Saturday, November 20, 2021

Stupidity and the Medicare Advantage Scam

I am assuming that all NYC retirees and workers know that the City is trying to screw with retirees Medicare benefits. Enough with abuse of power and illegal actions, let's look at the City's stupidity.

Cross Over Retirees

Consider a current 66 year old male NYC retiree with traditional Medicare and GHI Senior Care coverage. He has a 62 year old wife. With respect to Part D coverage at age 65, he continued his family drug coverage with GHI which he started when he retired at age 62. He pays the the family GHI-CBCBS drug premium ($149.96), not the Senior Care family drug premium ($300.60).

In FY-2021 the City paid $2,023.61 per month to GHI for CBP/EBCBS family health insurance. This was for workers and retirees with non-Medicare eligible dependents. This means that the City is paying GHI $2,023.61 for this retiree's family health insurance even though he is Medicare eligible. I am almost dead sure that the City is not paying GHI the $194.14 per month individual Senior Care premium for this retiree, since it is already forking over the $2,023 each month.

Now consider that in 2021 this retiree and his wife adopted two newly born children. The retiree now has three dependents on his health insurance coverage and the City now has a 25 year liability for family GHI CBP/EBCBS health insurance costs. As I stated above the monthly cost for the GHI family coverage is $2,023.61. That is $24,283 per year. Even when the retiree's wife turns 65, the City will still have to pay the $2,023 per month

The New MAP Plan for January 1, 2022 - With a Court Stay in Place

On January 1, 2022 the City wants to jam this retiree, along with all other Medicare eligible retirees (not HIP-HMO), into a Medicare Advantage plan with the express purpose of avoiding paying the Senior Care $194.14 per month premium. Of course, the City is not actually paying for this retiree. The City then wants to give the "savings" to the union welfare funds (the MLC).

In fact the City will probably never save any money on this retiree.

Political Blowback

Since the City can not escape paying the $2,023.61 per month for this retiree, would it not be more politically advantageous to leave this retiree in his current "Senior Care". You know this family is going to be radically motivated to rip the heart out of the scum that are screwing up their health insurance. Of course all effected retirees are going to want to get revenge but the City is not even getting any "savings" in this case.

I created this exaggerated case to highlight the complications of the Medicare Advantage scam. There about 158,000 Medicare eligible city retirees covered by Senior Care. I guarantee you that 25% of those retirees fall into this cross over scenario to some extent. Just think of a 66 year old retiree marrying a 55 year old. Happens all the time. All of a sudden the cost goes from zero to $24,283 per year.


The City has created a Catch-22 for the Medicare eligible retirees. The City will not be saving anything on these cross over retirees and yet the City is punishing them by reducing their benefits.

The retirees are either forced into the new inferior "free MAP" plan or pay the Senior Care $191 a month premium each for themselves and everyone of their Medicare eligible dependents plus $125 month each, for Part D coverage, for themselves and everyone of their Medicare eligible dependents.

Of course the new free MAP plan is not totally free since the drug coverage will cost $125 per month each for the retiree and any of his/her Medicare eligible dependents. In addition, the retiree can not choose to buy the Part D drug coverage on the open market since CMS gives Medicare Advantage plans a monopoly on Part D coverage. Interestingly, the retiree in Senior Care plan can shop for a better Part D drug plan.

How About a Little Intelligence

The City has pressure on it health insurance costs. Instead of picking on a party that the City thinks it can walk over, how about bringing all parties together. That means the insurance companies, the workers, and the retirees. Get the insurance companies to offer better coverage at lower cost and require all the workers and the retirees to make a monthly payment. That would also mean that the City would have to be totally transparent. That is a big problem. Don't feel sorry for the City. The federal government gave the City $1.02B in FY-2022 to pay for workers health insurance.

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