City of New York Medicare Coverage Changes, Effective January 1, 2022

As a follow-up to our last Medicare program update on June 30th, 2021, the Municipal Labor Committee met on July 14th to formally vote on adopting a new NYC Medicare Advantage Plus Program effective January 1, 2022. The MLC General Membership voted overwhelmingly to award the contract to “The Alliance,” a joint bid from Emblem Health and Anthem, to administer the new plan for all City Medicare retirees.

This award ensures that no premium contributions will come out of retirees’ pension checks and active members’ paychecks. All savings generated from this RFP have been collectively bargained by the MLC to be deposited into the unions’ Stabilization Fund which will extend free healthcare to all retired and active City workers for several more years.

As we stated last month, there has been a large amount of negativity being circulated amongst the City’s Medicare population as they feel changing to a Medicare Advantage plan will be a degradation of benefits. This is not the case. Members are equating the individual Medicare Advantage plans advertised on television with the customized plan that was collectively selected by the City and MLC. The plans are in no way similar to the customized group NYC Medicare Advantage Plus Program that was awarded to the Alliance. The Alliance plan is far superior and comprehensive in nature and, according to our MLC consultants, 850,000 physicians (approximately 99.5% of all physicians in the United States) who accept Medicare will accept the NYC Medicare Advantage Plus Program.

The Alliance plan allows Medicare retirees to go to any doctor or hospital that accepts Medicare regardless if that provider is in the insurer’s network or not. As long as the provider accepts payment from Medicare, they are obligated to accept the NYC Medicare Advantage Plus Program payment. This includes all hospitals in the NYC area, including those at Memorial Sloan Kettering and The Hospital for Special Surgery (HSS), and almost all hospitals nationally. The program is a national program, so it covers retirees in any State which they work or reside or when they travel.

While the Alliance plan will cover all services that are covered under traditional Medicare, it will also include coverage for the following additional benefits: routine foot care; annual preventive physical; worldwide emergency coverage; Healthy Meal Delivery; Healthy Pantry; Medicare Community Resource Support; Health Fitness Tracker; non-emergency transportation; a Wellness Incentive card; and telemedicine.  The NYC Medicare Advantage Plus Program also includes a spectrum of Care Advocacy resources and Care Management programs not included in the Senior Care plan.

The new contract will be a five-year agreement and will be effective January 1, 2022, and will save the City and unions $600-$650-million per year for the next five years.

In addition, the PICA RFP that was recently completed will save an additional $317-million over three years. The MLC has a written agreement with the City that every penny saved from both these RFPs will accrue to the unions’ Stabilization Fund, thereby extending a “no contribution” medical program to both our active and retired members for the next several years. In addition, the City has agreed that Medicare Part B premiums, which will still be required under this new plan, will continue to be reimbursed by the City as has always been the case.

The Alliance is working on member communication pieces that they will mail to all Medicare participants in early August detailing all components of the new Custom Group Medicare Advantage Program. In addition, there will be a call center established by the Retiree Alliance to handle inquiries at that time. This new program will replace GHI Senior Care and continue to be the $0 cost plan for all City Medicare eligible members. It was agreed by the City and MLC that the Emblem Health Senior Care and HIP VIP plans will continue to be an option going forward; however this will no longer be a no-cost option. The estimated cost for these programs would be approximately $200 per month. Future plan changes, opting in or out, can be made during future annual fall open enrollment periods. It is strongly believed that once Medicare members experience the new custom group Alliance Medicare Advantage plan that members will not desire a return back to the Senior Care program. Families who have both a Medicare eligible member as well as a non-Medicare eligible spouse, known as a split contract, will only have a change to the Medicare eligible member’s plan. The non-Medicare eligible family member will continue to be covered by the same plan, regardless of plan carrier.

The DEA will continue to keep our members apprised as the plans are rolled out.