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Judge OKs Revised Medicare Advantage Program, Schedule

Retirees Will Have At Least Until March 31 to Decide; Lawyer: Not Over Yet


A Manhattan Supreme Court Justice has given tentative approval to the city’s implementation of its fiercely contested switch of retiree health coverage to a Medicare Advantage plan, but with its effective date pushed back from Jan. 1 to April 1 and the period for those affected to opt out of the new program extended to June 30.

The city’s chief negotiator said Dec. 15 that she was happy the process would move forward, but a lawyer for the retirees, while calling the ruling “a terrific win” indicated that once the program started he intended to bring a further legal challenge against what he called “forcing” his clients to give up their traditional, city-paid coverage.

Terms Set by Judge

Justice Lyle Frank in late October had barred the city from imposing an Oct. 31 deadline for the roughly 250,000 affected retirees to decline being transferred from the current health program to the city’s new Medicare Advantage Plus Plan, ordering de Blasio administration officials to put together a new plan for providing greater information to retirees and the actual implementation.

Based on the plan submitted by city officials Dec. 7, he ordered that even after the program takes effect April 1, retirees will have an additional three months to opt out if they find themselves dissatisfied with the new coverage. He also required the city to send retirees a list of the corrections and additions that have been made to its Enrollment Guide no later than Jan. 7, and to ensure that there will only be one set of deductibles for all retirees during 2022.

The city will also be required to update him every two weeks after that detailing how many medical providers Continued on Page 18

RENEE CAMPION: Happy process is nearing conclusion.

Continued from Page 1

have been contacted personally regarding the plan, and when those who have not yet gotten notification will receive it.

“We’re happy that it’s reaching a conclusion,” city Labor Commissioner Renee Campion said in a phone interview. “There are still a few things we have to provide the judge with, but we’re moving forward.”

Fight Not Over?

The attorney for the retirees, Steve Cohen, said a short time later that while he was elated by the ruling, this would not be the end of the battle over Medicare Advantage Plus.

“It was a terrific win for the retirees—the judge did virtually everything we asked him to do,” he said.

But once the program takes effect April 1, if not later, he continued, “We get to challenge the very legality of what the city is trying to do: force the retirees into a plan and take away a benefit they’ve had for 40 years.”

Both Ms. Campion and leaders of the Municipal Labor Committee, the umbrella group for the city’s public-employee unions, have said they were making the move to have an outside health-care provider administer retiree coverage in order to save money while maintaining a level of benefits they contended was as good, if not better, than what is currently in effect.

The expected $600 million in annual savings under the agreement the two sides reached in July will be placed in the joint Health Stabilization Fund, which will have the dual effect of limiting the city’s need to dip into its budget to replenish that fund when health-care costs rise significantly, and thus leave more money available for potential wage increases for active employees.

Retirees Suspicious

A collection of activist retirees, wary of previous Medicare Advantage plans that proved detrimental to recipients and convinced their unions were shortchanging them to benefit active members who can vote in union elections, have held rallies for more than six months at locales including the City Hall area and the lower Broadway headquarters of the United Federation of Teachers to protest the change.

Their suspicions were heightened when Aetna, the losing bidder of the two finalists for the contract to run the new plan, sued several months ago questioning the ability of the health-benefit consortium known as The Alliance to provide benefits to such a large group and claiming misrepresentations had been made by the two biggest providers involved—Empire Blue Cross BlueShield and Emblem Health.

In October, shortly before he ordered the city to push back implementation and provide more information to retirees, Justice Frank dismissed Aetna’s lawsuit, stating that he was making no conclusion as to whether The Alliance had been a better choice to run the program, but rather ruling that there was nothing arbitrary or capricious about its selection by union and city officials.

City’s Response

In a deposition early last month, Deputy Labor Relations Commissioner Claire Levitt, who specializes in health-benefit issues, argued that Medicare Advantage Plus amply protected retirees’ interests when compared to the current Senior Care program administered by the city.

She noted that it featured “a single ID card, simpler retiree experience, national network platform, Silver Sneakers fitness program and fitness tracker device.” It also included, she wrote, no copay for primary-care visits, a $1,470 out-of-pocket maximum per year; no annual maximum for durable medical equipment, no hearing copays; 365 days of hospital coverage; nonemergency transportation to and from a doctor’s office or pharmacy for up to twenty- four visits per year within 30 miles, and an annual $500 hearing-aid allowance, no copay for telehealth and a $200 wellness-reward program.

“The Medicare Advantage Plus plan,” Ms. Levitt continued, “replaces traditional Medicare and a Medicare Supplement plan with an integrated program at a lower cost than the current Senior Care program and with no premium cost to the retirees.”

She said that the “preauthorization requirements about which some concerns have been voiced are very similar to the requirements under the Empire-Emblem CBP plan for active employees.”

Price for Opting Out

Affected retirees, Ms. Leavitt said, had “a choice of Senior Care at the current $191.57 [monthly] rate or the premium-free Medicare Advantage Plus plan, or, if their current plan is not Senior Care, they can choose to remain in their current plan at the current cost.”

She also noted that the city and the MLC were forming a joint committee “to monitor the Medicare Advantage Plus plan to ensure that Alliance meets commitments and delivers quality services to New York City retirees.”

Assistant Corporation Counsel Rachel M. DiBenedetto provided an affirmation Nov. 5 to Justice Frank of the steps the city had already taken to inform retirees about the program since he blocked its implementation based on arguments by Mr. Cohen that his clients remained in the dark about key features and consequences of the change.

She stated that there have been roughly 70 webinars on the program, to which approximately 34,000 retirees tuned in. “Alliance is also undertaking a targeted print and digital media campaign to reach the ten markets with the largest percentage of retirees, intended to explain the new plan in further detail.”

Contacting Providers

The firm will also, Ms. DiBenedetto stated, “reach out to, via direct calls and automated messaging, over 3,400 providers—in network and out of network—that have seen a high percentage of New York City retirees.” It had begun a series of 12 webinars to inform providers about the advantages of the new program.

She noted that Ms. Levitt’s affidavit cleared up key sources of “misinformation and confusion” by making clear to retirees that “All New York City hospitals are participating in the Alliance network, including Memorial Sloan Kettering and [the Hospital for] Special Surgery, which had not been involved in previous Medicare Advantage programs.

Ms. DiBenedetto also informed Justice Frank that retirees who opted out of Medicare Advantage Plus would be permitted to subsequently rescind their requests and enroll in the new plan.

Mr. Cohen said of Justice Frank’s impact on the process, “The Judge put in great protections for retirees and required the city to give more-accurate information than the city and The Alliance [had been] putting out. This is very encouraging.”

PERSISTENCE PAID DIVIDENDS: These retirees were among the thousands who objected to the city shifting their health coverage to a Medicare Advantage program, and while a Manhattan Supreme Court Justice has pushed back the deadline for opting out of the transfer, originally scheduled to be Oct. 31, to at least March 31 next year, he is allowing the change to go forward, predicated on city officials providing greater information on the program to all those affected.

Michel Friang/The Chief-Leader

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