Middle Country retirees briefed on district‑sponsored Anthem Medicare Advantage plan; enrollment effective May 1

Jim Donovan, assistant superintendent for human resources for Middle Country Central School District, opened a retiree education meeting to introduce a new district‑sponsored Medicare Advantage plan and the vendors administering it.

Kim Parker, who said she works in Anthem’s group retiree solutions for Medicare Advantage, told attendees the plan combines Medicare Part A and Part B, NYSHIP secondary coverage and prescription benefits into a single group Medicare Advantage plan administered by Anthem Blue Cross Blue Shield. "This is a group sponsored Advantage Plan," Parker said, adding that it is not an individually marketed plan and includes extra benefits beyond traditional Medicare.

Anthem representatives said core cost sharing under the district plan includes a $0 medical deductible, $25 copay for primary‑care and specialist visits, inpatient hospital stays covered at 100% and a $3,650 annual maximum out‑of‑pocket for medical services. Additional benefits listed by Anthem include a routine hearing exam and a hearing‑aid allowance (up to $1,500 per ear, $3,000 maximum every four years), eyeglass/contact benefit every two years, routine foot care (12 visits per year) and access to the SilverSneakers fitness program.

Pharmacy benefits were described in tiers: Anthem said generic prescriptions carry a $0 copay (retail 30‑day or 90‑day retail/mail), preferred brand 30‑day retail copays were listed at $30 and nonpreferred brand 30‑day copays at $60; maintenance 90‑day supplies were described with higher 90‑day copays for brand tiers. Anthem said specialty medications are dispensed 30 days at a time but prior‑authorization renewals for specialty meds can be approved for 12 months.

Anthem emphasized network access: the plan uses the Blue Cross Blue Shield national PPO network so members may see Medicare providers nationwide and, according to Anthem, can see out‑of‑network Medicare providers with the same cost sharing as in‑network providers. Parker said providers coordinate prior authorizations with Anthem and that members do not need to manage authorization logistics.

Benistar Admin Services (the district’s third‑party administrator) presented itself as a retiree concierge and advocate that will help with enrollment, provider and pharmacy lookups, claims issues and billing. Emily, a Benistar associate, explained the enrollment process: retirees will be auto‑enrolled but Benistar needs Medicare numbers to complete enrollment; eligible members who do not want the plan must call to opt out. Benistar said it will bill members monthly for any member contribution and can set up ACH payments.

District staff and vendor representatives gave several operational details: an approximate example premium figure was discussed during Q&A (Anthem staff said an example individual premium is in the neighborhood of $250 per month and family roughly double that, though exact amounts vary by bargaining unit and contractual contribution); some bargaining units will retain contractual rights to opt out and return to NYSHIP, while others will not; there is a 90‑day window to return to NYSHIP after electing the Anthem plan for groups that have that contractual option; and the plan’s effective date is May 1. Staff said the contract has an evergreen clause and was contracted through 2025 with annual renewals thereafter.

Attendees raised questions during a lengthy Q&A. A physician in the audience warned against choosing plans on price alone and recounted past delays getting authorizations for tests, asking how Anthem defines an emergency and how quickly authorizations are handled. Parker and Benistar staff replied the plan follows CMS/Medicare guidelines for emergency care and that Benistar will advocate and expedite urgent authorizations with providers when necessary. Several attendees asked whether the district would benefit financially; staff said the district sought an equal or better plan at lower cost because NYSHIP retiree costs had risen sharply and the negotiated program offers long‑term stability language with Anthem but cannot guarantee future CMS adjustments.

District officials and vendors repeatedly told attendees that exact monthly member contributions depend on the retiree’s bargaining unit and negotiated contribution rate; staff urged retirees to check the enrollment letter (which, they said, notes opt‑out eligibility on page 3 for certain units) and to contact benefits or Benistar for a unit‑specific cost calculation. Vendors also highlighted member tools — the Sydney Health app, LiveHealth Online telemedicine (0 copay), a 24/7 nurse line, and online 'Find Care' resources — and said formulary exception requests are approved in the majority of cases.

The meeting concluded with staff and vendor representatives remaining available to answer individual questions. Attendees were directed to additional scheduled webinars and told to call Benistar or Anthem for personal, HIPAA‑protected concerns.

Ending: The district will proceed with auto‑enrollment and a May 1 effective date; eligible retirees concerned about the change were told they can call Benistar or benefits for unit‑specific cost details and, if eligible by contract, can return to NYSHIP within a 90‑day window or during future open enrollment.