NYC retirees oppose loophole in Medicare Advantage that could let them keep traditional coverage

Retired municipal employees, furious at the city’s attempts to enroll them in a cost-cutting Medicare Advantage plan, are looking for a loophole in the contract that they believe could allow them to stay in traditional Medicare at no additional cost, but would require the purchase of Mayor Adams. to make it happen.

For nearly two years, the municipal government has been trying to move approximately 250,000 retirees to the Advantage Plan on the grounds that it would save the city about $600 million annually through increased federal subsidies.

Thousands of retirees have turned against the move, fearing they will lose access to certain doctors, medical procedures and medications through the Private Advantage Plan.

Despite the outrage, Mayor Adams and the city’s municipal labor committee leaders this month signed a contract with health insurance giant Aetna that they say will make Advantage the only free health insurance available to municipal retirees. The Adams administration argued that the radical option was in line with court orders that blocked a previous iteration 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 clause called “Option C” that would allow municipal retirees to maintain traditional Medicare coverage without increasing costs to them.

But option C will only be possible if Adams chooses it from two other Advantage implementation structures that don’t come with traditional Medicare opt-out options.

Under Option C, the Adams administration will be responsible for a monthly payment of $20 for each member who chooses a traditional Medicare supplement over Advantage, the contract, which was released March 10, says. The $600 million in annual budget savings his administration projects from the Advantage Plan will almost certainly shrink, though it’s not clear by how much.

Representatives for Adams did not respond to requests for comment Tuesday.

United Federation of Teachers president Michael Mulgrew, whose union is one of the largest in the city, played a key role in pushing the Aetna deal this month, and his spokeswoman suggested option C was unlikely.

Spokeswoman Alison Gendar said Option C was built into Aetna’s contract as a contingency that could be activated “in the event the city council changes the city’s administrative code to allow additional ‘pay-for’ options,” citing Advantage- the relevant legislation that the administration and trade unions proposed unsuccessfully to the Council last year.

However, at a Mayor’s Office of Labor Relations public hearing on Aetna’s five-year contract Tuesday morning, dozens of anti-Advantage municipal retirees urged Adams to choose Option C.

“Please, Mr. Mayor, choose option C. Choose Medicare, not Money-care,” David Kotelchuk, a retired professor at Hunter College, said at a virtual hearing.

Gale Benjamin, a municipal government veteran who recently retired as director of the city council’s Land Management Committee, shares Kotelchuk’s sentiment and argues that while the Adams administration may not get “all the savings they would like” under Option C, it could be reasonable. compromise.

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

Retirees who oppose Advantage have pointed to federal studies showing that beneficiaries are sometimes denied “medically necessary” care under such plans, due in part to pre-authorization protocols.

“This is a matter of life and death. If you deny access to some of these doctors and treatment, I am dying,” retired Baruch College English professor Jacqueline Disalvo, who is wheelchair-bound and suffering from multiple health problems, told the hearing.

Many municipal retirees concerned about Advantage are now benefiting from Medicare with the city-subsidized GHI SeniorCare Supplement, the traditional Medicare coverage system. The SeniorCare add-on expires when the Aetna Advantage plan is due to go into effect September 1, but anti-Advantage retirees say Option C will open up the city to create a new version of the SeniorCare structure.

The Adams administration, Mulgrew, and other municipal labor committee leaders argued that Advantage would provide reliable care for retirees as well as save the city hundreds of millions of dollars a year.

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

“To my knowledge, Option C was never really discussed, and I didn’t even know it was an option,” said Davis, whose union was among 26 who voted against the Aetna Advantage plan during a controversial municipal labor committee meeting in March. 9.

Davis said that his union would switch to supporting Plan Advantage if Adams chose Option C. However, Davis admitted that Option C would undermine Adams’s justification for pursuing Advantage in the first place.

“It will definitely eat into the savings they can put aside,” he said.