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New York City retirees oppose Medicare Advantage loophole that could allow them to keep traditional coverage


Retired city workers, furious about the city’s effort to enroll them in a cost-cutting Medicare Advantage Plan, are targeting a contractual loophole they believe could allow them to stay on traditional Medicare at no additional cost, but would require the mayor’s purchase Adams. for it to happen.

For nearly two years, the city government has tried to switch its roughly 250,000 retired workers to an Advantage plan, arguing it would save the city about $600 million a year thanks to increased federal subsidies.

Thousands of retirees have taken up arms over the measure, fearing they will lose access to certain doctors, medical procedures and drugs under the privately managed Advantage plan.

Despite the protests, Mayor Adams and the heads of the city’s Municipal Labor Committee signed a contract agreement this month with health insurance giant Aetna that they said would make Advantage the only premium-free health insurance Available for municipal retirees. The Adams administration has argued that the drastic option complies with court orders that blocked an earlier version of its Advantage plan.

However, the Daily News has learned that the $200 million Advantage contract that the Adams administration intends to award to Aetna includes a provision called “Option C” that would allow municipal retirees to maintain traditional Medicare coverage at no further cost to them. .

But Option C would only be possible if Adams selects it over two other Advantage implementation structures that don’t come with traditional Medicare opt-out options.

Mayor Eric Adams answers questions after a news conference at the Queens District Attorney's office on February 14, 2023 in the Bronx, New York.

Under Option C, Adams management would be responsible for paying a monthly fee of $20 for each member who chooses a traditional Medicare supplement over Advantage, the contract states, which was publicly posted on March 10. If Adams were to authorize that fee arrangement, the $600 million in annual budget savings his administration projects from the Advantage plan would certainly be cut, though it’s unclear by how much.

Adams’ spokespersons did not return requests for comment Tuesday.

The president of the United Federation of Teachers, Michael Mulgrew, whose union is one of the largest in the city, played a key role in advancing the Aetna contract this month, and a spokeswoman for him suggested it is unlikely that the Option C is carried out.

Spokeswoman Alison Gendar said Option C was included in Aetna’s contract as a contingency that could be triggered “in the event the City Council changes the city’s administrative code to allow for additional ‘pay’ options,” a reference to Advantage-related legislation that management and unions submitted to Council last year without any success.

New York municipal retirees protest a City Labor Committee vote to eliminate traditional Medicare as the only health care option in lower Manhattan, New York, on March 9, 2023.

Still, at a public hearing Tuesday morning on the five-year Aetna contract held by the Mayor’s Office of Labor Relations, dozens of anti-Advantage city retirees asked Adams to opt for Option C.

“Please, Mr. Mayor, choose Option C. Choose Medicare, not Money-care,” David Kotelchuck, a retired Hunter College professor, testified at the virtual hearing.

Gail Benjamin, a city government veteran who recently retired as chair of the City Council Land Use Committee, echoed Kotelchuck’s sentiment, arguing that while the Adams administration may not get “all the savings it would like ” with Option C, it could be a reasonable option. commitment.

“Option C would be desirable for both the retirees and the city,” Benjamin testified.

Dana Simon, 65, left, speaks in protest of the City Labor Committee's vote to eliminate traditional Medicare as the only health care option in lower Manhattan, New York, on March 9, 2023.

Retirees opposed to Advantage have pointed to federal studies finding that beneficiaries are sometimes denied “medically necessary” care under such plans, in part because of prior authorization protocols.

“This is a matter of life and death. If you deny access to some of those doctors and treatments, I die,” retired Baruch College English professor Jacqueline Disalvo, who is wheelchair bound and suffers from multiple health problems, told the hearing.

Many of the City’s Advantage-conscious retirees currently benefit from Medicare with a city-subsidized GHI SeniorCare supplement, a traditional Medicare coverage setup. The SeniorCare supplement would expire when Aetna’s Advantage plan goes into effect on September 1, but retirees who oppose Advantage say Option C would open the door for the city to create a new version of the SeniorCare framework.

The Adams administration, Mulgrew and other leaders on the City Labor Committee have argued that Advantage would provide retirees with robust care while saving the city hundreds of millions of dollars a year.

New York municipal retirees protest a City Labor Committee vote to eliminate traditional Medicare as the only health care option in lower Manhattan, New York, on March 9, 2023.

Professional Staff Congress President James Davis, whose union represents some 30,000 City University of New York employees, said he was surprised he hadn’t heard of Option C until his team stumbled upon it this morning. week while reviewing the recently released Aetna contract, which is hundreds of pages long.

“Option C, to my knowledge, has never really been discussed, and I didn’t know it was even an option,” said Davis, whose union was among the 26 that voted against adopting Aetna’s Advantage plan during a contentious meeting. of the Municipal Labor Committee in March. 9.

Davis said his union would shift to support the Advantage plan if Adams chose Option C. Davis acknowledged, however, that Option C would undermine Adams’ rationale for pursuing Advantage in the first place.

“It would definitely eat into any savings that they could allocate,” he said.

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