• Important News Regarding Medicare Advantage Plans

  • Affinity will transition its Medicare Advantage plans to EmblemHealth effective January 1, 2019.
    This change affects Medicare members with the following Affinity Medicare plans:

    • Affinity Medicare Passport Essentials (HMO) Plan
    • Affinity Medicare Passport Essentials NYC (HMO) Plan
    • Affinity Medicare Ultimate (HMO-SNP) Plan
    • Affinity Medicare Solutions (HMO-SNP) Plan

    For the rest of 2018 (until December 31st), members will continue to receive their current Medicare benefits from Affinity. Starting January 1, 2019 Affinity will transition its Medicare plans to EmblemHealth. The Medicare Advantage benefits that were outlined in the Annual Notice of Change letter in late September will not change in 2019 and will be administered by EmblemHealth. Members do not have to take any action. Over the next few weeks, members will receive additional information from EmblemHealth, including a welcome call and EmblemHealth ID card.

    We are committed to offering members the support and service they may need to ensure a smooth transition to EmblemHealth. For questions, please contact an Affinity Customer Service Medicare Advocate at 877.234.4499 (TTY 711), Monday to Sunday from 8:00 a.m. to 8:00 p.m.

    Letter to Affinity Medicare Advantage Members: English | Spanish
    Letter to Providers: English  

  • FAQs for Medicare Advantage Members

    I heard Affinity is transitioning Medicare to EmblemHealth. What is happening at this time?
    Affinity will transition its Medicare Advantage plans to EmblemHealth effective January 1, 2019.
    How will this affect my Medicare coverage?
    For the rest of 2018 (until December 31st), you will continue to receive your current Medicare benefits from Affinity. Starting January 1, 2019 Affinity will transition its Medicare plans to EmblemHealth; your 2019 benefits will be provided by EmblemHealth.
    How does the Affinity Medicare transition affect my Medicare Advantage coverage?
    The 2019 Medicare Advantage benefits that you would have had through Affinity will be provided by EmblemHealth starting January 1, 2019.
    My family has coverage through Affinity’s Medicaid program. Is their coverage affected?
    No. This transition only affects Affinity’s Medicare Advantage plans. Coverage through any other Affinity plan – such as Medicaid, Essential Plan, Child Health Plus (CHP) and HARP (Enriched Health) – remains in place and is not affected in any way.
    Do I have to do anything at this time to ensure my Medicare coverage continues as is?
    No – at this time no further action is required. You will receive more information from EmblemHealth.
    What happens if I am in the middle of treatment when my Affinity Medicare Advantage plan is transferred to EmblemHealth?
    Affinity’s care management staff will work with you and your provider, as well as with EmblemHealth, to transition any ongoing care needs.
    What happens if my primary care physician is not part of the EmblemHealth network?
    Most of the providers participating in the Affinity network also participate with EmblemHealth. EmblemHealth is actively reaching out to those Affinity providers who are not currently in their network to invite them to join. Your provider also can contact EmblemHealth directly to become a participating provider by calling EmblemHealth Provider Customer Service at 866.447.9717 between 8:00 a.m.-5:00 p.m., Monday-Friday.
    Will my 2019 benefits change?
    At the end of September, all Affinity members were sent an Annual Notice of Change mailing about the changes to their Medicare benefits for 2019. The benefit changes outlined in that communication are the same ones that EmblemHealth will provide on January 1, 2019.
    Will I receive a new ID card from EmblemHealth?
    Yes, EmblemHealth will issue new ID cards to all members.
    Who is EmblemHealth?
    EmblemHealth has served the New York City area and surrounding communities for more than 75 years and is one of the largest not-for-profit health plans, serving 3.1 million people across the New York tri-state area. EmblemHealth was formed from two companies, Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP).
    Who can I contact if I need help choosing a new Medicare Advantage plan?
    For help choosing a new plan you may call Health Insurance Information, Counseling and Assistance Program (HIICAP) at 800.701.0501. Counselors are available to answer your questions, discuss your needs, and give you information about your options. All counseling is free. You can also call 800.MEDICARE (800.633.4227) 24 hours a day, 7 days a week, or refer to your Medicare & You Handbook for a list of all Medicare health and prescription drug plans in your area.
  • FAQs for Providers

    I saw an article in Crain’s that Affinity is transitioning Medicare members to EmblemHealth. What is happening at this time?
    Effective January 1, 2019, Affinity Health Plan will transition its Medicare Advantage Plan members to EmblemHealth. After that date, EmblemHealth will administer the Medicare Advantage contract in accordance with regulatory requirements.
    What about the letter I received from Humana and Affinity regarding joining Humana’s provider network?
    You can still join Humana’s network and if you have already signed a contract with Humana, nothing will change. However, Affinity will not be transferring its Medicare business to Humana on January 1, 2019.
    As a provider, how does this affect my participation in the Affinity network?
    This transaction affects only Affinity’s Medicare program, including Affinity Medicare Ultimate, Affinity Medicare Solutions, Affinity Medicare Essentials and Affinity Medicare Essentials NYC. Your participation in other Affinity programs – such as Medicaid, Essential Plan, CHP and HARP – remains in place and is not affected in any way by this transaction.
    Are there any changes at this time to how I submit claims and / or requests for authorizations and appeals?
    No. You should continue to submit claims, as well as requests for authorizations and appeals, in the same way that you currently do. Until the Affinity Medicare members are transitioned to EmblemHealth – which is on January 1, 2019 – Affinity will continue to process claims, authorizations and appeals and perform all other requirements under its Medicare contract. All claims and appeals for dates of service on or before December 31, 2018 will continue to be processed by Affinity. Dates of service on or after January 1, 2019 will be the responsibility of EmblemHealth.
    What about transition of care for my Affinity Medicare patients who are in the middle of treatment?
    Affinity’s Care Management staff will work with providers and members, as well as with EmblemHealth, to transition any ongoing care needs that may exist at December 31, 2018.
    What if I don’t have a network contract with EmblemHealth at this time?
    In order to continue to take care of Affinity’s Medicare members and receive in-network reimbursement beginning January 1, 2019, you will need to have a network participation agreement in place with EmblemHealth. If you currently do not have a network participation agreement with EmblemHealth, and you want to join their network, please call EmblemHealth Provider Customer Service at 1-866-447-9717 during the hours of 8:00am-5:00pm Monday- Friday.
    Can I still see my Affinity patients if I don’t want to contract with EmblemHealth?
    You can continue to see your Affinity patients through December 31, 2018. You’ll need to be contracted and credentialed through EmblemHealth to see your Affinity patients in 2019.
    Can Affinity Members keep their current Affinity Plan in 2019?
    At the end of September, all Affinity members were notified about changes to their Medicare benefits for 2019. The benefits outlined in that communication are the same benefits that EmblemHealth will administer on January 1, 2019.
    Will Affinity members receive new ID cards?
    Yes, EmblemHealth will issue new ID cards to all members.