions. The PSC Retirees chapter, chaired by Bill Friedheim, helped to educate colleagues on these matters and led public demonstrations. But the MLC had agreed with the City early in the de Blasio administration to reduce health care costs, and, in a second health savings agreement, agreed to tie wage increases for their active members to a list of potential health cost reductions. The PSC and our allies argued that these “savings” should be found elsewhere, in ways that would not impact either active or retired city workers, such as by negotiating to reduce skyrocketing hospitalization costs.
Negotiations to reduce hospital costs are under way, but we did not prevail in the MLC. Watch the PSC retirees’ webpage (https://www.psc-cuny.org/whats-happening-retiree-healthcare) and the Clarion for our forthcoming analysis of the structural and political issues behind this change, as well as strategies to address it going forward.
Supporters of the change argued that the customized Medicare Advantage Plus program will simultaneously reduce the City’s costs and produce better health outcomes for retirees. The City and the “Alliance” of health insurance companies have provided the following highlights about how the new plan would affect retirees:
- This Medicare Advantage Plus program “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 provide all benefits provided by Medicare.”
- The new program has been negotiated specifically for New York City employees and is unlike any Medicare Advantage program in existence anywhere else.
- It is a PPO (Preferred Provider Organization), not an HMO, so it does not restrict access to healthcare providers.
- Retirees will continue to benefit from premium-free coverage.
- The City and the Alliance have assured the MLC unions that retirees will continue to have access to the same doctors and hospitals they currently use. Specifically, members will have in-network access to all providers in the Emblem and Empire networks in New York, and all Blue Cross-Blue Shield associated networks around the country. These providers are contractually bound to accept NYC Medicare Advantage Plus members.
- The Alliance and the City assert that all doctors and hospitals that currently accept Medicare will accept the City’s Medicare Advantage plan even if they do not accept other Medicare Advantage plans because the City’s plan is a customized group plan. The Alliance will pay out-of-network providers who accept Medicare at the Medicare rate. If an out-of-network provider refuses to accept payment even after speaking to an Alliance “concierge,” the Alliance will reimburse the member at the Medicare rate less copays/coinsurance.
- This new program not only mirrors and improves on the benefits in the current Senior Care Plan, but also includes aggressive oversight to protect member benefits and must follow Medicare rules.
However, the City and the Alliance have not released the full details of the new program to date. Therefore, we are not yet able to verify all the claims made by the Alliance.
This transition raises many questions for our members and for all municipal retirees. Here is what we do know as of right now.
1. Retirees 65 years and older will automatically be enrolled in the new Medicare Advantage Plus program effective January 1, 2022, unless they affirmatively “opt out.”
- From September 1 to October 15, 2021, retirees will be able to opt out of the new Medicare Advantage Plus program and enroll in one of the current Senior Care health insurance options, but will have to pay a monthly premium. The City says it will make estimated premium amounts available by mid-August.
- Beginning in 2022, the City will offer an “Annual Transfer Period” in the fall, during which retirees can opt in or out of the Medicare Advantage Plus plan for the following year.
- Retirees 65 and older must make sure they are enrolled in both Medicare Part A and Part B. There is more information about how to sign up for Medicare Parts A and B here: https://www1.nyc.gov/site/olr/health/retiree/health-retiree-medicare-eligible.page.
- You will continue to be reimbursed for Medicare Part B premiums if you are enrolled in the new Medicare Advantage Plus plan or opt out and remain with Senior Care.
- If you drop all City coverage and elect to buy another Medigap plan (e.g., AARP), you will lose eligibility for reimbursement of your Part B premium and IRMAA.
- Retirees or dependents who are not yet 65 will continue to be covered, as now, under their current health insurance plans.
- PSC retirees will continue to receive prescription drugs, dental, hearing and vision benefits through the PSC/CUNY Welfare Fund.
2. The NYC Office of Labor Relations (OLR)/Employee Benefits Program has issued FAQs, which you can find and should read here: https://www1.nyc.gov/site/olr/health/retiree/health-retiree-responsibilities-assistance.page
OLR intends for these FAQs to clarify the new Medicare Advantage Plus Program. The PSC-CUNY Welfare Fund has also prepared a set of FAQs: http://www.psccunywf.org/medicare-advantage-plus-faqs-from-nyc-health-benefits-program.aspx.
3. On Monday, July 26, The Alliance established a a call center (1-833-325-1190) to answer questions about the NYC Medicare Advantage Plan. The call center hours of operation are Monday to Friday, 8 am to 9 pm ET. The call center was opened in advance of the opt-out period, so you can get answers to your pre-enrollment questions before you have to make a decision. This number is also featured on the PSC retiree health care page of our website: https://www.psc-cuny.org/whats-happening-retiree-healthcare. You should read the City’s FAQs before calling this number because they may answer some of your questions
4. In mid-August, the Alliance will mail a Notice of Change letter (as required by Medicare) and a pre-enrollment kit to retirees aged 65 or older. This kit will include a summary of benefits and comparison of costs and benefits between current Medicare and the new Medicare Advantage program, as well as opt-out premium and other information. Retirees whose mailing address has changed should go to the NYC OLR website and submit their new address. The change of address form is here:
5. The Alliance says that it will mail educational materials and provide additional educational meetings for retiree members—in-person, online/virtual, and by telephone. We will keep you updated as new information comes to our attention.
Many PSC retirees actively opposed this change, as did the PSC leadership. (For more background on the PSC’s opposition, see https://www.psc-cuny.org/whats-happening-retiree-healthcare.) One benefit of our opposition is that we have the full attention of the Alliance, and they have indicated they will attend closely to your questions. Along with the PSC-CUNY Welfare Fund, the PSC leadership will monitor implementation and intervene as problems arise.
Finally, to enable the PSC to contact you immediately about this and other critical issues as they arise, please provide us with your current contact information at https://psc-cuny.org/update.