Change in NYC Retiree Health Care Benefits.

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BarbBrooklyn
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Change in NYC Retiree Health Care Benefits.

Post by BarbBrooklyn »

https://www1.nyc.gov/office-of-the-mayo ... ogram-city

The Municipal Labor Council, a consortium of the Unions in NYC has signed off on accepting the City's new Medicare Advantage Plus plan.

They are telling us that this is "new, better, fewer out of pocket costs" and that it will be accepted by any doctor and hospital that accepts traditional Medicare.

Since my husband and I each have doctors who DO NOT accept other Medicare Advantage plans, how do we evaluate if this new default health insurance is worth it? There will be an option to stay with our current traditional Medicare plan plus supplemental (at a much higher price point) but there is no longer a cap on out of pocket expenses. I have Catastrophic Medical for myself but I can't get it for DH due to prior medical hx.

We have a very short time period in which to make this choice (about 6 weeks in September/October). How do we evaluate?

Much debate and mudslinging on the various union's social media, but not much hard information.
BarbBrooklyn | "The enemy of a good plan is the dream of a perfect plan."
talzara
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Re: Change in NYC Retiree Health Care Benefits.

Post by talzara »

BarbBrooklyn wrote: Mon Aug 02, 2021 10:38 am They are telling us that this is "new, better, fewer out of pocket costs" and that it will be accepted by any doctor and hospital that accepts traditional Medicare.

Since my husband and I each have doctors who DO NOT accept other Medicare Advantage plans, how do we evaluate if this new default health insurance is worth it?
That sounds like a Medicare Advantage PPO plan.

All doctors accepting Medicare assignment are required to accept Medicare Advantage PPO plans. If your doctor refuses to take your plan, you may report him to Medicare. The penalty for repeat offenders includes a fine and suspension from Medicare, which would prevent the doctor from being reimbursed for Original Medicare patients.

Blue Cross is a federation of independently-operated health plans. Out-of-area claims are paid through the local Blue Cross licensee. A Massachusetts doctor who treats a New York resident would bill Blue Cross of Massachusetts, which will pay the claim and get reimbursed by Empire Blue Cross.

The word "PPO" does not appear in the mayor's press release, but the teachers' union says that the NYC Medicare Advantage Plus Program is a PPO plan:
The NYC Medicare Advantage Plus Plan is a Group Medicare PPO, which 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 of those 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, like 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.

https://www.uft.org/news/you-should-kno ... -plus-plan
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BarbBrooklyn
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Re: Change in NYC Retiree Health Care Benefits.

Post by BarbBrooklyn »

talzara wrote: Mon Aug 02, 2021 12:14 pm
BarbBrooklyn wrote: Mon Aug 02, 2021 10:38 am They are telling us that this is "new, better, fewer out of pocket costs" and that it will be accepted by any doctor and hospital that accepts traditional Medicare.

Since my husband and I each have doctors who DO NOT accept other Medicare Advantage plans, how do we evaluate if this new default health insurance is worth it?
That sounds like a Medicare Advantage PPO plan.

All doctors accepting Medicare assignment are required to accept Medicare Advantage PPO plans. If your doctor refuses to take your plan, you may report him to Medicare. The penalty for repeat offenders includes a fine and suspension from Medicare, which would prevent the doctor from being reimbursed for Original Medicare patients.

Blue Cross is a federation of independently-operated health plans. Out-of-area claims are paid through the local Blue Cross licensee. A Massachusetts doctor who treats a New York resident would bill Blue Cross of Massachusetts, which will pay the claim and get reimbursed by Empire Blue Cross.

The word "PPO" does not appear in the mayor's press release, but the teachers' union says that the NYC Medicare Advantage Plus Program is a PPO plan:
The NYC Medicare Advantage Plus Plan is a Group Medicare PPO, which 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 of those 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, like 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.

https://www.uft.org/news/you-should-kno ... -plus-plan
Thank you SO much for that clarification! I really appreciate it.
BarbBrooklyn | "The enemy of a good plan is the dream of a perfect plan."
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dodecahedron
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Re: Change in NYC Retiree Health Care Benefits.

Post by dodecahedron »

BarbBrooklyn wrote: Mon Aug 02, 2021 10:38 am Since my husband and I each have doctors who DO NOT accept other Medicare Advantage plans, how do we evaluate if this new default health insurance is worth it? There will be an option to stay with our current traditional Medicare plan plus supplemental (at a much higher price point) but there is no longer a cap on out of pocket expenses. I have Catastrophic Medical for myself but I can't get it for DH due to prior medical hx.
I am puzzled by inability to get coverage for DH due to medical hx. If you still live in NY, you and DH should benefit from NY's extremely strong protections against discrimination due to pre-existing conditions (which are long-standing and have been in place since long before the ACA.)

https://www.nysenate.gov/legislation/laws/ISC/3232

https://www.commonwealthfund.org/blog/2 ... e-you-live
island
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Re: Change in NYC Retiree Health Care Benefits.

Post by island »

Does this affect Port Authority employees or are they state or some other group? Thanks
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Re: Change in NYC Retiree Health Care Benefits.

Post by BarbBrooklyn »

dodecahedron wrote: Mon Aug 02, 2021 12:40 pm
BarbBrooklyn wrote: Mon Aug 02, 2021 10:38 am Since my husband and I each have doctors who DO NOT accept other Medicare Advantage plans, how do we evaluate if this new default health insurance is worth it? There will be an option to stay with our current traditional Medicare plan plus supplemental (at a much higher price point) but there is no longer a cap on out of pocket expenses. I have Catastrophic Medical for myself but I can't get it for DH due to prior medical hx.
I am puzzled by inability to get coverage for DH due to medical hx. If you still live in NY, you and DH should benefit from NY's extremely strong protections against discrimination due to pre-existing conditions (which are long-standing and have been in place since long before the ACA.)

https://www.nysenate.gov/legislation/laws/ISC/3232

https://www.commonwealthfund.org/blog/2 ... e-you-live
At the time that I signed up for Catastrophic coverage, I was told he didn't qualify. Thinking back, that might have been because that they weren't accepting applications for spouses. In any eveny, it is water under the bridge; that program is now closed to everyone.
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BarbBrooklyn
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Re: Change in NYC Retiree Health Care Benefits.

Post by BarbBrooklyn »

island wrote: Mon Aug 02, 2021 12:52 pm Does this affect Port Authority employees or are they state or some other group? Thanks
I don't think that Port Authority is included in this group.
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NavyIC3
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Re: Change in NYC Retiree Health Care Benefits.

Post by NavyIC3 »

BarbBrooklyn wrote: Mon Aug 02, 2021 12:59 pm
island wrote: Mon Aug 02, 2021 12:52 pm Does this affect Port Authority employees or are they state or some other group? Thanks
I don't think that Port Authority is included in this group.
This applies only to the unions that are part of the NYC Municipal Labor Committee. Port Authority is a multi-state (NY & NJ) agency.
talzara
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Re: Change in NYC Retiree Health Care Benefits.

Post by talzara »

BarbBrooklyn wrote: Mon Aug 02, 2021 12:37 pm Thank you SO much for that clarification! I really appreciate it.
There's one more clarification that could affect your decision. Medicare doctors must accept your plan for pricing, but they do not have to accept payment directly from your plan. You may have to pay up-front and get reimbursed later.

A commercial PPO plan bundles the pricing with the payment. In-network doctors have agreed to charge the allowable rates and bill the insurance company. Out-of-network doctors have not signed the agreement, so they can treat you as an uninsured patient and charge you 10 times as much.

A Medicare PPO plan is a hybrid. All Medicare doctors have already agreed to the rates because they're the same rates as Original Medicare. They can't treat you as an uninsured patient because you're still a Medicare patient. However, out-of-network doctors have not signed an agreement with the insurance company, so they don't have to bill the insurance company. They can't bill Medicare, either, because you have an Advantage plan.

Original Medicare doesn't have this problem. Medicare doctors have to accept payment directly from Medicare.

The FAQ from the teachers' union describes the payment problem:
In the very rare instance where a provider that accepts Medicare tells a retiree they will not accept payment from the NYC Medicare Advantage Plus Plan, the retiree should first contact the concierge service that will be provided so that the plan can work with the provider to make sure they understand it is the same payment schedule and billing protocol and answer any questions the provider may have. If despite that effort, the provider still refuses, the member can pay the provider and then submit the claims to the plan for reimbursement. So long as the service is a Medicare covered benefit and Medicare fee schedule is followed, the member will only be responsible for their copays/coinsurance as defined by the plan.

https://www.uft.org/news/you-should-kno ... -plus-plan
retire2022
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Re: Change in NYC Retiree Health Care Benefits.

Post by retire2022 »

BarbBrooklyn wrote: Mon Aug 02, 2021 12:59 pm
island wrote: Mon Aug 02, 2021 12:52 pm Does this affect Port Authority employees or are they state or some other group? Thanks
I don't think that Port Authority is included in this group.
Port Authority is a public benefit corporation established by act of congress on behalf of STATE Government for NY and NJ.

https://en.wikipedia.org/wiki/Port_Auth ... New_Jersey

NYC government is an entire different entity.
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Re: Change in NYC Retiree Health Care Benefits.

Post by BarbBrooklyn »

For those of you who are reading this, would you opt into this plan?
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Re: Change in NYC Retiree Health Care Benefits.

Post by Outafter20 »

BarbBrooklyn wrote: Tue Aug 03, 2021 5:17 pm For those of you who are reading this, would you opt into this plan?
I am a retired NYC employee but still a ways off from Medicare. However, from everything I have been reading (and my union was the only one in the MLC to vote against it), I would stick with the traditional Medicare and pay for the supplement. Especially if you live outside NYC.
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Re: Change in NYC Retiree Health Care Benefits.

Post by talzara »

Outafter20 wrote: Tue Aug 03, 2021 5:23 pm I am a retired NYC employee but still a ways off from Medicare. However, from everything I have been reading (and my union was the only one in the MLC to vote against it), I would stick with the traditional Medicare and pay for the supplement. Especially if you live outside NYC.
Ironically, you're probably more likely to have trouble in New York. Blue Cross has relatively low market share in New York.

It would be easier in other states where Blue Cross has higher market share.

For example, Blue Cross has 99% of the non-Medicare market in Alabama. A doctor who won't accept payment from Blue Cross will starve.
Last edited by talzara on Tue Aug 03, 2021 7:47 pm, edited 1 time in total.
Outafter20
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Re: Change in NYC Retiree Health Care Benefits.

Post by Outafter20 »

talzara wrote: Tue Aug 03, 2021 7:39 pm
Outafter20 wrote: Tue Aug 03, 2021 5:23 pm I am a retired NYC employee but still a ways off from Medicare. However, from everything I have been reading (and my union was the only one in the MLC to vote against it), I would stick with the traditional Medicare and pay for the supplement. Especially if you live outside NYC.
Ironically, you're probably more likely to have trouble in New York. Blue Cross has relatively low market share in New York.

It would be easier in other states where Blue Cross has higher market share.

For example, Blue Cross has 99% of the non-Medicare market in Alabama. A doctor who won't accept payment from Blue Cross will starve.
True, but this Medicare Advantage Plan is an alliance between Empire BCBS (which covers Part A) and EmblemHealth (which covers Part B). EmblemHealth has a much larger market share in the New York area than it does anywhere else in the country. If you tend to see a lot of doctors, but aren't hospitalized often, this plan might work better in New York.
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Re: Change in NYC Retiree Health Care Benefits.

Post by Good Listener »

talzara wrote: Mon Aug 02, 2021 12:14 pm
BarbBrooklyn wrote: Mon Aug 02, 2021 10:38 am They are telling us that this is "new, better, fewer out of pocket costs" and that it will be accepted by any doctor and hospital that accepts traditional Medicare.

Since my husband and I each have doctors who DO NOT accept other Medicare Advantage plans, how do we evaluate if this new default health insurance is worth it?
That sounds like a Medicare Advantage PPO plan.

All doctors accepting Medicare assignment are required to accept Medicare Advantage PPO plans. If your doctor refuses to take your plan, you may report him to Medicare. The penalty for repeat offenders includes a fine and suspension from Medicare, which would prevent the doctor from being reimbursed for Original Medicare patients.

Blue Cross is a federation of independently-operated health plans. Out-of-area claims are paid through the local Blue Cross licensee. A Massachusetts doctor who treats a New York resident would bill Blue Cross of Massachusetts, which will pay the claim and get reimbursed by Empire Blue Cross.

The word "PPO" does not appear in the mayor's press release, but the teachers' union says that the NYC Medicare Advantage Plus Program is a PPO plan:
The NYC Medicare Advantage Plus Plan is a Group Medicare PPO, which 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 of those 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, like 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.

https://www.uft.org/news/you-should-kno ... -plus-plan
What if the city later changes the plans.
talzara
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Re: Change in NYC Retiree Health Care Benefits.

Post by talzara »

Outafter20 wrote: Tue Aug 03, 2021 7:45 pm True, but this Medicare Advantage Plan is an alliance between Empire BCBS (which covers Part A) and EmblemHealth (which covers Part B). EmblemHealth has a much larger market share in the New York area than it does anywhere else in the country. If you tend to see a lot of doctors, but aren't hospitalized often, this plan might work better in New York.
That's better than relying on the Blue Cross network in New York, but it's not as universal as relying on the Blue Cross network in Alabama. There will be doctors in New York who don't take EmblemHealth, but doctors in Alabama will starve if they don't take Blue Cross.

Also, are you sure that Blue Cross isn't also covering Part B? The teachers' union FAQ says that the provider network includes Empire and Emblem:
This program will provide access to all doctors that take Medicare coverage, approximately 850,000 providers nationwide. About 640,000 of those Medicare providers are currently in the Empire/Emblem Alliance networks and are contractually bound to see NYC Medicare Advantage Plus members.

https://www.uft.org/news/you-should-kno ... -plus-plan
About 75% of Medicare doctors are in-network with the plan. The other 25% of doctors must live in states where Blue Cross has low market share.
Outafter20
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Re: Change in NYC Retiree Health Care Benefits.

Post by Outafter20 »

talzara wrote: Tue Aug 03, 2021 10:06 pm
Outafter20 wrote: Tue Aug 03, 2021 7:45 pm True, but this Medicare Advantage Plan is an alliance between Empire BCBS (which covers Part A) and EmblemHealth (which covers Part B). EmblemHealth has a much larger market share in the New York area than it does anywhere else in the country. If you tend to see a lot of doctors, but aren't hospitalized often, this plan might work better in New York.
That's better than relying on the Blue Cross network in New York, but it's not as universal as relying on the Blue Cross network in Alabama. There will be doctors in New York who don't take EmblemHealth, but doctors in Alabama will starve if they don't take Blue Cross.

Also, are you sure that Blue Cross isn't also covering Part B? The teachers' union FAQ says that the provider network includes Empire and Emblem:
This program will provide access to all doctors that take Medicare coverage, approximately 850,000 providers nationwide. About 640,000 of those Medicare providers are currently in the Empire/Emblem Alliance networks and are contractually bound to see NYC Medicare Advantage Plus members.

https://www.uft.org/news/you-should-kno ... -plus-plan
About 75% of Medicare doctors are in-network with the plan. The other 25% of doctors must live in states where Blue Cross has low market share.
No one seems to know for sure who is covering what as it isn't written anywhere (at least from what I have seen). The EmblemHealth/BCBS plan for non medicare eligible retirees and current city employees, Emblem covers doctors, lab tests, x=rays, DME, etc. BCBS covers hospitalization only.
talzara
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Re: Change in NYC Retiree Health Care Benefits.

Post by talzara »

Good Listener wrote: Tue Aug 03, 2021 7:47 pm What if the city later changes the plans.
According to the teachers' union, you may switch to a different plan:
Yes, your choice of New York City health plan can always be changed during an open enrollment period or by invoking your once-in-a-lifetime change (under the rules that govern the NYC Health Benefits Program). In the past, transfers between plans were only permitted every other year. Beginning in 2022, transfers between plans will be permitted every year in the Fall.

https://www.uft.org/news/you-should-kno ... -plus-plan
Tanelorn
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Re: Change in NYC Retiree Health Care Benefits.

Post by Tanelorn »

Outafter20 wrote: Tue Aug 03, 2021 7:45 pm Empire BCBS (which covers Part A) and EmblemHealth (which covers Part B).
Empire BCBS had a poor network and reputation when I last knew them, which was some time ago. Sample reviews do not suggest this has changed.

https://www.consumeraffairs.com/insuran ... ss_ny.html
retire2022
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Re: Change in NYC Retiree Health Care Benefits.

Post by retire2022 »

Op

A friend of mine forwarded this link:

“ The plan has been cast as a necessary measure to rein in mounting health care costs and reduce strain on the city’s budget.”

https://theintercept.com/2021/08/19/med ... york-city/
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BarbBrooklyn
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Re: Change in NYC Retiree Health Care Benefits.

Post by BarbBrooklyn »

talzara wrote: Tue Aug 03, 2021 10:56 pm
Good Listener wrote: Tue Aug 03, 2021 7:47 pm What if the city later changes the plans.
According to the teachers' union, you may switch to a different plan:
Yes, your choice of New York City health plan can always be changed during an open enrollment period or by invoking your once-in-a-lifetime change (under the rules that govern the NYC Health Benefits Program). In the past, transfers between plans were only permitted every other year. Beginning in 2022, transfers between plans will be permitted every year in the Fall.

https://www.uft.org/news/you-should-kno ... -plus-plan
Raising this question again; we've gotten more information , but the connundrum for me is if we go with this new PPO plan and then want to switch back to ordiginal Medicare, getting a supplement will be subject to medical underwriting. My husband had open heart surg in 2005, is on blood thinners, bp meds and may be about to get a dx of cognitive impairment.

What do the wise folks here think?

Staying with the current orig Medicare plan will cost about$200 each per month (in addition to regulat part b fees). We will need to aquire part D for each of us (which right now costs 150/ month each).
200+145+150?x2x12=

ppo will cost nothing aside from regular part B fees, part d is 125/ month each.
145+125 x2x12=

So many unknowns. There is a cap on OOP for MA; none on traditional Medicare.

Are there brokers who can help figure this out? I would be willing to pay some serious money to get expert advise on this.

NB, we tend to use docs who accept EVERYTHING, including Medicaid; most of our docs are at NYU and/or NYP). But living in NYC (a medical mecca), there are situations in which we might want/need to access MSK for cancer trestment; we are told MSK is out of network for PPO plan.
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Tattarrattat
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Re: Change in NYC Retiree Health Care Benefits.

Post by Tattarrattat »

If you are seriously ill, traditional Medicare will be much better for your care than any Medicare Advantage plan. Personally, I would never sign up for any managed care plan over traditional unless I absolutely couldn't afford traditional.
talzara
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Re: Change in NYC Retiree Health Care Benefits.

Post by talzara »

BarbBrooklyn wrote: Sun Sep 05, 2021 5:40 pm Raising this question again; we've gotten more information , but the connundrum for me is if we go with this new PPO plan and then want to switch back to ordiginal Medicare, getting a supplement will be subject to medical underwriting.
Group Medigap policies are not medically underwritten. You would only be subject to medical underwriting if you buy your own policy.

The Medigap premium may increase if only the sickest retirees stay on Original Medicare. On the other hand, wealth is correlated with better health, and the wealthier retirees will be more likely to buy the Medigap policy.
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Re: Change in NYC Retiree Health Care Benefits.

Post by Madbull »

BarbBrooklyn wrote: Mon Aug 02, 2021 10:38 am ....Much debate and mudslinging on the various union's social media, but not much hard information.
With no knowledge of the new option being offered to y'all, I just wanted to chime in and say that's not surprising. My mother retired from a County Govt in Texas. Up until several years ago, retiree coverage used to only be a UHC PPO plan, (different pricing for pre-65 and 65+ of course). They then decided to add a Humana Medicare Advantage plan for those 65+ in an attempt to better manage costs overall. Even with multiple seminars held in the ~4 months up to enrollment, all I heard at the two I attended while trying to decide if I should switch her over were horror stories from employees and retirees where someone they knew had an Advantage plan and how bad it was.

They were very clear that the County hand-selected the exact coverage they wanted Humana to offer for the best result for the retirees and the County itself. I can now say after she's been on it for years, they did good and I'm happy I switched her over.

She went from ~91/mo for the UHC PPO w/a $700 Ded, an 85/15 co-insurance split, and $4.5k Max OOP, to ~47/mo on the Humana Medicare Advantage plan w/a $0 Ded, No split, No copays (except acupuncture which is $25), and a $1k Max OOP. (We were told that was the lowest Max OOP option they could select for us when negotiating the plan, but it was moot since they believed no one should really have much in the way of OOP costs). Welp, after several years, several procedures, random ER trips, numerous medications and plenty of doctor visits, the only time I have to pay anything for her is on RXs. And those follow a standard $10/20/40/50 Tiers 1-4 setup.

TLDR - Medicare Advantage plans don't have to be bad. It's about the specifics of that particular plan. In the case of being employer offered, it's about how and what they negotiated for with their retirees. Try to get a copy of the benefits book. They likely won't want to supply it until after OE and they send them out to those who opted in, but it should be within the agenda packet backup documents for whatever presentation was provided to the City Council when they were deciding on bringing that plan as a new option.
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BarbBrooklyn
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Re: Change in NYC Retiree Health Care Benefits.

Post by BarbBrooklyn »

talzara wrote: Tue Sep 07, 2021 1:16 pm
BarbBrooklyn wrote: Sun Sep 05, 2021 5:40 pm Raising this question again; we've gotten more information , but the connundrum for me is if we go with this new PPO plan and then want to switch back to ordiginal Medicare, getting a supplement will be subject to medical underwriting.
Group Medigap policies are not medically underwritten. You would only be subject to medical underwriting if you buy your own policy.

The Medigap premium may increase if only the sickest retirees stay on Original Medicare. On the other hand, wealth is correlated with better health, and the wealthier retirees will be more likely to buy the Medigap policy.
It has been made clear that if we opt out of the MA PPO and stick with traditional Medicare, we will be on our own getting Medigap policies.

Can we get a Medigap from, say AARP that wouldn't require underwriting?
BarbBrooklyn | "The enemy of a good plan is the dream of a perfect plan."
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Re: Change in NYC Retiree Health Care Benefits.

Post by abner kravitz »

BarbBrooklyn wrote: Wed Sep 08, 2021 12:10 am
talzara wrote: Tue Sep 07, 2021 1:16 pm
BarbBrooklyn wrote: Sun Sep 05, 2021 5:40 pm Raising this question again; we've gotten more information , but the connundrum for me is if we go with this new PPO plan and then want to switch back to ordiginal Medicare, getting a supplement will be subject to medical underwriting.
Group Medigap policies are not medically underwritten. You would only be subject to medical underwriting if you buy your own policy.

The Medigap premium may increase if only the sickest retirees stay on Original Medicare. On the other hand, wealth is correlated with better health, and the wealthier retirees will be more likely to buy the Medigap policy.
It has been made clear that if we opt out of the MA PPO and stick with traditional Medicare, we will be on our own getting Medigap policies.

Can we get a Medigap from, say AARP that wouldn't require underwriting?
The rules are a little fuzzy, but I believe in NY and CT you can buy a Medigap policy at any time without medical underwriting and pay the same as everyone else, by law. I think MA is almost the same. Those are the only States where this is true (ME has some protective rules also but they are slightly more restrictive).

This is my understanding anyway. You should confirm rather than relying on my advice of course.
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Re: Change in NYC Retiree Health Care Benefits.

Post by Outafter20 »

BarbBrooklyn wrote: Wed Sep 08, 2021 12:10 am
talzara wrote: Tue Sep 07, 2021 1:16 pm
BarbBrooklyn wrote: Sun Sep 05, 2021 5:40 pm Raising this question again; we've gotten more information , but the connundrum for me is if we go with this new PPO plan and then want to switch back to ordiginal Medicare, getting a supplement will be subject to medical underwriting.
Group Medigap policies are not medically underwritten. You would only be subject to medical underwriting if you buy your own policy.

The Medigap premium may increase if only the sickest retirees stay on Original Medicare. On the other hand, wealth is correlated with better health, and the wealthier retirees will be more likely to buy the Medigap policy.
It has been made clear that if we opt out of the MA PPO and stick with traditional Medicare, we will be on our own getting Medigap policies.

Can we get a Medigap from, say AARP that wouldn't require underwriting?
Not sure where you got that information from. The city will still be providing a medigap policy for $191 per month. It is on the NYC OLR website.

You can get a policy on your own but you will lose the Part B reimbursement, and IRMAA reimbursement, if applicable.
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Re: Change in NYC Retiree Health Care Benefits.

Post by talzara »

abner kravitz wrote: Wed Sep 08, 2021 5:57 amThe rules are a little fuzzy, but I believe in NY and CT you can buy a Medigap policy at any time without medical underwriting and pay the same as everyone else, by law. I think MA is almost the same. Those are the only States where this is true (ME has some protective rules also but they are slightly more restrictive).
Health insurance in New York is guaranteed issue and community-rated. This is why ACA policies are so expensive for people under the age of 50. It also applies to Medigap policies. Medigap Plan C costs $301 to $513 in New York City: https://www.dfs.ny.gov/consumers/health ... ons/plan_c

The OP lives in New York, but some retirees move out of state. They will not be able to buy a New York Medigap policy since it is based on state of residence. However, the group Medigap policy will still be available no matter where they live.
Brian96
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Re: Change in NYC Retiree Health Care Benefits.

Post by Brian96 »

Hi BarbBrooklyn,

Just found your post. I am also facing the choice between moving to the new Medicare Advantage Plus Plan or staying with my current plan which is one of the Medicare Supplement plans that are offered, called Empire Medicare Related. The monthly cost was very doable since I had no interest in joining the “senior plan” even though it had no fee attached. All our docs accepted the Empire plan but not the senior plan. The senior plan is/was your plan, yes? The plan my wife and I are currently on will triple in cost come Jan 2022.

It is tempting to tryout the MA+ offering, but somehow it seems too good to be true. A plan that markets itself as offering more benefits, but costs less, and still saves NYC a bundle?

What are your current thoughts?

Brian96
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NavyIC3
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Re: Change in NYC Retiree Health Care Benefits.

Post by NavyIC3 »

Brian96 wrote: Mon Oct 11, 2021 3:02 pm Hi BarbBrooklyn,

Just found your post. I am also facing the choice between moving to the new Medicare Advantage Plus Plan or staying with my current plan which is one of the Medicare Supplement plans that are offered, called Empire Medicare Related. The monthly cost was very doable since I had no interest in joining the “senior plan” even though it had no fee attached. All our docs accepted the Empire plan but not the senior plan. The senior plan is/was your plan, yes? The plan my wife and I are currently on will triple in cost come Jan 2022.

It is tempting to tryout the MA+ offering, but somehow it seems too good to be true. A plan that markets itself as offering more benefits, but costs less, and still saves NYC a bundle?

What are your current thoughts?

Brian96
It doesn't matter if the doctor accepts the "GHI Senior Plan". If he accepts Medicare the senior plan will pay the remaining 20% after Medicare pays the 80%. There is a $203 Medicare deductible (2021) and a $50 GHI deductible annually.
Brian96
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Re: Change in NYC Retiree Health Care Benefits.

Post by Brian96 »

@NavyIC3,

Thanks for your post - very helpful. As of now, if I choose to opt out of the MA+ plan (NYC Retirees must opt out or be auto-enrolled in MA+) then I can only stay with the plan I’m in. Still, I’ll revisit the senior plan since it’ll be 1/3rd the cost of the Empire plan.

Brian
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BarbBrooklyn
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Re: Change in NYC Retiree Health Care Benefits.

Post by BarbBrooklyn »

Brian96 wrote: Mon Oct 11, 2021 3:02 pm Hi BarbBrooklyn,

Just found your post. I am also facing the choice between moving to the new Medicare Advantage Plus Plan or staying with my current plan which is one of the Medicare Supplement plans that are offered, called Empire Medicare Related. The monthly cost was very doable since I had no interest in joining the “senior plan” even though it had no fee attached. All our docs accepted the Empire plan but not the senior plan. The senior plan is/was your plan, yes? The plan my wife and I are currently on will triple in cost come Jan 2022.

It is tempting to tryout the MA+ offering, but somehow it seems too good to be true. A plan that markets itself as offering more benefits, but costs less, and still saves NYC a bundle?

What are your current thoughts?

Brian96
Hi, Brian:

Right now, my inclination is to stick with the no-cost MA Advantage plan for this coming year and see how it shakes out. Our current docs/hospitals all appear to be on board.


The GHI senior plan that we currently have is fine and if that is what you are thinking of switching to, it's been good for us.
BarbBrooklyn | "The enemy of a good plan is the dream of a perfect plan."
Brian96
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Re: Change in NYC Retiree Health Care Benefits.

Post by Brian96 »

Hi BarbBrooklyn,

Thanks for your reply. We currently have what’s called the Empire Medicare Related Plan, one of the 3 supplemental plans that CUNY offers with the Senior plan as one of them. However, the only choice during this signup period is to shift to the MA+ or remain where we are. The Empire plan requires a monthly fee and has been terrific. However it will triple in price come 2022.

I’ve tried my best to research both plans, and with my bias against a Medicare Advantage, haven’t been able to weed it out of consideration. When ya have something that works, it’s challenging to make a change. No one knows what the future will bring in investing and personal health, and I’m very cautious about the unknown-knowns involved in the switch.

Still, I’m grateful to have the choice.

Best,
Brian
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Re: Change in NYC Retiree Health Care Benefits.

Post by rjbraun »

Evidently, a judge has ordered NYC to delay retiree Medicare health care plan switch until April 1, 2022:

https://www.thecity.nyc/2021/12/15/2283 ... plan-delay
rjbraun
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Re: Change in NYC Retiree Health Care Benefits.

Post by rjbraun »

rjbraun wrote: Thu Dec 16, 2021 9:49 am Evidently, a judge has ordered NYC to delay retiree Medicare health care plan switch until April 1, 2022:

https://www.thecity.nyc/2021/12/15/2283 ... plan-delay
An update:

https://www.thecity.nyc/2022/3/3/229603 ... ourt-winAn
Danw
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Re: Change in NYC Retiree Health Care Benefits.

Post by Danw »

retire2022
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Re: Change in NYC Retiree Health Care Benefits.

Post by retire2022 »

Danw
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Re: Change in NYC Retiree Health Care Benefits.

Post by Danw »

https://image.uftmail.org/lib/fe3915707 ... dfc069.pdf

The City’s deadline of November 4, stated in the letter above, seems to have passed. Any new info?
retire2022
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Re: Change in NYC Retiree Health Care Benefits.

Post by retire2022 »

Danw wrote: Fri Nov 18, 2022 4:40 pm https://image.uftmail.org/lib/fe3915707 ... dfc069.pdf

The City’s deadline of November 4, stated in the letter above, seems to have passed. Any new info?
Key word: NYC retiree+Medicare Advantage

https://www.google.com/search?q=nyc+ret ... 19&bih=657
Danw
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Re: Change in NYC Retiree Health Care Benefits.

Post by Danw »

retire2022 wrote: Fri Nov 18, 2022 5:19 pm
Danw wrote: Fri Nov 18, 2022 4:40 pm https://image.uftmail.org/lib/fe3915707 ... dfc069.pdf

The City’s deadline of November 4, stated in the letter above, seems to have passed. Any new info?
Key word: NYC retiree+Medicare Advantage

https://www.google.com/search?q=nyc+ret ... 19&bih=657
Thanks
retire2022
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Re: Change in NYC Retiree Health Care Benefits.

Post by retire2022 »

Danw wrote: Sat Nov 19, 2022 12:40 pm
Thanks
You are welcomed.

I suggest you write letters to your elected officials Mayor & City Council members and your union.

Here is something published by Barbara Caress who teaches at Baruch College on centernyc.org 9/28/2022:

It gives a summary of what has happened.

http://www.centernyc.org/urban-matters- ... ond-chance
Danw
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Re: Change in NYC Retiree Health Care Benefits.

Post by Danw »

retire2022 wrote: Sat Nov 19, 2022 2:44 pm
Danw wrote: Sat Nov 19, 2022 12:40 pm
Thanks
You are welcomed.

I suggest you write letters to your elected officials Mayor & City Council members and your union.

Here is something published by Barbara Caress who teaches at Baruch College on centernyc.org 9/28/2022:

It gives a summary of what has happened.

http://www.centernyc.org/urban-matters- ... ond-chance
The website of the group that filed the lawsuit has a lot of information.

https://www.nycretirees.org/
retire2022
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Re: Change in NYC Retiree Health Care Benefits.

Post by retire2022 »

All, here is the latest, the appeal Adams administration lost:

"On Tuesday morning, a panel of judges on the Supreme Court’s appellate bench rejected the argument from Adams’ team and ruled Frank’s decision should stand."

https://www.nydailynews.com/news/politi ... story.html

also a group of retirees are suing for additional co pays: https://nypost.com/2022/11/29/nyc-retir ... re-copays/
retire2022
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Re: Change in NYC Retiree Health Care Benefits.

Post by retire2022 »

All, the link is the public radio Marketplace dot org program on traditional Medicare program to Medicare Advantage program.

https://www.marketplace.org/2022/12/05/ ... ntage/amp/
retire2022
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Re: Change in NYC Retiree Health Care Benefits.

Post by retire2022 »

All, while the next thread discusses Medicare Versus Medicare Advantage, it is worth noting that there are third party reports on why traditional Medicare seems better than MA.

viewtopic.php?t=390071
retire2022
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Re: Change in NYC Retiree Health Care Benefits.

Post by retire2022 »

Latest NPR report that Medicare Advantage program overcharged during audit.

https://www.npr.org/sections/health-sho ... d-auditors
retire2022
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Re: Change in NYC Retiree Health Care Benefits.

Post by retire2022 »

Topic Author
BarbBrooklyn
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Re: Change in NYC Retiree Health Care Benefits.

Post by BarbBrooklyn »

Retire, I so appreciate your updating this thread. I have a lot on my plate right now but am a following this thread and the updates on FB and from colleagues.
BarbBrooklyn | "The enemy of a good plan is the dream of a perfect plan."
Danw
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Re: Change in NYC Retiree Health Care Benefits.

Post by Danw »

The group that filed the lawsuit posted this about the Arbitrator’s ruling.
https://www.nycretirees.org/_files/ugd/ ... bddbed.pdf
retire2022
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Re: Change in NYC Retiree Health Care Benefits.

Post by retire2022 »

BarbBrooklyn wrote: Fri Dec 16, 2022 4:21 pm Retire, I so appreciate your updating this thread.
Barb, you are welcomed.

Not a big deal, anyone can search through the news and ANYONE here can retrieve the links with key words or google news alerts as posted previously.

By anyone, please feel free to post links at your leisure here.

The endeavor or search can be posted and shared here:

https://www.google.com/search?q=nyc+ret ... 19&bih=657

Here is the timeline posted by UTF.

https://www.uft.org/your-rights/safety- ... n-timeline

"4.The NYC Medicare Advantage Plus plan is created. The NYC Medicare Advantage Plus plan was a brand-new plan that was created ONLY for Medicare eligible retirees to mirror their current benefits at less cost. Because it was a Medicare Advantage plan, the plan allowed the city and the unions to tap into federal funds to save approximately $600 million a year while providing retirees essentially the same coverage as GHI Senior Care. The MLC fought hard to make sure the new premium-free plan was a preferred provider organization (PPO) plan, not a health maintenance organization (HMO), so retirees could go to doctors outside the plan’s large network. They also fought to ensure that other health care plans, including GHI Senior Care, would remain as “pay-up” options for retirees."
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