This time next week, New York City might be switching out the Medicare coverage it has traditionally given retired city workers and their dependents, and instead signing them up for coverage with a privately managed “Medicare Advantage” or Medicare Part C health insurance plan.
Doing so would fulfill a June 2018 agreement put in place under former Mayor Bill de Blasio, meant to help the city cut expenses. The United Federation of Teachers and District Council 37 municipal unions have come out as supporters of the city’s switch to Medicare Advantage. They are among a group that says that with the change the city could save $600 million a year—10% of the city’s total budget.
But it will also mean changing a health coverage promise that has been made to city workers since the 1960s.
Former city workers are fighting to keep the coverage they were originally promised. They have formed organizations like the Cross-union Retirees Organizing Committee (CROC) and NYC Organization of Public Service Retirees––the latter of which even filed a $55 million class-action lawsuit in Manhattan Supreme Court against the city’s proposed health care coverage changes on behalf of 183,0000 retirees.
Retirees are upset that the new plan has a different fee structure and offers a network with fewer doctors, which would force them to pay out-of-pocket costs.
Several former city workers showed up at City Hall on Jan. 9 looking to get into City Council chambers for the hearing on a bill that could change the city’s administrative code 12-126, which delineates the kind of health insurance coverage provided to city employees. An amendment to this code would give the city the go-ahead to change the retirees’ insurance plan.
Advocates for maintaining the current Medicare plan say they have proposed alternative methods for the city to save money and keep retirees happy. “[I]t is not true that Medicare Advantage is the only path to achieving savings for the city, or that premiums must be charged to retirees who remain enrolled in Senior Care or for active employee health insurance,” said James Davis, president of the Professional Staff Congress (PSC)/CUNY union, during his testimony to the council’s Committee on Civil Service and Labor.
Mayor Eric Adams is in support of putting all retirees into a Medicare Advantage plan, but Davis said forcing city retirees, whose average pension is $26,596 per year, to pay up to $200 a month in fees if they don’t want Medicare Advantage and want to keep their current plans, would impoverish many of them: “For low-income retirees and their dependents, that is not a real choice. You have heard that if you fail to change the administrative code, retirees will be forced into Medicare Advantage, but many will be forced to enroll if the administrative code is changed. That is not legislating boldly; it is accepting a tiered system that regulates access by income and race.”
Barbara Caress, a PSC/CUNY member and health care consultant, told the council meeting about the widely noted differences between Medicare and Medicare Advantage. She said that care centers like the Mayo Clinic have informed patients not to participate in Medicare Advantage because of confusion about fee structures and out-of-network providers. “Provider directories are always out of date,” Caress asserted. “The only way to know if a doctor is in or out is to ask. And even then, there is no guarantee that a doctor will still be accepting [Medicare Advantage] when you need her care.
“We know that [Medicare Advantage] works for most retirees most of the time, but when it doesn’t, the consequences could be catastrophic––no access to the doctor or treatment that might save your life. That is the nightmare of NYC retirees.”
Some City Council representatives, like members Charles Barron and Kristin Richardson Jordan, have already been vocal in opposing any change to administrative code 12-126. Other advocates who are pushing to have the administrative code remain without changes posted a Change.org petition at https://www.change.org/p/mayor-de-blasio-preserve-medicare-part-b-for-nyc-retirees/u/30951908.
The City Council is expected to hold a vote on any amendments to administrative code 12-126 on Jan. 19.