Thursday, September 16, 2021

City Incompetence and the Medicare Advantage Scam

I have previously written about the Medicare Advantage takeover. OLR is calling it the MAP plan.

By law the City is required to pay for health insurance for its employees and retirees as per Section 12-126.b of the Administrative Code of New York City

(1) The city will pay the entire cost of health insurance coverage for city employees, city retirees, and their dependents, not to exceed one hundred percent of the full cost of H.I.P.-H.M.O. on a category basis.

For more updated info on the MAP plan check this Facebook page. It also appears that the PBA union is not on board with the MAP plan.

OLR sent out an undated letter around August 15, 2021, stating as part of the MAP implementation that retirees would receive an enrollment guide, an FAQ sheet, and a plan comparison chart. It also promised to include in the package an opt-out form for retirees who do not wish to be enrolled in the Medicare Advantage plan. The letter did not say when the package would be sent. OLR’s website, as of August 18, 2021, stated that the enrollment package would be sent in late August.

It is now September 16, 2021 and I have yet to receive the package. Update - on 9/17/2021 I received a package from Blue Cross/Blue Shield.

The most current opt-out period is 9/15/2021 to 10/31/2021. It originally was 9/1/2021 to 10/15/2021 as per the August 18, 2021 website FAQ sheet.

OLR also gave a call center number in the August letter. The call number is answered by employees of Blue Cross who are unable to answer issues involving OLR’s control of the process. OLR is legally required to administer the health insurance program for city retirees (S.126.d of the NYC Admin Code), not Blue Cross.

OLR is hiding behind its website and has given no OLR phone number where retirees can call.

The website is constantly changing so it is not an adequate legal notice of the specifics of the MAP plan. As of today, there is still no summary plan description of the MAP plan even on the website. I suspect OLR is having serious trouble drafting a document that will pass legal muster.

CSM, the federal Medicare administrator, states that Medicare Advantage plans are voluntary. It is not clear how OLR is unilaterally placing all Medicare eligible city retiree in the MAP plan.

I suspect there will be litigation on the MAP conversion and aside from legal issues, OLR will probably have to deal with gross incompetence issues. I know the new mayor is going to love this headache.

OPEB issues in the NYC 2020 CAFR

The Comptroller issues the city’s annual financial report every October 31. The following comments are based on data from the FY-2020 report. The NYCERS Actuary also published OPEB Report on 9/10/2021.

As of June 30, 2020, there were 243,978 city retirees and beneficiaries. My estimate based on CAFRs from the five city pension funds is that 75% of city retirees are enrolled in Medicare.

The two main health insurance plans covering the Medicare portion of this group are GHI and HIP. GHI, a supplemental plan, covers about 80% of the group and HIP, an HMO plan, covers about 15%. The are 12 other plans, some of which are Medicare Advantage plans, but together they only cover about 5% of the total Medicare group.

For FY-2021 (new info from NYCERS Actuary) the city was paying the follow monthly premium for each member of the group:


  • Non-Medicare Single : $775.66
  • Non-Medicare Family : $2,035.61
  • Medicare : $194.14
  • Non-Medicare Single : $776.66
  • Non-Medicare Family : $1,901.23
  • Medicare : $181.58
  • Non-Medicare Single : $1,160.34
  • Non-Medicare Family : $2,701.42
  • Medicare Single : $291.83
  • Medicare Family : $576.92

It is clear that the premiums for Medicare covered retirees are the least expensive premiums and represent the lowest cost to the City. As of 1/1/2022 GHI Medicare retirees will be forced into the MAP plan unless they choose to opt out and stay in the GHI plan which will now cost $191 a month.

(new info) Current HIP medicare retirees who are enrolled before 12/31/2021 can stay in the HIP plan but that plan will close to new enrollees after 12/31/2021. It is not clear why there is a different approach for the HIP retirees.

Without access to the new MAP contract with Emblemhealth/Blue Cross, I have to assume that the City will no longer be paying the Medicare premiums for GHI retirees and beneficiaries covered by Medicare. As of 1/1/2022, CSM will pay Emblemhealth/Blue Cross directly to cover 100% of authorized Medicare charges. Previously CSM paid the doctors 80% of the charges and GHI or HIP paid the remaining 20% using the premiums paid by the City.

It is not clear what the city will be paying for retirees covered by Medicare but who have spouses and children not eligible for Medicare.

Where is the saved money going? Into the union welfare funds and increased insurance costs for active employees. Just check the fringe benefit numbers in the City's FY-2022 Adopted Budget on page 1406 (page 1412 of PDF document). Actually the city scatters a lot of these costs throughout the budget, especially for DOE and CUNY.

Bottom line, the City is walking away from its statutory obligation to pay the entire cost for city employees, city retirees, and their dependents health insurance limited only by the cost of the HIP-HMO coverage. This is not a collectively bargained obligation. It is a law.

The new MAP plan is not equal to the previous supplemental insurance plans. The City has previously offered Medicare Advantage plans to retirees and the retirees have chosen the supplemental plans overwhelmingly. (new info, 9/20/2021) The City has just been sued by Aetna over claims of violations of standard City procurement rules.

If the retiree wishes to keep his/her previous free GHI coverage as of 1/1/2022, he/she will now have to pay $191.57 per month and if there is coverage for a Medicare spouse the premium doubles to $383.14. In addition, the GHI benefit is less generous than it currently is. Existing retirees covered by HIP can stay in the HIP plan premium free. Medicare Retirees covered by the others plan can choose to stay in them but will now also have to pay the City's premium as well as their own.

NYSUT and School Districts in New York State

With the passage of Chapter 504 of the laws of 2009, the NYSUT, which includes the city UFT Local, negotiated a permanent protection (Chapter 729 of the Laws of 1994) for their retirees from NYS school districts from unequal treatment with respect to health insurance benefits versus active workers. Any reduction to retiree health insurance benefits must be equal to reductions to active worker health insurance benefits. See Section 14 from Part B of Chapter 504 below.

This statute is something called a chapter law. It is not part of the consolidated laws of NYS which are published separately like the RSSL or the Education Law. You are not going to be able to easily find it unless you know about it ahead of time. Actually Chapter 729 was renewed for one year earlier in the 2009 legislative session. You can check Chapter 30 of 2009 to see the annual renewal along with a very clear justification of the law. Later in the session, Chapter 504 made it permanent. This means that BERS and TRS retirees can not be sucked up into the MAP plan. They can not have their benefits diminished nor can the city reduce its contributions to health insurance benefits below active workers.

So why did the UFT abandon their city retirees?

I think the UFT was just incompetent with respect to the legal rights to retirees of school districts. Of course, I may be wrong. The UFT may just be dishonest and wanted to get the increased money for their welfare fund and screw the retirees.

Chapter 504 of the Laws of 2009 - Part B - Section 14

§ 14. Section 1 of chapter 729 of the laws of 1994 relating to affecting the health insurance benefits and contributions of retired employees of school districts and certain boards, as amended by chapter 30 of the laws of 2009, is amended to read as follows:

Section 1. From on and after June 30, 1994 [until May 15, 2010,] a school district, board of cooperative educational services, vocational education and extension board or a school district as enumerated in section 1 of chapter 566 of the laws of 1967, as amended, shall be prohibited from diminishing the health insurance benefits provided to retirees and their dependents or the contributions such board or district makes for such health insurance coverage below the level of such benefits or contributions made on behalf of such retirees and their dependents by such district or board unless a corresponding diminution of benefits or contributions is effected from the present level during this period by such district or board from the corresponding group of active employees for such retirees.

JUSTIFICATION: (Chapter 30 of the Laws of 2009 - a one year extension - C.504/L.2009 made it permanent)

Health insurance coverage for school district retirees has been protected from unilateral reduction since 1994 under provisions of a law which is subject to annual renewal. The law provides that school districts may reduce neither the level of health insurance coverage nor their contribution toward its cost for retirees, unless the reduction applies equally to active employees. This protects retirees by in effect making them part of the collective bargaining process. The law does not, however, prevent school districts from taking cost-cutting measures, so long as these apply equally to active employees and retirees. There has been no evidence of harm befalling school districts over the past decade as the result of this requirement for fair treatment of their retirees.

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