12/06/2021
EmblemHealth New Medicare Advantage Plan in 2022 for CNY (City of New York) Members
Recently it was announced that all Medicare beneficiaries with Emblem Health (GHI) as their secondary insurance are going to be transferred to a combined BC/BS/Emblem Medicare Advantage plan (unless they opt out). No announcement has been made regarding deductibles and/or copay amounts and upon calling both Emblem and BC/BS no rep can tell me whether these members are going to be subject to any Medicare deductible and or copay/cost sharing. If subject to deductible is there any interface to determine this a la NGS Connex? Will Availity have this information? Right now on NGS Connex all other current MA plan members show a 0$ deductible remaining, however, some AARP-MC, Aetna MC etc. are indeed subject to the Medicare deductible. As the city is probably the largest single employer in NYC this represents a significant portion of most practices and will significantly affect us all but we have received very little in the way of specific information regarding this new MA plan. As an aside , all of my patients report they have not received any information on this subject as well. Thank you for your consideration of this matter.
If this plan is approved for 2022, the patients would have a deductible that would be slightly higher than the traditional Medicare part B deductible. The Medicare Advantage plan would have a deductible of $253, and traditional Medicare has a $233 part B deductible for 2022. After the deductible is met, patients will have to pay a $15 co-pay for each visit for office visits, with an out-of-pocket maximum of $1,470. When it comes to verifying deductibles, this information may or may not be available with NGS Connex, AvaIlity, or any third party vendor if doing an eligibility check with the patient’s Medicare MBI. To verify this information, it is recommended to check eligibility with the local Blue Cross vendor. For patients who decide to opt into the new Medicare Advantage plan, Anthem Blue Cross Blue Shield will be administering benefits for NYC retirees. Providers outside of the Anthem service area can check with their local Blue Cross carrier for co-pays, deductibles, and other benefits. As long as a provider is in network with either Blue Cross or Emblem Health, patients enrolling in this new managed care plan should be considered in network for their patients continued care.
In the event that a provider is OON, they can see City of New York retirees and will still get paid 100% of the Medicare Allowed rate. No contract required. You can continue seeing these members as long as you are eligible to receive payments from Medicare. Your reimbursement is the same as under Original Medicare. These members are not required to obtain a referral before they see a provider. While this is scheduled to go into effect in January, there are a lot of lawsuits and litigation surrounding this change where its implementation could be delayed since the announcement was made over the summer in this change from the current supplement benefits from Emblem Health and Blue Cross.