Stanley H Wilson, Editor

THE NYC MEDICARE ADVANTAGE PLUS PLAN

When do I opt out of this new plan to remain in Emblem Health Senior Care as a Supplement to Original Medicare?

You have until October 31, 2021. If you do not do anything you will be automatically put into the NYC Medicare Advantage Plan on January 1, 2022.

What do I do to opt out of the NYC Medicare Advantage Plus Plan and keep Emblem Health Senior Care as a supplement to Original Medicare?

You fill out and sign the opt out form located towards the back of the booklet you received entitled MEDICARE Group Plan-NYC Medicare Advantage Plus Enrollment Guide. EACH MEDICARE ELIGIBLE PARTICIPANT (i.e., retiree, spouse or dependent) MUST COMPLETE A SEPARATE OPT-OUT FORM. By signing and submitting this form you are agreeing to pay an additional $191.57 a month to remain in your current health plan for 2022. Please note that the additional $2.83 for 365 days of hospitalization will continue to be covered by the CSA Welfare Fund. If you opt out now you do not do it again if you want to stay with Senior Care.

If you can’t print the form or can’t locate the guide contact Stanley Wilson at unitleader@csa-rcmu.org or 917- 692-2942 and the form will be mailed to you.

What do I do if I am currently in HIP-VIP or any other plan that is not Emblem Health Senior Care and want to remain in that plan?

There is a different form to sign and submit if you want to stay in your current plan which is NOT Emblem Health Senior Care. You can get this form by going to the CSA Welfare Fund website which is csawf.org OR contact Stanley Wilson and a form will be mailed to you. If you have HIP-VIP or any plan which is not Emblem Health you can remain in your current plan by opting out of the new NYC Medicare Plus Plan. If you opt out of the new Medicare Advantage Plan you can continue with your current plan and be grandfathered into it since as of January 1, 2022, the only plans available to NYC municipal Medicare retirees to join or switch into will be the new MA Plan and Senior Care.

How can these opt-out forms be submitted?

The ways to submit the form are located at the bottom of the form. At our General Membership Meeting on October 1 Dr. Hathaway mentioned that using certified mail return receipt or priority mail and faxing the forms are good ways of submitting them. If you fax the form, make sure you have and keep the transmittal receipt. You can also email the form. If you do this, request both a delivery receipt and a read receipt to prove the email was delivered and read by the recipient. He does NOT recommend that you use the phone number listed as a way of submitting your opt-out form. The CSA Welfare Fund can’t submit the form for you.

What else should I know about opting out of the new Medicare Advantage Plan?

● Beginning in 2021, you may change plans every year. In 2021 you may only opt-out to your current plan. After 2022 you will only be able to opt out to Senior Care or the Medicare Advantage plan.

● You can switch between Senior Care and Medicare Advantage each year.

● If you are currently in Senior Care with the prescription drug benefit opting out of the Medicare Advantage plan you will keep your Senior Care prescription benefit.

● If a member turns 65 after October 31, they will be enrolled in their plan’s Medicare plan through the end of the year. If they wish to remain in that plan, they will need to file an opt out form with the Alliance and OLR. If they don’t file this form, they will automatically be placed in the NYC Medicare Advantage Plus Plan as of January 1, 2022.

● The cost to remain in Emblem Health Senior Care after January 1, 2022, will be $191.57 plus $125 for the prescription drug benefit. The cost of being in the new Medicare Advantage Plan will only be $ 125 a month for the prescription drug benefit.

What do I do if I want the new Medicare Advantage Plan as of 1-1-2022?

There is nothing to do right now. You should be getting a welcoming guide in December. When your new card arrives be sure to alert all your doctors that you will have a new plan on Jan. 1

What are some of the advantages of joining the new NYC Medicare Advantage Plus Plan?

● This is a $0 premium plan which is guaranteed for 5 years. The only cost is $125 a month for the prescription drug plan. The current cost under Senior Care is $150.30.

● There is an Annual Maximum Out of Pocket Medical Expense of $1470. There is no cap with Senior Care as a supplement to Original Medicare.

● This plan replaces both traditional Medicare and a Medicare Supplement Plan (Senior Care) with a single integrated program administered by an insurer approved by Medicare. You will now have one card and one EOB per medical service. Through a contract with Medicare, this plan provides all health care services previously covered by original Medicare and supplemented by Senior Care. The plan must follow Medicare rules and provide all benefits provided by Medicare.

● There is no co-pay for visits to your primary care physician

● Emergency care when traveling outside of the U.S.

● Transportation costs for 24 one-way trips to doctor’s offices

● Home meals delivery for patients after they are discharged from the hospital

● Silver Sneakers Fitness Program

● Wearable health and fitness tracker

● Live Health Online

● 24/7 Nurse Line

● House Call Program

You can read about these features on pages 4 to 11 of the guide to the new plan.

● There is a dedicated number to call if you have any questions, problems, or concerns. That number is 833-325-1190.

What are the concerns people have expressed about the NYC Medicare Advantage Plan?

The first concern is about networks. About 640, 000 of the approximately 850,00 Medicare

doctors in the US are in the plan. These doctors are contractually bound to see NYC

Medicare Advantage Plan patients. Medicare providers that are not contracted with the plan

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. If 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. This includes all the hospitals in NYC including Memorial-Sloan Kettering which recently officially joined the network. As of this writing, while the Hospital for Special Surgery will see patients from the plan, they are not officially in the network. They are expected to join very shortly.

What if the provider does not agree to accept payment from the NYC Advantage Plan?

Some people have expressed consternation about a doctor refusing to take the plan. There is a definite method to follow. First, contact the concierge service of the plan. 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 that doesn’t work, the member can pay the provider and then submit the claim(s) to the plan for reimbursement. So long as the service is a Medicare covered benefit and the Medicare fee schedule is followed, the member will only be responsible for his or her copays/coinsurance as defined by the plan. You should receive this reimbursement within 30 days.

Please look at the document you received in the CSA Welfare Fund eblast on October 4. You are urged to give this document to a provider reluctant to accept the plan.

The other area of member concern involves pre-authorizations.

What services require pre-authorizations?

Just like plans for active City employees, certain medical procedures will require pre-authorization under the NYC Medicare Advantage Plus Plan. As found in the guide to the new plan the following are some of the most common services that require prior authorization:

● Inpatient hospital admissions

● Skilled nursing facility

● Rehabilitation including, physical, occupational, and speech therapy

● Complex radiology – MRI, CT, and PET scans

● Prosthetics/orthotics

● Transplants

Also please refer to the additional information about prior authorization contained in the October 4 email blast from the CSA Welfare Fund. The complete list of pre-authorizations is listed. You can also find this document by going to www.csawf.org and look for Medicare Advantage Plan Update Presentation-September 30, 2021. If you can’t access this information, Stanley and it will be mailed to you.

While Original Medicare has an increasing number of pre-authorizations for items like durable medical equipment and physician services, it has far less than the new NYC Medicare

Advantage Plus Plan. Original Medicare uses ABN’s (Advance Beneficiary Notification) in which the patient signs a form saying they know that the service to be performed might not be approved and, if that is the case, they will have to pay for the service. If the provider didn’t have you sign an ABN, you can’t be billed. The NYC Medicare Advantage Plus Plan does not use ABNs.

What else should we know about prior authorizations?

The plan has told us they take from 3 to 5 days. It is the provider’s responsibility to ask for prior authorization. If the doctor is not in the network, remind them about this. You can appeal a denial of service. The representatives of the new plan estimate that only about 3 to 4 percent of approvals will be denied.

What happens when the retiree or spouse is under 65 and the other one is 65 or older?

As they currently do, they must choose an insurer that offers both an over 65 option and an under 65 options. The over 65 members will be automatically enrolled under the NYC Advantage Plus Plan and the under 65 will be in the Empire GHI CBP plan, both with a zero premium. If the retiree chooses to pay to remain in another pay up plan, the under 65 spouses will pay up to remain with the same insurer.

Where do I go for more information and clarification?

● Call the new plan at 833-325-1190

● Go to their website which is empireblue.com/nyc-ma-plus. If you want to know if your doctor is in the network, you can use this site. You must know the doctor’s zip code.

● Email Dr. Hathaway at dhathaway@csawf.org

● Email Mark Brodsky at mark@csa-nyc.org

● Email Stanley at shw29@verizion.net or call at 917-692-2942

CSA CONVENTION-Saturday, October 30 at the midtown NY Hilton-6^th Ave. between 53rd &54^th Streets. If you plan to attend, you must show proof of vaccination and photo ID. As Mark Cannizzaro has stated only do what you are comfortable doing. The Retiree Chapter will have their own program including breakfast. Although this part is free, you must register. The full day conference is $100 which includes lunch. You will get a $25 rebate from the Manhattan Unit if you are paying this. Please let Stanley Wilson know if you are paying the $100. To register go to csa-nyc.org/conference.

ELECTION DAY - NOVEMBER 2, 2021

by Richard Oppenheimer

The CSA is endorsing Eric Adams for Mayor, Brad Lander for Comptroller, Jumaane Williams for Public Advocate, Alvin Bragg for Manhattan DA and Mark Levine for Manhattan Borough President. Early voting is from 8AM to 5PM on Oct. 23, 24 and 30. It is from 7AM to 4 PM on Oct. 25 and 29. It is from 10 AM to 8 PM on Oct. 26, 27 and 28. Voter registration deadline is Oct. 8. Request for absentee ballots deadline is Oct. 18. To find your poll site go to VOTE.NYC.