Gloversville Enlarged School District moves to Medicare Advantage plan from Anthem

The Gloversville Enlarged School District in New York will offer a Medicare Advantage (PPO) plan with Anthem beginning May 1, 2024. The Anthem plan will provide medical benefits for school district retirees, including the National Access Plus benefit. The plan allows members to receive services from any provider if the provider is eligible to receive payments from Medicare. School district members’ copay or coinsurance percentage will be the same whether their provider is in- or out-of-network.

The Medicare Advantage plan offers the same hospital and medical benefits that Medicare covers, while covering additional benefits that Medicare does not, such as LiveHealth Online^® and SilverSneakers^®.

Locally or nationwide, doctors’ or hospitals,’ member share-of-cost (SOC) does not change. Non-contracted providers may continue treating school district members and will be reimbursed 100% of Medicare’s allowed amount for covered services. The prefix on the Medicare Advantage ID cards is XLU.

Detailed prior authorization requirements are also available to contracted providers by accessing the Availity Essentials Provider Self-Service Tool at availity.com. Providers will follow their normal claim filing procedures for Gloversville Enlarged School District member claims. They may call Provider Services at 800-450-8753 for eligibility, prior authorization requirements, and any questions about school district member benefits or coverage.

Through our efforts, we can help our care provider partners deliver high quality, equitable healthcare.