Court Stay for Retirees Fighting the City's Medicare Advantage Scam

On July 7, 2023, the trial court issued a stay stopping the City from terminating Medicare supplemental insurance, Senior Care, for 139,442 city retirees on Medicare and their estimated 50,000 spouses. As part of the termination the City is jamming these retirees and their spouses into a private Medicare Advantage insurance plan offered by Aetna.

The following is a reported response to the stay from the Mayor:

Mayor Eric Adams’ office said the city is considering appealing the injunction. “We are extremely disappointed by this misguided ruling,” it said in a statement. “The city’s Medicare Advantage plan, which was negotiated in close partnership with the Municipal Labor Committee, improves upon retirees’ current plans, including offering a lower deductible, a cap on out-of-pocket expenses, and new benefits, like transportation, fitness programs, and wellness incentives. Further delay in implementing it will only cause greater uncertainty for our retirees and have a detrimental impact on our city’s budget.”

The statement is at best misleading. The mayor and the Municipal Labor Committee did collude to deprive Medicare eligible retirees of health benefits that have been in place since 1966 since the start of Medicare. The fight over which plan is better is something that the Mayor wants to ignore. The alleged new benefits are not important when compared to access to quality health care, especially when you have serious health issues. The further delay that the mayor is worried about is not a delay but a very real hope that the retirees will keep their health benefits. As I have outlined below the just adopted City budget has sufficient funds allocated to cover the cost of Senior Care for Medicare eligible retirees.

As reported by the actuary in his FY-2022 OPEB report, there are a total of 246,832 city retirees with

• 73,601 (plus 46,510 spouses) who are not eligible for Medicare and
• 173,231(plus 61,646 spouse) who are eligible for Medicare.

When you subtract the 139,442 retirees covered by Senior Care, you are left with 33,789 Medicare eligible city retirees who have elected private health insurance via Medicare Advantage contracts between CMS, the federal Medicare administrator, and private insurance companies. As of January 1, 2022, the City is essentially no longer paying anything for Medicare Advantage contracts (monthly COBRA rate is $7.65). It is not clear why.

The City is currently paying $204.10/month per person for the Senior Care supplemental coverage. (The COBRA premium is $208.18/month).

That adds up to $464M per year - ((139,442 retirees + estimated 50,000 spouses)*$204.10*12).

Note: The Health & Hospitals Corp. and the Housing Authority have 20,205 retirees covered by Medicare supplemental coverage and would have saved money if the termination had gone into effect on Sept. 1, 2023

On June 30, 2023, the City Council adopted the NYC budget for FY-2024. The Mayor had asked for $2.959B for retirees’ health insurance and $5.64B for workers’ health insurance. The final budget cut the retiree health insurance appropriation by $500M down to $2.459B, what appears to be a ballpark number for the Medicare supplemental cost.

As reference, the adopted budget has the following allocations for health insurance:

• Workers $5.644 billion
• Retirees $2.459 billion

Note: The monthly cost for employees and non-Medicare eligible retirees

• without dependents is $923.67, and
• with dependents it is $2,265.67.

Note: The adopted budget also includes

• $896 million for employee welfare fund benefits and
• $449 million for retiree welfare fund benefits.

Just for the reord, that is a total of $9.4 billion for health insurance and welfare benefits for workers and retirees.

Enough Money for Senior Care

The retiree health insurance costs for FY-2024 based on retiree and spouse counts from the actuary’s June-2022 OPEB report breaks down as follows

• Non-Medicare retirees $1.565 billion
• Medicare retirees $0.464 billion
• Part B refunds for Medicare retirees $0.465 billion

The total of these three amounts is $2.494, very close to the $2.459B amount in the adopted budget. It appears that the adopted budget has enough money to pay for the Medicare supplemental coverage for the 139,000 plus Medicare retirees and their spouses, as if the City knew that it was going to have trouble in court.

The Mayor’s initial $500 million request and its final cut seems to have no rationale.

What these numbers show is that the Medicare with Senior Care is the most economical part of the health insurance program for City workers and retirees. In addition, Medicare with Senior Care is the most effective part of that health coverage.

Three Card Monte -- NYC FY-2024 Executive Budget and Health Insurance Costs

On May 31, 2023, retired employees of NYC filed suit against NYC over the termination of their Medicare supplemental health insurance. The City is doing this to save $450.0 million per year. The Health and Hosptials Corp. and the Housing Authority will also save a total $60.0 million per year.

So why is the City so desparate for money that it choose to strip its older city retirees of their health insurance and force them into a second class private insurance plan (Medicare Advatage)? The City could have attacked any number of other programs. Why the retirees?

The City has previously stated that it is giving these savings to the Health Insurance Satbilization Fund (HISF) which in turn allows the City labor unions to funnel the money into their welfare funds. This is already getting comfusing but this may be why the unions sold the retirees down the river.

The City Budget - FY-2022 to FY-2024

In FY-2022, the City adopted a budget of $98.7B. This year, FY-2024, the City is proposing a budget of $106.7B. See chart below.

Health Insurance Costs from FY-2022 to FY-2024

Health insurance and welfare fund costs are embedded in the personal service category.

Again if you refer to the chart below, you can see that the City's health insurance costs have increased significantly from 2022 to 2024: the City spent

1. $5.0B on employee health insurance in 2022
2. $5.2B on employee health insurance in 2023
3. $5.6B on employee health insurance in 2024

Why did employee health insurance increase $400M in 2024? Is this the money that is going to be given to the union welfare funds?

1. $2.1B on retiree health insurance in 2022
2. $2.0B on retiree health insurance in 2023
3. $3.0B on retiree health insurance in 2024

And why did the retiree health insurance costs go up $1.0B in 2024? Isn't the City saving $375M ($450M full year) by terminating insurance for retirees on Medicare.

Welfare Fund Costs from FY-2022 to FY-2024

The welfare funds have dropped since 2022 but not radically. Quite different from health insurance.

1. $1.118B on employee welfare fund benefits in 2022
2. $0.858B on employee welfare fund benefits in 2023
3. $0.876B on employee welfare fund benefits in 2024

1. $0.494B on retiree welfare fund benefit in 2022
2. $0.442B on retiree welfare fund benefit in 2023
3. $0.449B on retiree welfare fund benefit in 2024

Health Insurance and Welfare Fund Costs for NYC

Category	FY-2022 Adopted Budget	FY-2022 Modified Budget	FY-2023 Adopted Budget	FY-2023 Modified Budget	FY-2024 Executive Budget
Total Budget
Personal Service	$53.4B	$54.4B	$52.9B	$52.5B6	$55.6B
Other Than Persanal Service	$45.9B	$53.4B	$47.7B	$52.4B	$48.3B
Debt Service	$1.3B	$6.3B	$2.4B	$4.5B	$4.8
Less: Intra -City Expenditures	-$1.9B	-$2.3B	-$2.0B	-$2.3B	-$2.0B
Net Total	$98.7B	$111.8B	$101.1B	$107.1B	$106.7B
Fringe Costs
Health Ins.-Employees	$5.880B	$5.061B	$5.399B	$5.164B	$5.640B
Health Ins.-Retirees	$2.142B	$2.142B	$2.260B	$1.969B	$2.959B
Welfare Funds-Employees	$1.040B	$1.118B	$0.938B	$0.858B	$0.876B
Welfar Funds-Retirees	$0.491B	$0.494B	$0.442B	$0.442B	$0.449B
Pensions	$9.921B	***	$9.305B	***	$9.525B

Lets Get Something Straight About the Health Insurance Stabilization Fund - It's the City That Is Raiding It, Not Senior Care.

I just read a letter written by the president of the local representing NYC correction officers. He was trying to defend his vote to sell out retirees health benefits. He starts out moaning about the Health Insurance Stabilzation Fund (HISF). He states that rising health care costs are diminishing the HISF.

The City and the unions have been crying over the HISF ever since this attack on retirees started. So below is the income statement chart for the fund since 2012. I've only included the main items.

The fund has only paid GHI $378M over the eleven year period.

But over the same period the HISF fund has paid:

1. the City $1.889B ($77M every year plus a $1.0B bonus in 2015).
2. the union welfare funds $996M and
3. other discretionary benefit providers $654M.

Payments to the City, the welfare funds, and the other benefit providers are controlled by the unions and the city subject to collective bargainning. You know collective bargainning, where the unions fight with the City to get what they deserve and not give things back to the City.

Income Statement History for the HISF

Fiscal Year	Opening Balance	1984 HBA City Contib Pay In	City Liability Pay In: GHI less than HIP	Other Benefit Pay Out	Welfare Fund Pay Out	2009 HBA City Refund Pay out	GHI Pay out: GHI greater than HIP	CBA City Refund Pay out	Closing Balance
2012	$587M	$35M	$465M	$48M	$38M	$112M	$0.0M	$0.0M	$894M
2013	$894M	$35M	$0.0M	$39M	$38M	$112M	$0.0M	$0.0M	$744M
2014	$744M	$35M	$1.162B	$40M	$38M	$112M	$50M	$0.0M	$1.706B
2015	$1.706B	$35M	$336M	$45M	$38M	$112M	$100M	$1.0B	$789M
2016	$789M	$35M	$1.202B	$43M	$52M	$112M	$8M	$0.0M	$1.829B
2017	$1.829B	$35M	$54M	$57M	$188M	$112M	$0.0M	$0.0M	$1.586B
2018	$1.586B	$35M	$232M	$57M	$38M	$112M	$2.0M	$0.0M	$1.643B
2019	$1.643B	$35M	$136M	$27M	$81M	$112M	$39.3M	$0.0M	$1.587B
2020	$1.587B	$35M	$0M	$83M	$171M	$112M	$3.9M	$0.0M	$1.369B
2021	$1.369B	$35M	$154M	$74M	$160M	$112M	$175.9M	$42.8M	$1.031B
2022	$1.031B	$35M	$0.0M	$136M	$100M	$112M	$0.0M	$0.0M	$900M

The MLC (DC-37 and UFT) and the City Attack on Senior Care

Along with the garbage about the HISF, this president had the gall to say that the MLC only voted to adopt the Aetna Medicare Advantage plan and not the termination of Senior Care. The City was required by a collective bargainning agreement to get the approval of the MLC before it terminated the GHI Senior Care contract. This union wants to hide the fact that it was part of the crime.

I hope every Correction Officer, who has to retire on disability and collect Social Security benefits, knows that he/she will get hammered with the Medicare Advantage crap. This is not about Aetna, all Medicare Advatage plans are inferior to Medicare with a supplemental plan.

I hope I don't have to tell anyone how to deal with statements from insurance companies. We have a massive legal industry based on this situation.

New Battle in the City's War on the City's Retirees

In 2021, the former City administration, without a legal opinion from Corp Counsel, tried to force Medicare eligible (ME) retirees to pay for their Medicare supplemental insurance, Senior Care.

This attempt flew in the face of 55 years of practice based on local law and collective bargaining agreements. The City wanted to save the $191 a month per retiree and spouse that it was paying for this coverage so that the City could give that money to the City unions’ welfare funds.

The City did not plan on the retirees fighting back in court and then having them win both at trial and on appeal.

The City then tried to gut the law guaranteeing the City’s obligation to pay for health insurance. That was the law that the court based its decision on. Again, the City failed. This time at the City Council.

Revenge

Now, in retaliation for losses in court and at the City Council, the Adams administration is dropping the 57 year old Medicare supplemental coverage (Senior Care) for older (ME) city retirees.

As of September 1, 2023, the City will force all Medicare eligible retirees and spouses (238,000) into a inferior Medicare Advantage plan (private insurance) which will cost the City nothing. Retirees, however, will be locked into paying whatever the new plan charges for Part D drug coverage. The only retirees to be left alone are the ones in the HIP Medicare Advantage plan (22,300).

This is a more drastic attack on the retirees than the illegal 2021 attempt to force retirees to pay for Senior Care. The City is now arbitrarily and capriciously dropping all health coverage for older retirees other than for the proposed Aetna Medicare Advantage plan. This means about 170,000 Senior Care retirees and spouses will be wrenched out of Medicare and jammed into a private health insurance plan.

It is a absolute fact that traditional Medicare with supplemental insurance is better than any Medicare Advantage plan. Anyone who tells you otherwise, including the mayor or any union rpresentative, is either lying or uninformed. This action is about reducing benefits to save money, period.

In addition, Medicare Advatage insurers have been exploiting Medicare for over a decade as noted by NY Times (4/1/2023):

"Nearly every large insurer in the program has settled a fraud lawsuit for such conduct. Evidence of the overpayment has been documented by academic studies, government watchdog reports and plan audits."

You can just imagine the turmoil that this will cause for very old retirees who will no longer be covered by Medicare and Senior Care. They won’t even know about it until they go to their doctor and are told that they don’t have Medicare anymore.

Also included will be 780 line of duty widows who will have their health insurance turned upside down.

Costs

This attack will potentially save the City $454M per year ($2,400 per retiree & spouse) . Health & Hospital Corp will save $45.8M per year and the Housing Authority will save $16.1M per year. These are rough amounts based on the NYCERS & TRS actuary’s 2022 annual OPEB report. There are some complications which include:

1. 13,000 ME retirees who have non-ME eligible dependents that will still cost the City $27,000 per year per retiree.
2. Non-ME retirees who have waived health coverage but will now re-enroll in GHI-CBP at $10,200 or $27,000 per year

The City claims $600M annual savings but never documents their figures.

Senior Care is the least expensive component of the City’s legal obligation to pay for the costs for health insurance for its workers and retirees. It is also the most effective component of that coverage.

Betrayal

For the City to be able to drop Senior Care, it had to get a majority of the city unions to agree. On March 9, 2023, the UFT and DC-37 agreed to sell out these older retirees, many who were their members when they worked for the City. For what? We can only suspect.

The UFT, however, will have legal (Chapter 504/Laws 2009 Part B - Section 14) problems with these cuts. Any dollar reductions imposed on retiree benefits will have to be matched by dollar reductions imposed on current workers. The UFT has not been honest with their members about this state statutory requirement.

Opting Out

By federal law the City must allow any retiree to opt out of the mandatory Medicare Advantage plan. The City is trying to equate this federal opt out choice to a retiree’s waiver of health insurance benefits. This will be challenged in court. They City does not have the right to penalize retirees for exercising their rights under the Medicare law.

The City is pushing this waiver concept for retirees opting out because they want to be able to:

1. stop refunding Part B premiums to these retirees
2. terminate any welfare drug subsidies they receive (possibly all welfare benefits) and
3. drop health insurance coverage for dependents of these retirees.

This plan is punitive on it face and reflects the City’s anger at having been beaten in the courts and at the City Council. It also reflects the betrayal by the unions of the retirees.

Retirees with sufficient financial resources will have a choice to avoid the garbage MA plan but most retirees will not have the money to opt out.

Choice

In 1965, choice was the driving concept behind the City – Union agreement to offer health insurance to workers and retirees.

The City's 1965 letter to the Board of Estimate

The City of New York Department of Personnel- City Civil Service Commission,
220 Church Street,
New York, N. Y. 10013,

December 14, 1965.

To the Board of Estimate: Subject: Proposed Resolution Extending Choice of Health Insurance Plans to Active and Retired City Employees. Gentlemen—

On October 24, 1946, the Board of Estimate adopted a resolution ( Cal. No. 11), approving a proposed agreement between The City of New York and the Health Insurance Plan of Greater New York for the furnishing of medical benefits to the employees of The City of New York or of any agency or department thereof, who are paid out of the City treasury, and their families, who voluntarily elect medical coverage.

The City was prompted in entering into this agreement with the Health Insurance Plan of Greater New York and in authorizing the payment of up to 50 per cent of the premiums of the medical, surgical and hospital insurance coverage by the great need for The City of New York to provide for and protect the general health and welfare of its employees and their families. The City took into consideration the fact that sickness and physical disability of employees or members of their families are responsible for the loss of many man-days in each year's work, are reflected in lower morale among employees and affect their work and productivity.

Your honorable Board, on February 11, 1965, adopted a resolution ( Cal. No. 155), which allowed The City of New York to contract with the Associated Hospital Service of Greater New York ( Blue Cross), Group Health Insurance, Inc. ( G.H.I.), United Medical Service, Inc. ( Blue Shield), and the Metropolitan Life Insurance Company, to provide a choice of health insurance plans for certain employees in the uniformed forces of The City of New York.

As a result of collective bargaining negotiations entered into with the representatives of certain classes of employees in the uniformed forces and other occupational groups; personnel orders were issued by his Honor, the Mayor, and determinations made by the Comptroller in the case of employees subject to Section 220 of the State Labor Law, providing for the assumption by The City of New York of

- 75 per cent of the total payment for choice of health and hospital insurance during the first year of such choice, not to exceed 75 per cent of the full cost of H.I.P.-Blue Cross (21-day plan) on a category basis, and, thereafter, of

- 100 per cent of the full payment for choice of health and hospital insurance, not to exceed 100 per cent of the full cost of H.I.P.-Blue Cross ( 21-day plan) on a category basis.

It appears desirable that the City institute a uniform policy for all City employees with respect to choice of health and hospital plans. Therefore, in line with the resolutions previously adopted by the Board of Estimate and with the various personnel orders issued by his Honor, the Mayor, on the choice of health and hospital insurance plans, with the assumption by the City of a greater share of premium costs, there is herewith presented for your consideration and determination a proposal, in which the Director of the Budget and I concur,

providing
- to all City employees who are eligible for H.I.P.: Blue Cross coverage and
- to retired employees,
health and hospital insurance benefits, which are the same as, or equivalent to, those offered to members of the uniformed forces and other categories of City employees.

Respectfully submitted, THEODORE H. LANG, City Personnel Director.

Retiree Data

Medicare Eligible Retirees with Senior Care out of all Medicare Eligible Retirees

Agency	Senior Care Retirees	Spouses	All Medicare Retirees	Spouses
City -	139,442	49,320	173,231	61,646
HHC	15,156	3,940	20,110	5,266
HA	5,046	1,660	6,741	2,217
WFA	2	0	5	1

Appellate Win - Now the Political War at the City Council over Section 12-126

On November 22, 2022, a NY appeals court decided in favor of the Medicare eligible city retirees in their fight with the City to keep their Medicare supplemental insurance coverage. The City had attempted force the retirees into a Mediacer Advatage plan that the City did not have to pay for.

The Stabilization Fund and Age Discrimination

In a previous post about the Medicare Advantage Scam I highlighted a document from OLR to the former Mayor. It went into great detail about the Health Insurance Stabilization Fund, the HISF.

In 1983 the City and its labor unions agreed to set up the HISF to equalize HIP and GHI insurance rates.

In 2005 HIP and GHI merged into Emblemhealth. The City fought this merger in court but lost the fight.

The HISF Agreement

The following is part of a section from the UFA's 2008-2010 labor contarct with the City that recites the HISF agreement:

Section 3.

A. Effective July 1, 1983 and thereafter, the City's cost for each employee and each retiree under ager 65 shall be qualized at at the community rated basic HIP/HMO plan payment rate as approved by the State department of Insurance on a category basis of individual or family e.g.the Blue Cros/GHI-CBP payment for family coverage shall be equal to the HIP/HMO payment for the family coverage.

B. If a replacement plan is offereed to employees and retirees under age 65 which exceeds the cost of the HIP/HMO equalization provided in Section 3a, the City shall not bear the additional costs.

C. The City (and other related Employers) shall continue to contribute on a City employee benefits program-wide basis the additional annual amount of $30 million to maitain the health insurance stabilization reserve fund which shall be used to continue equaliztion and protect the integrity of health insurance benefits.

The health insurance stabilization reserve fund shall be used: to provide a sufficient reserve; to maintain to the extent possible the current level of health insurance benefits provide under the Blue Cross/GHI-CBP plan; and if sufficient funds are available , to fund new benefits.

The health insurance stabilization reserve fund shall be credited with the dividends or reduced by the losses attributable to the Blue Cross/GHI-CBP plan.

Pursuant to paragraph 7 of MLC Healt benefits Agreement, notwithstanding the above in each of the fiscal years 2001 and 2002, the City shall not make the annual $35 million contributions to the health insurance stabilization fund.

It appears that this agreement violates the federal age discrimination law (ADEA - 1967) by giving a benefit to a subset of a group based only on their age. Why didn't the agreement provide equaliztion for retirees age 65 and older?

How Come?

Actually, there was no need to provide an equalization mechanism for retirees age 65 or older. The cost of their health insurance, both for GHI Senior Care and HIP-Medicare, has always been significantly less than the HIP/HMO benchmark.

In fact, the City has always used the GHI Senior Care cost as the internal benchmark cost for Medicare eligible city retirees. This was done administratively without reference to Section 12-126 which had set up the HIP/HMO benchmark. With the start of Medicare in July 1966, the HIP/HMO health care service model conflicted with the original Medicare indemnity model, whereas the GHI/CBP indemnity model was a better match.

Starinting 1965, the City contracted with GHI to provide an alternative health insurance plan. other than HIP, to employyes and retirees. GHI was built to handle claims coming in from out of network doctors and hospitals.

In 1966, Medicare began paying 80% of doctors and hospital costs for enrolled retirees over age 65. Very quickly most doctores and hospitals began particpating in Medicare. HIP was not equiped to pay claims from independent doctors and non-HIP hospitals. The City adapted the GHI/Blue Cross plan Over the years, GHI Senior Care has become the dominant choice of city retirees enrolling in Medicare with a 84% share while the HIP Medicare plan has a 12% share

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.

Catch-22

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.

A Simple Look at the Pro's and Con's of Medigap Insurance and Medicare Advantage Insurance From the Wall Street Journal

I have previously written about the City's Medicare Advantage scam. That is the one where the City saves money by taking away traditional Medicare/Medigap insurance from retirees over age 65 and dumping them into a Medicare Advantage plan. The City then gives the money saved to City unions for their patronage welfare funds.

It is really difficult sorting through the pros and cons of the Medicare/Medigap versus the Medicare Advantage plans. This is especially hard since the insurance companies, who run the Medicare Advantage plans, spend huge amounts of money promoting their extremely profitable businesses.

I recently, however, came across a very simple straight forward explanation in the Wall Street Journal, of all places. Please read the article.

The basic conclusion is that if you can afford it, the Medicare/Medigap program is the better choice, since soon or later we all have signification health issues. For decades the City, by statute, has been paying for the Medigap insurance for its retirees. Now it wants retirees to pay for the insurance and give the savings to the union welfare funds.

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:

GHI-EBCBS

• Non-Medicare Single : $775.66
• Non-Medicare Family : $2,035.61
• Medicare : $194.14

HIP-HMO

• Non-Medicare Single : $776.66
• Non-Medicare Family : $1,901.23
• Medicare : $181.58

Other

• 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.

July 14, 2021 - Medicare Advantage Plan for Some NYC retirees

On July 14, 2021 the Municipal Labor Council agreed with the City to replace the Emblem Health Senior Care plan with a Medicare Advantage (MA) plan run by Emblem Health/Blue Cross for targeted city retirees eligible for Medicare effective January 1, 2022. The cost of the MA plan will be paid by CSM, the government agency that manages Medicare. The current basic Emblem Health/GHI Senior Care plan will no longer be free.

The retirees had no say in the decision, and it was all done in secret.

The targeted retirees are not being given a choice. Targeted retirees who have signed up for GHI-Senior Care supp plan will be allegedly forced into the new MA plan. The City states that targeted retirees can opt out of the MA plan and stay in your current add on plan but the City will no longer pay the Senior Care basic coverage subsidy.

I find this strange since MA plans are voluntary. I don't see how the City can interfer with a retiree's (and/or his/her spouse's) Part B coverage without the retiree's and/or the spouse's consent. I'm sure The City can offer the MA plan to the targeted retirees but I don't think they can force anyone into it.

As a complication, there are currently 14 City medicare add-on plans, including Senior Care, offered by the City to these targeted retirees, each with the Senior Care subsidy. The City claims it will continue to offer these plans. But effective as of 1/1/2022, I am assuming, the City will no longer be paying the Senior Care subsidy to those plans. The City will have to lay out clearly all the new premiums and any changes in benefits for these plans so that retirees can make an informed decision. The City has alteady cut the benefits for Senior Care as of January 1, 2022.

Wouldn't it be interesting if the City already offered MA plans on voluntary basis? Actually, they do but retirees have not keen on the option.

Targeted City Retirees

Targeted city retirees are Medicare eligible retirees (age 65 or older or receiving SSA disability) who do not have spouses under age 65 or children under age 26. I suspect that this group will total about 55-60% of all city retirees, teachers at higher percent and police/fire at a lower percent.

For example, I estimate that each year 18% of new NYCERS retirees are targeted retirees. Eventually all these retirees will fall under the MA umbrella unless they continue to have beneficiaries outside the scope of Medicare. Slowly over time the percent increases but deaths are always cutting into the total retiree population.

The City will still have to provide regular GHI(CBP) health insurance for non-targeted retirees.

The City's Obligation to Pay for Health Insurance - NYC Admin Code Section 12.126

The mandating statute for health insurance is listed below. It sure appears to me that the City is no longer paying for the health insurance for targeted retirees. I am actually beginning to think that there may be some serious legal issues based on the City's obligation to pay for city retiree's health insurance. Retirees rights are not based on a collective bargainning agreement but a NYC Admin Code section of law.

And it is only older retirees that are being targeted.

Section 12-126.b. Payment of health insurance costs. Except as otherwise provided in section 12-126.1 and section 12-126.2 of this chapter, for city employees, city retirees and their dependents:

* (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.

Where such health insurance coverage is predicated on the insured's enrollment in the hospital and medical program for the aged and disabled under the Social Security Act, the city will pay the amount set forth in such act under 1839 (a) as added by title XVIII of the 1965 amendment to the Social Security Act;

Quotes from the City's press release

This is a quote from the July 14, 2021 City press release

The NYC Medicare Advantage Plus Program replaces the current Senior Care program, which is a supplement to traditional Medicare, as the program that is free to all retirees. Other buy up options, including the Senior Care plan and the HIP VIP program will remain available to retirees.

It does appear from the press release that Senior Care will still be available but the retiree will have to pay the basic coverage premium which the City has been paying for up till now. That should be an interesting amount. Will it be what the City has been paying or will be jacked up for increased risk that Emblem health will claim?

It appears that the City will also continue to offer the other 13 supplemental plans but without the current subsidy.

Medicare retirees will still be paying for their Part D drug coverage which is most often handled by GHI(CBP) or Senior Care for most Medicare eligible retirees. The new MA plan will offer option of paying for Part D drug coverage.

From the City’s press release:

Retirees will still be eligible for the reimbursement of the Medicare Part B benefit that they receive today.

This means that the City will still be refunding $1,800/yr. to every Medicare retiree and every Medicare covered spouse. I’m assuming the IRMAA premiums will also still be refunded. These can run up to $2,500/yr.

Cost Savings

From the City’s press release:

Implementing the NYC Medicare Advantage Plus Program will produce approximately $600 million annually in health care cost savings for the system. … The City spends over $1 billion a year on retiree benefits, including the Part B Medicare reimbursement, and this will help the City control those costs while improving the quality of care for retirees.

This may be the most critical part of the new plan. This decision is supposed to save the City money while keeping the same level of benefits for the targeted retirees. Retirees, however, will now have $15 copays for all doctor visits.

The savings are created by the City offloading its supplemental health insurance costs to Medicare via the Medicare Advantage program. With the MA plan, the City will not pay for the second level of insurance coverage that it currently provides to targeted city retirees. Medicare will now be paying for that coverage via the MA plan.

Do you get the feeling that Medicare is getting the short end of the stick along with the retirees? What happens if CSM wakes up one morning and sees that every employer is dumping their retiree health care costs on Medicare?

The City does not report what it currently pays for the individual Senior Care premium for basic coverage to Emblem Health for each targeted city retiree. It also doesn’t report the current premium for regular employees and non-targeted city retirees.

I suspect that the City will not report out the details of the new agreement with Emblem Health, the flow of funds from Medicare (CSM) to Emblem Health for this new MA plan, nor Emblem Health’s projected profit from the deal.

On a very basic level a MA plan privatizes Medicare. As such the retiree is dealing with a profit-making insurance company as opposed to CSM, the government entity which runs the Medicare program. Retirees will also be paying $15 copays starting 1/1/2022 both in the MA plan and in Senior care. This is a new cost for retirees for every doctor’s visit. Designed to cut down on visits to the doctor and increase profits. If a retiree chooses to stay with Senior Care, not only will he/she have to pay the basic premium but also the new copays. This is what happens when you are not part of the decision.

Access to Doctors

From the City press release:

A major concern for retirees is whether they can keep their current doctors and hospitals in a NYC Medicare Advantage Plus Program. In the City’s Medicare Advantage Plus Program, a retiree can go to any doctor or hospital that accepts Medicare. It doesn't make a difference if that provider is in the insurer's network or not. As long as the provider takes payment from Medicare, they are obligated to accept the NYC Medicare Advantage Plus Program payment. That includes all the hospitals in the NYC area, including those at Memorial Sloan-Kettering and The Hospital for Special Surgery (HSS), and almost all hospitals nationally and 99.5% of all doctors. The program is a national program so it covers retirees in any State in which they work or reside and when they travel.

This is a very misleading statement. Doctors who accept Medicare will provide service, but you may have to pay for the full cost of the service and then submit a claim to Emblem Health for reimbursement. I suspect that this will happen a lot. This is the big problem with MA plans along with the referral issue. This is why many reirees stay away from MA plans.

Currently most doctors do accept Medicare. They submit their charge to CSM for the 80% payment for the covered service and usually attempt to collect the finally 20% from Senior Care. Only then do they send a bill to the retiree for the remainder of the charge. Doctors are comfortable with reimbursements from CSM. They tend to be wary of payment from MA plans.

City Budget - Retiree Health Insurance

Over the last five years the City has budgeted the following amounts for retiree health benefits:

• 2022 = $1.693B
• 2021 = $0.268B (orig. $2.293B)
• 2020 = $0.779B (orig. $2.500B)
• 2019 = $2.230B
• 2018 = $2.170B

It would be very informative to get the itemized details and supporting data for these numbers. That is real transparency.

The City OLR site has new FAQ sheet on its website.

This is another info link from a AFSCME local for a MA plan implemented in Illinois Illinois.