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Dollars and Common Sense: Medicare Advantage for Retirees Can Work Well, With the Right Oversight


The City Labor Committee has handed Mayor Adams a victory, but no doubt set up future battles by approving the latest version of the proposed Medicare Advantage plan for retirees.

Former employees who have opposed the change are right to point out some of the general concerns related to these plans, including a prior authorization system that can delay needed care and challenge medical providers’ decisions about patient necessity, as well as as a small group of doctors within the network.

However, this is not an out-of-the-box product identical to other Medicare Advantage plans. The city has spent months using its significant financial clout to get insurer Aetna to tailor a plan to the city’s specifications, including a much smaller list of procedures subject to prior authorization with a commitment to participate in periodic reporting on denials and rationalizations. .

The vast majority of doctors who accept the expiring SeniorCare program will also accept the Medicare Advantage Plan. Aetna cap annual deductibles lower than the current program, as well as instituting an out-of-pocket maximum of $1,500 per year. The insurer’s profit motives will no doubt push it to skimp on care, which is why the city is rightfully committing to continuous monitoring.

Detractors point to examples of negative impacts, such as a person living in an assisted-care facility that may require residents to maintain traditional Medicare. These cases must be taken seriously and the city must intervene directly with the providers to alleviate any potential friction. However, policy making for hundreds of thousands of people cannot be done on the basis of possible setbacks in specific cases, and the fact remains that the Stabilization Fund must be replenished.

The city erred in looting the fund for unrelated expenses and should commit to leaving it for its intended purpose. If you want to find additional savings to help smooth things out for retirees, it’s worth discussing a nominal premium for active employees, who are virtually alone among public sector employees nationwide who don’t pay any premiums.

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