NYC Retirees with Emblem/Empire

[FargoI]

Admins- hopefully this is a permissible thread.

Hello. I am looking to learn from others who retired from the City of New York and currently participate in either NYC's Pre-65 Empire/Emblem(GHI) coverage or Medicare+ NYC's GHI (Senior Care).

I am particularly interested in learning how folks who live outside the tri-sate are navigating around the low reimbursement rates for non-par providers ($28 for a PCP visit). Thank you.

Stay safe. Stay well
FARGOI

 

[MichaelB]

No problem with the thread, but it’s been moved to the health care forum where it should get more visibility.

 

[braumeister]

Admins- hopefully this is a permissible thread.

Hello. I am looking to learn from others who retired from the City of New York and currently participate in either NYC's Pre-65 Empire/Emblem(GHI) coverage or Medicare+ NYC's GHI (Senior Care).

I am particularly interested in learning how folks who live outside the tri-sate are navigating around the low reimbursement rates for non-par providers ($28 for a PCP visit). Thank you.

Stay safe. Stay well
FARGOI

My mother retired from there and had that coverage. She moved to Ohio and ran into this situation where they never paid much on her claims. We tried for a while, talked to lots of people there at Emblem/GHI but never really got past their stone wall. Mom died in 2012, but I doubt if much has changed since then. All I can do is wish you well.

 

[FargoI]

Condolences on your Mom's passing. I'm told once Medicare is in place- as the primary, GHI is a reasonable secondary. Where one does not have a participating provider under their primary insurance, guarantors are subject to 'balance billing.' Balance billing for those that are unaware....for any insurer, can be a financial nightmare.

 

[braumeister]

Condolences on your Mom's passing. I'm told once Medicare is in place- as the primary, GHI is a reasonable secondary.

I would have to disagree with whoever told you that. They paid very little of what Medicare didn't pay.

 

[FargoI]

From your recollection, were the Ohio clinicians Medicare participating clinicians? What i was told was as a secondary payer to Medicare, where Medicare is accepted...the secondary payments were sufficient to take the sting away.

 

[braumeister]

From your recollection, were the Ohio clinicians Medicare participating clinicians? What i was told was as a secondary payer to Medicare, where Medicare is accepted...the secondary payments were sufficient to take the sting away.

Unfortunately, that was not the case. Medicare was fine; they paid normally. But GHI paid hardly any of the Medicare deductible.

Possibly things have improved since then, but do your due diligence.

 

[MichaelB]

A web search turns up this plan document. https://www.emblemhealth.com/conten...r_City_of_New_York_Employees_and_Retirees.pdf

This is a Medicare Supplement plan. Medicare pays for about 80% of eligible expenses, and the supplement covers the remaining 20%. The provider network is nationwide and includes all physicians and organizations that participate in Medicare. Participating providers cannot balance bill.

With a Medicare Supplemental Plan, Medicare determines the reimbursement rate and eligibility of a charge. The supplemental insurer doesn’t have the choice of no paying once Medicare approves the procedure.

 

[MBSC]

Medicare was fine; they paid normally. But GHI paid hardly any of the Medicare deductible.

A web search turns up this plan document. https://www.emblemhealth.com/conten...r_City_of_New_York_Employees_and_Retirees.pdf

This is a Medicare Supplement plan. Medicare pays for about 80% of eligible expenses, and the supplement covers the remaining 20%. The provider network is nationwide and includes all physicians and organizations that participate in Medicare. Participating providers cannot balance bill.

Correct. There are multiple retiree plans available but the GHI Senior Care retiree plan acts like an individual-market Medicare supplement. The member is responsible for the "Medicare Deductible" (doesn't specify Part B only or both A/B) plus the first $50 of additional Medicare cost sharing (plan deductible).

(Page 33) GHI Senior Care

If you are a retiree eligible for Medicare, you can enroll in the GHI Senior Care program. You may have a deductible to pay before your plan begins to pay. Annual deductible: $50 after meeting Medicare deductible. GHI will pay 20% of the reasonable charge as determined by Medicare, after Medicare has paid 80% of the reasonable charge.

 

[FargoI]

Thank you to all for the feedback and information.

If anyone has experience with pre-65 Emblem coverage outside of the tri-state area, I would appreciate hearing about your experiences.