12/13/2021

New BC/BS Emblem Retirees Plan-NYC-Patient Deductibles and Responsibility

With the new (BC/BS-Emblem) Medicare Advantage (Alliance) plan coming in 2022. Are their members subject to medicare deductible? Are they subject to the secondary deductible that most GHI members had? If so what mechanism can we use to check the deductible amount both primary (medicare) and "secondary"? NGS Connex typically shows for medicare advantage plans that the patient has a zero deductible balance when in fact thru their MA plan some patients are still subject to the yearly medicare deductible. My office has tried to call both BC/BS and Emblem Health but their representatives were not helpful and didn't have that information.

When this plan is made available to NYC retirees, patients will be subject to an annual deductible of $253. The annual part B deductible of $233, with an additional $20 for the Medicare Advantage plan. This would be less than the Emblem Health/GHI deductible, which is typically $50 after the annual part B deductible has been satisfied. If patients enroll in this Medicare Advantage plan, coverage will not be under Emblem Health- claims will be submitted and processed by the local Blue Cross plan (if outside the Empire Blue Cross service area) only.

Checking eligibility and part B deductible will be through the local Blue Cross carrier through Blue Card eligibility, or by using a third party such as Navinet or Availity. We cannot be certain whether or not individual deductible information will be available in NGS Connex- if a patient is enrolled in any Medicare Advantage plan, we recommend that cost sharing accumulations such as deductible or out of pocket max be verified with a third party that can provide additional information, due to NGS Connex having limited information.