NYC Retirees’ War Against Being Forced Into a Subpar and Restrictive Medical Advantage Plan

From Editor/CEO Betsy Combier:

We are opposed to compulsory medicare insurance plans which “save the City money” without consideration of the best plan to protect the health, safety and welfare of the beneficiaries. As stated so eloquently by David Chester (pictured above),

“This is taxation without representation,” he said. “We were never consulted. We’re still not being consulted.”

See here as well:

Healthcare -Medicare Plan Plus

C’mon, Mayor-Elect Adams – show your cards and undo the de Blasio ruling on a disasterous Medicare Advantage Plan that harms all retirees, if not their health, at minimum their rights as a voting public.

Betsy Combier

Retiree health plan debacle continues

TRO still in place; retirees urging Adams to stop Medicare Advantage

New York City and its retirees are still at a stalemate over the proposed Medicare Advantage Plan, which was originally supposed to go into effect for the new year.

A judge issued a temporary restraining order on the plan in October. Not much has changed since then.

The NYC Organization of Public Service Retirees, which filed the lawsuit that resulted in the TRO, is still struggling to get the city to grant the smallest changes in order to make the process easier for retirees.

On Dec. 8, the organization met with the Municipal Labor Committee in court and asked that the panel correct several typos in the printed instructions it sent out to retirees several months ago. Marianne Pizzitola, the group’s president, told the Chronicle the city rejected the request, claiming it could not reprint the booklets due to a “worldwide paper shortage.” The city instead will be updating the instructions on its website.

“These people are not going to understand this. [They’re] a portion of the population that’s not internet-savvy,” said Pizzitola, a retired FDNY EMT and 9/11 first responder. “They may not even know they have to go there.”

The hearing was just another example of the city’s messy Medicare Advantage Plan rollout, she said. That mess, however, prompted a Manhattan Supreme Court judge to stop it from going into effect too quickly — retirees had been required to opt-out by the end of October, three months after Mayor de Blasio announced the program, but the judge ruled that the deadline was not appropriate because the choice is irreversible once decided by a retiree.

Thanks to the TRO, the plan will not be implemented during de Blasio’s term, but Pizzitola said she’s been struggling to get in contact with Mayor-elect Eric Adams.

“Two hundred and fifty thousand retirees, Mr. Mayor-elect, would like to hear from you, sir,” Pizzitola said.

Adams did not respond to requests for comment by the Chronicle.

David Chester, 70, is one of the 250,000 retirees opposing the healthcare plan switch. He spent 37 years working for New York City within the Departments of Education, Citywide Administrative Services and, largely, Social Services.

Chester has experienced a plethora of health issues within the last few decades, including two leukemia diagnoses, requiring quadruple bypass surgery, needing knee replacement surgery and developing a number of kidney stones.

He has also developed gastroesophageal reflux disease, chronic sinusitis and asthma from inhaling dust from 9/11 — the DSS office was located just 10 blocks from Ground Zero. Chester is enrolled in the World Trade Center Health program.

He said the city’s switch to the “subpar and restrictive Medicare DisAdvantage” is “mean” and “unfair” to its older population.

“This is taxation without representation,” he said. “We were never consulted. We’re still not being consulted.”

In October, Chester testified at a City Council Committee on Civil Service and Labor hearing, where he was surprised to find several elected officials speaking in favor of the switch. Chester suspects their support comes from the money-saving incentive — if implemented, the new plan is supposed to save the city $500 million a year, a number Chester says is only “a drop in the bucket” compared to the city’s budget.

“It’s a sales job,” he said. “They’re trying to sell it to us … Our own union — you would think they would advocate for us, and they’re not. They threw us under the bus.”

Chester’s primary objection to the switch concerns supplemental healthcare plan premiums, a worry thousands of other retirees share. He uses a GHI Senior Care plan to cover the 20 percent of services Medicare doesn’t, which comes without premium or co-pays. Under Medicare Advantage, however, only a select few doctors would accept the insurance and a co-pay for every medical procedure would be required.

If Chester chooses to opt-out and keep his supplemental insurance, however, he would be required to pay a $191 penalty each month.

“That adds up,” he said. “As a retiree, I’m on a fixed income.”

Chester reiterated Pizzitola’s concerns with the rollout itself, which has been so confusing and convoluted that he worries older retirees will have no idea what is going on.

 (1) comment


As a City of New York retiree with 33 years of service, I both depend on and expect the free Medigap Supplemental Insurance promised by the City and the unions, represented by the Municipal Labor Council (MLC).

At the height of my career, I had offers to work in the private sector for 40 to 45% more than I was making with the City. But, I stayed with the City to preserve my retirement benefits and serve the homeless. I am not alone in my dedication to serve the people of our great city.

We thought our interests would be represented by our former unions, because it’s also in the interest of current employees to have superior benefits in retirement. But, the unions have betrayed us, and the current employees, too.

We are now represented by the NYC Organization of Public Service Retirees (for Benefit Preservation). Our organization is new, formed in August, 2021, to fight this attempted diminution of our medical benefits. We are 12,000 strong and growing.

The City complains that medical insurance has ballooned in the last 10 years. But taking their numbers, and adjusting them for inflation, amounts to a pittance in a $99 billion budget. Specifically, the increased cost of NYC retiree medical benefits amounts to about one-tenth of one percent of the NYC budget.

According to The New School Center for New York City Affairs, the City does not have to diminish the benefits of its retirees or current employees to find savings. There are plenty of savings to be found elsewhere. New York State spends considerably less to insure its employees than the City does with no diminution of benefits.

How come NYS can find necessary savings on health insurance, but NYC can’t? Is it because Gregory Floyd, President of Teamsters Local 237 and Secretary of the MLC, is also on the board of Emblem Health, and this bait-and-switch on retiree medical benefits is a windfall for two politically connected insurance companies who want to go public?

It’s also no secret that Emblem Health CEO Karen Ignagni is on Mayor-Elect Eric Adams transition team. We hope he’s also beginning to see her as a political liability.

The City argues more than 45% of Medicare enrollees in New York State are now in Medicare Advantage plans. But just because a large number of people have been sold a load of hooey, it doesn’t mean it’s a superior option. Advantage plans are actually worse for taxpayers and retirees.

The Kaiser Family Foundation has found, “The federal government spent $321 more per person for beneficiaries enrolled in Medicare Advantage plans than for those in traditional Medicare in 2019, a gap that amounted to $7 billion in additional spending on the increasingly popular private plans that year…”

In addition, KFF found, “Slightly more than half of all Medicare Advantage enrollees would incur higher costs than beneficiaries in traditional Medicare with no supplemental coverage for a 6-day hospital stay…” g

The City is trying to leave retirees with just two options:

1. Keep our current Medicare and Medigap coverage, but it will no longer be free. Instead, there will be copays plus $191+ per month in premiums for each family member covered. That’s the price to be paid for retirees to see their current doctors and have the services they need.

2. Submit to “free” managed care operated by an Alliance of substandard insurance companies and providers (the Empire Blue Cross Blue Shield and Emblem Health networks). Many of the providers our retirees are currently receiving services from will not participate in the new NYC Medicare Advantage Plus Plan (MAPP). Dozens of services will now require pre-approval.

For a husband and wife with medical issues surviving on one NYC pension, that would be $382 or more each month to keep their current level of medical care plus numerous and expensive copays.

In order for the new plan to actually save money, services will have to be cut significantly and freedom of choice to choose providers will be limited.

Per retirees, the new MAPP is not attracting many providers, especially outside NYC. We’re rightly asking, who is to determine what unnecessary treatment is? A doctor with a medical degree and certifications, or a clerk at an insurance company?

The new MAPP was developed by the mayor’s Office of Labor Relations and the Municipal Labor Committee (MLC), a coalition of municipal employee unions that negotiates health benefits for the unionized city workforce. That makes the MAPP illegal.

According to the City’s very own Public Employment Relations Board website, the NYS Taylor Law bars unions and the City from negotiating the benefits of retirees. The NYS Taylor Law, according to PERB, specifically states, “No such retirement benefits shall be negotiated pursuant to this article, and any benefits so negotiated shall be void.”

I, 250,000 retirees, and 400,000 current employees are expecting our politicians to shelve the new NYC MAPP and not engage in a contract with the Alliance. That’s a lot of voters.

Because of this MAPP fiasco and betrayal, I will never, ever vote for de Blasio again. When questioned about it in the media he has not been truthful.

Speaking for the very large majority of City retirees and current employees, upwards of 625,000 of us will never vote again for anyone who can stop this travesty and doesn’t. That’s considerably more irate constituents than the roughly 444,000 voters who turned out for the last incumbent NYC mayoral primary in 2016.

One thing in particular that I like about something the Mayor-Elect said is, “We spend a lifetime pulling people out of the river. No one goes upstream and prevents them from falling in the first place.”

Let’s nip this one in the bud, Mr. Mayor Elect, so we don’t see an uptick in homeless, medically bankrupted, senior citizens on our streets. That will certainly cost a mayor and the City in terms of reputation. It will be a daily visual reminder of how the current mayor is failing the people. It will even cost the City more so in money. Per a 2017 report by the Coalition for the Homeless, it would cost the City “an average of $99 a day to house” each one.

We retirees and current City employees would very much rather remember at election time that Eric Adams ensured our current medical benefits continue. To all our elected officials, please make the correct moral and fiscally responsible choice by NOT supporting NYC MAPP.

See also:

NYC Employees File Lawsuit Opposing New Private Medicare Advantage Plus Plan

Michael Kane, et al. File Federal Case in Opposition to New York State Vaccine Mandate

Matthew Keil et al., v The City of New York, et al.

Why Medicare Advantage Plans are Bad: 7 Top Complaints

No Medicare Advantage

Queens Chronicle, January 6, 2022

Dear Editor:

After reading the new prior authorization pamphlet for the NYC Medicare Advantage Plus Program, I fully understand how truly terrible it is. To call it misleading is an understatement. It would have been easier for them to list the procedures and treatments that don’t need a preauthorization, rather than the two pages of everything that does (along with a disclaimer saying that the list is not even complete).

The brochure attempts to minimize the prior authorization policy by saying, “Just like the plans for active City employees, certain medical procedures will require preauthorization under the NYC Medicare Advantage Plus Plan.” While this may be true, it glosses over the fact that one of the main reasons people prefer original Medicare is because they do not need to get preauthorizations for most things. This is more important for seniors than younger people because as we get older we need more types of procedures and treatments, and having to get prior authorizations for everything creates added obstacles and adds more time, delaying the services we need.

The second paragraph of the brochure states that “Prior authorization helps ensure you get the proper care. It helps us work with your doctor to evaluate services for medical necessity before you receive treatment or services.” What does that even mean? Who knows your medical history better than your own doctor? He or she is the person that actually saw you and physically examined you and is referring you for things that they believe are medically necessary. How would the clerks working at Emblem Health be able to determine what your condition calls for without ever seeing your? After all, they only have your doctor’s paperwork to refer to. If they decide against it, then they are disqualifying what your doctor recommends, insinuating they know better.

The bottom line here is simple. Medicare Advantage Programs get a certain amount of money from the government for each person in a process called risk adjustment. The only way they make a profit is by spending less than they were allocated. So the less they approve for you, the more money they make for themselves.

Lee Rottenberg

Middle Village

Be the first to comment

Leave a Reply