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Judge blocks Medicare Advantage switch for 250K NYC retirees, days before crucial deadline
By
Caroline Lewis
Published Jul 7, 2023
Modified Jul 7, 2023
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Roy Rochlin/Getty Images
By
Caroline Lewis
Published Jul 7, 2023
Modified Jul 7, 2023
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A Manhattan judge is pressing pause on a controversial plan to push New York City government retirees onto a new privatized version of Medicare this fall – a major victory for critics of the switch.
In a plan that city officials said would save some $600 million a year, municipal retirees were supposed to be moved from their existing coverage – a combination of traditional Medicare with supplemental coverage paid for by the city – onto a private Medicare Advantage plan run by Aetna this fall. City officials had scheduled the deadline to opt out for this coming Monday, but seniors who decided to stay on traditional Medicare would have had to waive their city benefits and pay for their health coverage themselves.
A group of retired city workers filed a lawsuit in late May arguing that the Adams administration would be diminishing care for retirees and violating city law by making them pivot onto the new Aetna-run plan.
On Friday, Judge Lyle Frank granted retirees’ petition to temporarily block the transition while the case is pending in court.
“As this matter deals with health decisions of an aging and a potentially vulnerable population, mostly on fixed incomes, any lapse in care for these people could lead to deleterious impacts,” Frank stated in his order.
“This is now the third time in the last two years that courts have had to step in and stop the city from violating retirees’ health care rights,” Marianne Pizzitola, president of the New York City Organization of Public Service Retirees, one of the lead plaintiffs, said in a statement. “We call on the city and the Municipal Labor Committee to end their ruthless and unlawful campaign to deprive retired municipal workers of the health care benefits they earned.”
Adams administration officials have argued that the new plan will not be inferior to retirees’ existing coverage, but retirees have expressed concerns that some doctors will not accept the new plan — and that patients will need prior approval from Aetna for more types of medical services.
“We are extremely disappointed by this misguided ruling,” said Mayor Eric Adams' Deputy Press Secretary Jonah Allon via email. “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 incentive.”
Allon added that further delay will only cause greater uncertainty for the city’s retirees and could have a detrimental impact on the city’s budget. He said the mayor’s office is exploring options for an appeal.
Following the ruling, the City Council's Common Sense Caucus urged the Adams administration and union leaders to restart negotiations and find health insurance savings without diminishing the benefits retirees have earned.
“While this is not a final victory, Judge Frank’s strongly worded motion made it clear that the law, specifically New York City Administrative Code 12-126, is “unambiguous” in protecting the essential, cost-free health care that retirees have been promised, and that switching them to Medicare Advantage would cause “irreparable harm,” the caucus’s statement read. “This is why we fought to prevent the administrative code from being changed and were compelled to file an amicus brief in support of this lawsuit.”
The judge also rejected a request from Aetna to intervene in the lawsuit and defend its health plan.
This story was updated with statements from the mayor’s office, lawyers for the plaintiffs and the City Council Common Sense Caucus.
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new york city
health care
Health and Science
medicare
Caroline Lewis
Caroline Lewis is on the health care beat for WNYC and Gothamist. She has covered COVID, a nurses' strike, the overdose crisis and New York’s marijuana legalization effort, and spent a year investigating patients' medical bills. She always wants to hear about how everyday New Yorkers experience the health system. Got a tip? Email [email protected].
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Gothamist is funded by sponsors and member donations
Gothamist is funded by sponsors and member donations
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