NYC Aetna Medicare Advantage Plan

Are you a retiree in NYC weighing your Medicare options? The Aetna Medicare Advantage plan might be a solution for 2025, with potential for $0 premiums and added benefits over traditional plans. But what does it exactly entail and how does it fit into your healthcare strategy?

This no-fluff guide demystifies the NYC Aetna Medicare Advantage plan – coverage, costs, network – to help you decide.


Key Takeaways

  • The Aetna Medicare Advantage Plan in NYC provides comprehensive healthcare coverage for retirees, potentially offering lower out-of-pocket costs with premiums as low as $0 and including additional benefits like prescription drugs and wellness programs.


  • Compared to traditional Medicare, the Aetna Medicare Advantage Plan features an out-of-pocket maximum limit, which can protect retirees from high unexpected medical costs, while offering a broader scope of services including routine check-ups and preventive care.


  • Recent legal challenges have led to a permanent injunction blocking the transition of NYC retirees to Aetna’s Medicare Advantage Plan, thereby allowing them to retain their existing traditional Medicare coverage.

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Exploring the Aetna Medicare Advantage Plan in NYC

The Aetna Medicare Advantage Plan has become a popular choice for healthcare coverage among NYC retirees. This plan provides coverage for all included services at 100%, allowing retirees to have their own health coverage. But how does this plan stack up against traditional Medicare?

A close examination reveals that the Aetna Medicare Advantage Plan in NYC offers comprehensive coverage, including prescription drug coverage and extra benefits. Moreover, it may offer premiums as low as $0, which can significantly reduce out-of-pocket costs for retirees. This is a game-changer for many retirees, who now have the opportunity to enjoy extensive coverage without the worry of hefty expenses.


Exploring the Aetna Medicare Advantage Plan in NYC

Where might retirees source further information about this plan? The answer lies in the myriad resources available, including:


  • Aetna’s official website
  • The UFT’s FAQ specifically related to the Aetna Medicare Advantage PPO plan
  • The NYC Health Benefits Program section designated for retirees on the NYC Office of Labor Relations website


Armed with these resources, retirees can make informed decisions about their health coverage.


The Basics of Aetna Medicare Advantage

Understanding the basics of the Aetna Medicare Advantage Plan:


  • It is a privatized plan administered by Aetna
  • The primary objective is to assist individuals in living their healthiest lives, both physically and mentally
  • It was proposed as a city plan for NYC retirees, marking a significant shift in the healthcare landscape.


Aetna offers a range of Medicare Advantage plans, such as HMO-POS plans, PPO plans, and Dual Special Needs Plans (DSNP). Catering to the diverse needs of many retirees, these plans have specific eligibility criteria. For instance, individuals must be at least 65 years old or have a qualifying disability, and most HMO plans necessitate that enrollees have a primary care physician (PCP).

While the variety of plans and eligibility criteria creates confusion among potential enrollees, it also offers an array of choices to suit different needs and preferences.


Coverage Details for City Retirees

For any retiree in NYC, understanding the coverage details is an important step. The Aetna Medicare Advantage Plan offers unlimited coverage for inpatient hospitalization and includes coverage for routine check-ups and preventive care services.

However, not all retirees embraced this plan with open arms. Some were extremely disappointed due to concerns about restricted access to medical providers and increased out-of-pocket expenses.

In terms of prescription drug coverage, the Aetna Medicare Advantage Plan (PPO) with Extended Service Area (ESA) in New York City offers substantial benefits. These include retail copays of $0/$20/$40 for a 30-day supply and mail order copays of $0/$40/$80 for a 90-day supply, up to $2,960 in total drug costs.

Beyond traditional medical coverage, city retirees can also enjoy supplementary benefits such as:


  • Reduced deductibles
  • A limit on out-of-pocket expenses
  • Transportation
  • Fitness programs
  • Wellness incentives
  • Specified dental and vision services


This comprehensive offering underscores the Aetna Medicare Advantage Plan’s commitment to promoting overall health and wellness among retirees.


Comparing Costs: Traditional vs. Privatized Plans

The Aetna Medicare Advantage plans offer varying monthly premiums when costs are compared between traditional Medicare and privatized Medicare Advantage plans for HMO plans, ranging from $0 to $99, and for PPO plans, ranging from $0 to $99, with annual deductibles ranging from $0 to $1,000.


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In contrast, traditional Medicare plans in NYC exhibit an average monthly cost of $44, and enrollees need to procure a separate Part D plan for prescription drugs, which involves its own premiums.

One major difference lies in the out-of-pocket expenses. Under traditional Medicare, there is no out-of-pocket maximum, potentially leading to increased costs for recipients. Conversely, Medicare Advantage plans feature an annual out-of-pocket cap, which serves to limit the total expenses that participants may encounter.

This comparison provides a clear picture of the cost benefits associated with the Aetna Medicare Advantage Plan, making it a viable option for city retirees.

Navigating Health Coverage with Aetna Medicare in New York

Though navigating health coverage might seem as challenging as sailing uncharted waters, with appropriate guidance, one can confidently reach their destination. When it comes to finding preferred doctors under Aetna Medicare in New York, individuals can utilize the search feature on the Aetna Medicare website after logging in.

This enables them to identify doctors and specialists within their plan’s network, ensuring seamless access to healthcare services.

Grasping the concept of out-of-pocket expenses is another vital aspect. When enrolled in Aetna Medicare in New York City, standard out-of-pocket expenses may include premiums, deductibles, and copayments.


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For prescription drug coverage, after reaching a copay total of $2,960, individuals are then accountable for 50% coinsurance on Generic/Brand drugs until reaching the true out-of-pocket threshold of $4,700.

Although the term ‘cost-sharing’ may seem intricate, it is quite straightforward. In the context of Aetna Medicare in NYC, cost-sharing refers to the sharing of costs between the insurance provider and the insured individual.

Under Original Medicare, a typical cost-sharing arrangement involves a 20 percent coinsurance for most doctor visits and services, with the plan covering the remaining 80 percent. Understanding these terms can help retirees accurately estimate their healthcare expenses and plan their finances accordingly.


Finding Your Preferred Doctors

Identifying in-network doctors is a key step towards ensuring uninterrupted access to healthcare services. With the Aetna Medicare Advantage Plan in NYC, individuals can utilize the Aetna website’s search tool to locate doctors, dentists, hospitals, and other providers covered by their plan. This tool is reliable and can be used by both members and non-members alike.

The Aetna Medicare Advantage Plan network in NYC is quite comprehensive and includes a variety of specialty doctors.

However, if a doctor or specialist departs from the Aetna Medicare Advantage network, it’s important to note that out-of-network care will only be covered in emergencies. In other cases, the full cost will be the responsibility of the individual, and there are designated timeframes for altering or discontinuing the Medicare Advantage plan.


Understanding Out-of-Pocket Expenses

Grasping out-of-pocket expenses is a key aspect of managing your healthcare costs. With the Aetna Medicare Advantage Plan in NYC, the highest out-of-pocket limit is $8,300 for in-network services and $12,450 for in-network and out-of-network services combined.

A participant hits the yearly limit for out-of-pocket expenses when a specific amount has been paid. After this threshold is reached, there will be no further out-of-pocket expenses for Medicare-covered medical services for the remainder of the year.

Cost-sharing plays a significant role in determining out-of-pocket expenses for Aetna Medicare Advantage plan members. Through monthly premiums, copays, and coinsurance, cost-sharing can result in lower expenses for plan members compared to the 20 percent coinsurance typically charged by Original Medicare for various doctor visits and services.

However, it’s important to remember that members may incur out-of-pocket expenses in the following situations:


  • Seeking services from out-of-network providers
  • Receiving dental care beyond preventive measures
  • Being required to pay varying premiums, deductibles, and copayments.

Fitness and Wellness Benefits with Aetna Medicare

The fitness and wellness benefits constitute a major perk of the Aetna Medicare Advantage Plan. The plan includes fitness programs such as SilverSneakers instructor-led group fitness classes, providing retirees with an excellent avenue to maintain their physical health. But how can retirees enroll in these programs?

The enrollment process for fitness programs under Aetna Medicare Advantage plans is surprisingly straightforward for New York retirees., which provide fitness benefits to plan members, such as membership to SilverSneakers.

Furthermore, virtual mental health visits under Aetna Medicare require a $0 copay, making mental health assistance easily accessible to members. This access to virtual health resources can be facilitated through diverse telemedicine options, such as provider checkups with Teladoc or the Health Home Visit program with a licensed clinician.

Beyond fitness and mental health, the plan also covers an annual wellness visit at no additional cost. This encompasses routine measurements such as height and weight, as well as preventive screenings, including a blood screening test for diabetes.

These comprehensive fitness and wellness benefits underscore Aetna Medicare’s commitment to promoting overall health and well-being among city retirees.


Enrolling in Fitness Programs

Enrolling in fitness programs is a breeze with Aetna Medicare Advantage. The plan provides access to SilverSneakers instructor-led group fitness classes, and certain locations may offer supplementary classes.


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To enroll in these programs, retirees can simply utilize their Aetna Medicare Advantage plan membership, making it easy to participate in a variety of classes depending on their preferences and fitness goals.

Moreover, there are no additional fees for enrolling in fitness programs such as SilverSneakers; they are included within the Aetna Medicare Advantage Plan benefits at no additional cost. This makes it easy and cost-effective for retirees to stay active and healthy, further enhancing the appeal of the Aetna Medicare Advantage Plan.


Virtual Health Resources

In today’s digital age, virtual health resources are a significant boon. Aetna Medicare provides virtual mental health consultations with an MDLIVE Board Certified therapist or psychiatrist, enabling members to access mental health assistance through phone or video chat consultations. This service can address a range of mental health disorders, including depression, anxiety, and substance use disorders, providing comprehensive mental health support to members.

Arranging a virtual mental health appointment with Aetna Medicare is easy. Individuals can utilize telehealth services to connect with participating in-network primary care providers, specialist care, urgent care clinics, and mental health support for scheduled consultations.

In addition to this, the Aetna Medicare webcast series covers subjects related to maintaining a healthy and happy lifestyle, providing educational support to members. With these resources, retirees can easily manage their health right from the comfort of their homes.

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The Legal Landscape: NYC's Medicare Advantage Plan Developments

There have been substantial developments in the legal landscape surrounding NYC’s Medicare Advantage Plan. The city retirees won a legal case, leading to a permanent injunction by a judge of the New York State Supreme Court that halted the proposed transition to Aetna’s for-profit Medicare Advantage plan.

This decision ensures that the retirees can retain their existing traditional healthcare coverage.

The court’s decision has a wide-reaching impact, affecting an estimated 250,000 retirees who will now maintain their current traditional healthcare coverage instead of being moved to the Aetna Medicare Advantage Plan. This was a significant departure from the city’s initial plan to transition NYC retirees from their conventional Medicare coverage to a privatized Medicare Advantage Plan provided by Aetna.


Court Ruling Impact

The court’s ruling on the Aetna Medicare Advantage Plan has had a profound impact on NYC retirees. The court permanently enjoined NYC from transitioning retirees to a privatized Medicare Advantage plan administered by Aetna. This decision affects 250,000 retired city employees, who will now continue to be enrolled in traditional Medicare.


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The lawsuit was prompted by concerns such as the potential for restricted access to medical providers, increased out-of-pocket expenses, and instances of necessary care being denied under the plan. The successful plaintiffs in the lawsuit were retirees who challenged the city’s attempt to switch them to the Aetna Medicare Advantage Plan.


City Hall’s Response

City Hall’s response to the court ruling, under the leadership of Mayor Eric Adams, has been one of resilience. The legal representatives of the city intend to file an appeal against the ruling. This shows the city’s commitment to pursuing its original plan of transitioning retirees to the Aetna Medicare Advantage Plan.

However, the appeal process at City Hall is presently ongoing, and the plan has been put on hold due to a preliminary injunction that originally blocked its implementation scheduled for September 1.

Despite these challenges, City Hall has taken steps to ensure that there have been no alterations to retiree health insurance, and retirees have not been compelled to transition to a Medicare Advantage plan. This demonstrates the city’s commitment to ensuring the well-being of its retirees.

Support and Advocacy for NYC Retirees

Advocacy and support are vital in safeguarding the rights of NYC retirees. Unions in NYC, such as the City Health Plan and Union/Welfare fund, provide Creditable Prescription Coverage and assistance to retirees in choosing their health coverage. Furthermore, organizations such as PSC-CUNY aid NYC retirees in maintaining their existing health insurance.

Unions fulfill their responsibilities by engaging in bargaining, lobbying, and negotiating with employers to secure adequate pension and retirement benefits. They strive to enhance health benefits and the overall experience of retirees while simultaneously reducing costs. Amidst the legal and policy developments, these unions have been a beacon of support for retirees.

Retirees seeking to make well-informed decisions about their health coverage have several resources at their disposal. These include:


  • The plan they have chosen, which will provide information regarding their health benefits coverage
  • The New York City Department for the Aging’s Health Insurance Information, Counseling and Assistance (HIICAP), which offers a guide for retirees
  • HIICAP itself, which provides free and confidential health insurance information, counseling, and assistance.


Union Involvement

In advocating for the health coverage of NYC retirees, public sector unions play a major role. They are dedicated to preserving the health insurance benefits for retirees and resisting any alterations that could have a detrimental impact on their healthcare.


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Unions in New York City have had a substantial impact, including:


  • Approving a mandate for Medicare Advantage for retired city workers and advocating for the implementation of these plans for retirees
  • Staging protests against alterations to a municipal regulation safeguarding healthcare benefits
  • Resisting agreements that transition retirees from traditional Medicare
  • Securing a temporary injunction from a judge to halt the city’s initiative to transfer retirees to privatized Medicare


These actions demonstrate the influence and advocacy of unions in protecting the healthcare benefits of city workers.


Resources for Making Informed Decisions

To help retirees understand their Medicare Advantage Plan, Aetna offers the following resources in NYC:


  • Workshops and seminars
  • A dedicated helpline
  • Online resources on the Aetna Medicare website and Forbes Health
  • Healthcare plans for benefits packages
  • Plan Comparison Tool on NYSHIP Online or the NYCAPS ESS system


These resources are available to retirees in NYC to provide information and assistance with their Medicare Advantage Plan.

Retirees seeking personalized advice can access an updated list of NYC healthcare advisors for retirees through the NY State of Health website and the New Millenium NY, Inc. directory of home health services.

These resources can help retirees make informed decisions about their health coverage, ensuring that they receive the care they need.


In conclusion, the Aetna Medicare Advantage Plan offers a comprehensive coverage plan for city retirees, with a range of benefits from basic medical coverage to fitness and wellness programs. Despite legal hurdles and opposition, the city continues to advocate for the transition to this plan, believing in its potential to offer quality care at reduced costs.

However, the final decision rests in the hands of the retirees themselves, who, with the help of unions and various resources, can make well-informed choices about their health coverage.

Frequently Asked Questions



What is the difference between Aetna and Aetna Advantage?

Aetna Medicare Advantage offers the same coverage as Original Medicare along with additional benefits and access to health programs to help reach health goals, such as SilverSneakers® fitness membership and more.


→  What is the NYC Medicare Advantage plan?

The NYC Medicare Advantage plan is a private insurance alternative to original Medicare, offering all the same benefits and often additional coverage for dental and vision care.


→  Is Aetna available in NYC?

Yes, Aetna is available in NYC, offering a Medicaid Managed Long Term Care plan for those who qualify.


What services are included in the Aetna Medicare Advantage Plan for city retirees?

The Aetna Medicare Advantage Plan includes coverage for all services at 100%, providing retirees with comprehensive health coverage.


How can I find in-network doctors under the Aetna Medicare Advantage Plan in NYC?

You can find in-network doctors by using the search feature on the Aetna Medicare website after logging in. This will help you locate the doctors you need within the Aetna network.

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.