NYC Retiree Health Benefits - Update

Significant changes for how retirees of NYC government and eligible dependents age 65 and older receive their health insurance benefits were approved and will take effect September 1, 2023. NYC retirees age 65+ and their eligible dependents have had choices in how they receive their retiree health insurance benefits, with the vast majority of retirees in either HIP VIP HMO, or GHI Senior Care.

Beginning September 1, 2023, retirees in HIP VIP HMO will remain in this plan, unless they make a change to their coverage. All other Medicare-eligible retirees and their Medicare-eligible dependents will be placed into a new Aetna Medicare Advantage PPO plan, unless they enroll in the HIP VIP HMO in April or May (they must live downstate in order to be in HIP VIP HMO). Retirees also have the option of waiving retiree health coverage, though those who do so will not receive Part B premiums reimbursement or any IRMAA reimbursement for those responsible for higher premiums.

Since the new Aetna Medicare Advantage plan is a national Preferred Provider Organization (PPO), members will be able to use the plan when seeing providers who are in or out of Aetna’s network, so long as the provider accepts Medicare.

Prior authorization is always a consideration when discussing managed care. With the Aetna Medicare Advantage PPO, the following services will require prior authorization: hospital inpatient stays, skilled nursing facility stays, long term acute care stays, acute physical rehabilitation stays, services that could be experimental, investigational or cosmetic, and a limited list of Part B and Part D drugs. A chart comparing costs and benefits in GHI Senior Care, HIP VIP HMO and Aetna Medicare Advantage PPO can be found here.

For more information about this change, visit NYC’s Office of Labor Relations website here or Aetna’s website specifically for NYC retiree health benefits here. There are virtual and in-person events scheduled through July 2023 where one can learn more about this change; the schedule can be found here.