SBA Update on Medicare Advantage Plus Plan

Sergeants Benevolent Association
UPDATE TO
Medicare Advantage Information
Effective 08/18/2021

1. Members are “strongly” encouraged to attend any scheduled webinars, in person-seminars or call NYC Medicare Advantage Plus Plan dedicated telephone number at 1-833-325-1190, Monday to Friday, 8 a.m. to 9 p.m. for “factual “and up to date information on how the plan change effects them individually.
   
   In an attempt to encourage Medicare participants to “field test” the new Medicare Advantage Plus Plan members currently enrolled in HIP- VIP Premier (HMO) will be able to remain (grandfathered- participants) indefinitely in that plan and it will remain a zero - premium plan for at least the calendar 2022 plan year. Current HIP VIP Participants will be allowed to enroll in the new NYC Medicare Advantage Plus Plan, without waiving their right to return to HIP VIP, for any reason, effective January 2023. This is a one- time change that expires after 2022 enrollment period.
   
   ***Note: No new entrants will be allowed to be enrolled into this plan going forward.
   
   In an attempt to encourage Medicare participants to “field test” the new Medicare Advantage Plus Plan members enrolled in any of these currently available Medicare Plans* will be able to remain in the below plans (grandfathered- participants) however updated rates are still pending. Current participants will be allowed to enroll in the new NYC Medicare Advantage Plus Plan, without waiving their right to return to the below plans, for any reason, effective January 2023. This is a one- time change that expires after 2022 enrollment period.
   
   *Note: No new entrants will be allowed to be enrolled into these plans going forward.
   ***Note: This is predicated on these plans continuing to be available into Calendar 2022 and beyond and available thru the sponsoring medical carriers.
   
   
   • Aetna Medicare Advantage Plan PPO/ESA (NY/NJ/PA)
   • Aetna Medicare Advantage Plan PPO/ESA (all other areas)
   • Cigna Health (AZ)
   • Empire Medicare
   • Empire Medi Blue (PPO)
   • GHI HMO Medicare Senior Supplement
   • Humana Gold Plus
   • United Health Care Group Medicare Advantage Plus (Horizon) NYC
   • United Health Care Group Medicare Advantage Plus (Horizon) NJ
   
   
2. Extremely Important Information: There is a significant conflict, within Medicare guidelines, that member’s must be aware of. The issue is triggered when participants in a Medicare Advantage plan concurrently enroll in an independent Prescription Drug Program (PDP) such as Humana or AARP. This act leads to a termination of medical/hospital coverage. We are aware there are members or dependents, currently in GHI-Senior Care Plan*, enrolled in the SBA Prescription Drug Plan and purchased a supplemental Part D drug coverage thru an independent PDP. Those members that are moving to the new NYC Medicare Advantage Plus Plan cannot be dually enrolled in the MA Program and the independent PDP and must disenroll themselves from the PDP program.
   
   The SBA, after multiple discussions with the NYC-Office of Labor Relations and the Municipal Labor Committee has been able to obtain access, for our members to the NYC Medicare Advantage Plus Plan” Drug Rider.” This qualified Medicare Part D drug plan is a reliable and undisruptive platform where members looking for supplemental prescription coverage can safely enroll. We encourage those participants losing their ability to purchase an independent PDP to avail themselves of this benefit. Members will need to enroll in the “drug rider” during the October 2021 enrollment period and will only be allowed access annually during future Fall changeover periods.
   
   *Note: Members that opt for a “buy up” to the GHI-Senior Care can still procure simultaneously an independent PDP plan with no conflict.
   
   
3. The Alliance (Empire and Emblem Health) is actively communicating and publicizing the NYC Medicare Advantage Plus Plan nationwide. They are corresponding with their in- network Medicare Providers and providing extensive outreach nationally targeting out network providers, who accept the Medicare Reimbursement scheduled rates, encouraging them to join the network or educating them how to navigate the new plan and receive reimbursement for services.
   
   
4. Effective January 1, 2022 all new Medicare participants, or existing Medicare participants, outside those grandfathered, within the NYC Health Plan, will only have the option of enrolling in the NYC Medicare Advantage Plus Plan or the “buy up” GHI Senior Care (PPO) Program going forward. Annual changeover periods movement will be limited to these two programs. There will be no new plans becoming available to NYC Medicare participants into the future.
   
   
5. There are no conversations going on discussing elimination of the Medicare Part B reimbursement or the IRMAA. Anyone saying anything different is a liar!! That said Medicare participants are “strongly reminded” that any member who disenrolls or waives Medicare coverage from the NYC Health Benefits plan will be ineligible to receive the Medicare Part B reimbursement or the IRMAA.
   
   
6. Members will have on hand, as part of the Pre-Enrollment Guide (September 2021), an Opt-Out Form. This form will be used “only” if a Medicare participant chooses to opt out of the NYC Medicare Advantage Plus Plan.
   
   Important: Any member failing to document a decision to OPT OUT of participation in the new NYC Medicare Advantage Plus Plan and remain in their current plan by forwarding the required form, in a timely manner and as directed, will automatically be enrolled in the new NYC Medicare Advantage Plus Plan.
   
   Look out for the following communications from NYC OLR regarding the new
   “NYC Medicare Advantage Plus Plan”
   
   NYC OLR website for NYC Medicare Advantage Plus Plan announcement letter:
   https://www1.nyc.gov/assets/olr/downloads/pdf/health/retiree-ma-letter-073021.pdf
   
   Latest frequently Asked Questions:
   https://www1.nyc.gov/assets/olr/downloads/pdf/health/ma-faqs-08-12-21.pdf
   
   For further information NYC Medicare Advantage Plus Plan dedicated telephone number at 1-833-325-1190, Monday to Friday, 8 a.m. to 9 p.m.
   
   
7. New ID Cards for participants in the NYC Medicare Advantage Plus Plan will go out after the enrollment period and arrive by mail sometime in November 2021. This will be followed by a Welcome Kit mailing in December 2021.