In a first for the American Maritime Officers Medical Plan, an annual limit or cap will be placed on out-of-pocket costs paid by retired AMO members not yet enrolled in Medicare, as well as their dependents eligible for AMO Medical Plan coverage, effective January 1, 2026.
The union and employer trustees of the AMO Medical Plan have unanimously approved an annual cap on out-of-pocket expenses for pre-Medicare retirees of $30,000 per individual and $60,000 total per family. Until now, there has been no limit on annual out-of-pocket medical expenses that could be required by health care providers for pre-Medicare AMO retirees and their families.
By introducing a cap on annual out-of-pocket expenses for retired pre-Medicare AMO members and their eligible dependents, the AMO Medical Plan will offer important financial protection in the event of a catastrophic medical event, helping to reduce the financial burden on retired members and their dependents.
The annual cap may alleviate the potential need for retired AMO members covered by the AMO Medical Plan to obtain a supplemental insurance policy to cover out-of-pocket expenses until they become eligible for Medicare. For retired members who do choose to purchase a supplemental policy prior to Medicare eligibility, the annual cap may ease the process for doing so, since the maximum annual out-of-pocket cost will now be known and limited.
For pre-Medicare retired AMO members and their eligible dependents, the AMO Medical Plan provides coverage on an 80 percent basis, with 20 percent in co-insurance and co-payments (when utilizing an in-network provider or facility). Once retired AMO members and their eligible dependents enroll in Medicare, AMO Medical Plan coverage becomes a Medicare wrap-around benefit, covering the out-of-pocket portion of the approved amount that Medicare does not cover.
To help offset the cost of capping annual out-of-pocket expenses for the coverage of retired pre-Medicare AMO members and their eligible dependents, all applicable co-payment amounts for certain services will be increased by $5 for all AMO Medical Plan participants, effective January 1, 2026.
The AMO Medical Plan has mailed new insurance cards to plan participants accounting for the $5 co-payment increase and the out-of-pocket limit for pre-Medicare retired AMO members. Participants were also notified by email of the distribution of the new AMO Medical Plan insurance cards.
Please Note: There are no changes to the Blue Cross – Blue Shield or the Smith RX identification numbers on the new AMO Medical Plan insurance cards that have been issued. If you have not received your new cards in the mail by January 1, 2026, your existing cards will still contain the correct identification numbers to access your medical and pharmacy benefits.
For active AMO members, active and qualified AMO applicants, and their eligible dependents, the cap on annual out-of-pocket expenses remains the same – $3,000 per individual and $6,000 total per family. For active members and their eligible dependents, the AMO Medical Plan provides coverage on a 90 percent basis, with 10 percent in co-insurance and co-payments (when utilizing an in-network provider or facility).
No insurance premiums are charged for coverage under the AMO Medical Plan.