As his administration pushes to switch retirees from the city to a controversial Medicare Advantage plan, Mayor Adams will not authorize an implementation structure that would have given retirees the option to stay on traditional Medicare at no additional cost, a spokesman for the mayor said Wednesday. .
The pushback came a day after the Daily News reported that a large segment of the city’s 250,000 retirees pleaded with Adams to choose the alternative implementation framework, known as “Option C,” out of concern that their profits are ruined if they do. you are enrolled in Advantage.
However, Adams’ spokesman, Charles Lutvak, said it would make no sense for the mayor to choose Option C, because it would undermine the rationale for removing retirees from traditional Medicare coverage in the first place: budget savings.
“Such an approach would result in minimal savings and would undermine the city’s ability to continue to provide premium-free, high-quality care to active and retired employees,” Lutvak said of Option C. “As a result, we do not intend to offer this option to active or retired employees.”
The push to put retirees on an Advantage plan began in the fall of 2021 under former Mayor Bill de Blasio.
Like de Blasio, Adams has argued the change is necessary because the city projects it can save about $600 million a year if retirees have Advantage coverage instead of traditional Medicare. Adams has also argued that Advantage would ensure strong coverage for retirees.
Thousands of retirees have responded that they would lose access to certain doctors, medical procedures, and drugs with Advantage. They have pointed to federal studies showing that Advantage plans deny “medically necessary” care because, unlike traditional Medicare, they are run by private insurance providers who require prior authorization for some patients.
In response to demands from a group of grassroots retirees, the courts blocked the Adams administration from enacting the first iteration of its Advantage plan last year, ruling that a provision that would have imposed monthly premiums of $191 on retirees who wanted to staying in traditional Medicare violated a local law.
To circumvent that, Adams, with the support of city public sector union bosses, reached an agreement with health insurance giant Aetna this month that makes Advantage the only premium-free health care option available to the required city workforce, with a Sept. 1. start date. They have maintained that the agreement complies with court decisions.
Against that backdrop, anti-Advantage retirees saw a glimmer of hope in Option C, which was included in Aetna’s recently launched Advantage contract as one of three implementation paths from which Adams could choose.
While retirees could stay on traditional Medicare under Option C at no increased cost, the Adams administration would have to pay $20 per month for each member who made that choice, the contract states. The other two implementation frameworks, “Option A” and “Option B,” would make Advantage the only premium-free insurance available to retirees, though version B would allow them to enroll in traditional Medicare at their own expense.
Lutvak would not say which option Adams is more inclined to choose between A and B, or why C was included in the contract if it had not been considered. He also did not say how much the city’s projected budget savings would be reduced by Option C.
Lutvak reiterated that the only scenario in which the administration would be inclined to offer traditional Medicare, a setup that features a city-subsidized supplement known as Senior Care, is if retirees pay a premium for it.
“We support offering retirees the option to remain in Senior Care while paying a monthly premium, but without the City Council action that we have advocated for, we will move forward with eliminating Senior Care,” said Lutvak, referring to the legislation that management filed unsuccessfully. Council last year.
Marianne Pizzitola, a retired FDNY EMT who runs the New York City Public Service Retiree Organization, speculated that the Adams administration included Option C in the contract as a contingency in case the new Advantage plan is blocked. in the court.
“To date the mayor has never spoken to us, but if he had, I think he would tell me that he knew he was going to lose the next court battle and that he had to put option C in the contract to continue doing business with Aetna.” said Pizzitola, whose group blocked the first Advantage plan in court last year and has indicated it will sue over the new plan as well. “It’s always been about maximizing savings for the city and screwing retirees at the same time.”