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Judge blocks Medicare Advantage switch for 250K NYC retirees, days before
crucial deadline
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JUDGE BLOCKS MEDICARE ADVANTAGE SWITCH FOR 250K NYC RETIREES, DAYS BEFORE
CRUCIAL DEADLINE



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By
Caroline Lewis

Published Jul 7, 2023

Modified Jul 7, 2023

62 comments

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Roy Rochlin/Getty Images

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By
Caroline Lewis

Published Jul 7, 2023

Modified Jul 7, 2023

62 comments

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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.”

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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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Related stories
What 250K NYC retirees can expect from Medicare Advantage as opt-out deadline
approaches

Aetna reveals health care denial rates in Medicare Advantage court case for NYC
retirees


Tagged

medicare
Health and Science
health care
new york city

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Caroline Lewis


Caroline Lewis is on the health care beat for WNYC and Gothamist — and also
covers cannabis, both with an eye towards equity and accountability. She was
previously a health care reporter for Crain’s New York Business. Lewis has a
degree from the CUNY Graduate School of Journalism and is a native New Yorker,
although she has left occasionally. She did a Fulbright in Chile in 2011 and is
fluent in Spanish. She now resides in Brooklyn.

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Gothamist is funded by sponsors and member donations

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Gothamist is funded by sponsors and member donations

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