– FAQs updated July 2023 –
Read these frequently asked question’s if you are turning 65 or are retiring in the next few months.
Historic news in our fight to ensure high-quality health coverage for NYC retirees
On Friday, August 11, Justice Lyle Frank issued a ruling in New York State Supreme Court permanently blocking the City from removing retired City workers and their dependents from their current health insurance plans and forcing them either to enroll in the Aetna Medicare Advantage Plan or find their own coverage.
Message from President James Davis, August 14
Judge’s decision blocks Aetna Medicare Advantage
BASIC INFORMATION YOU NEED TO KNOW TO MAKE A DECISION
Movement of Medicare-Eligible NY Retirees is NOT Proceeding at this Time.
Message from PSC President James Davis, August 14:
The following appeared on the New York City Office of Labor Relations website on Friday, August 11:
New information and updates regarding the Aetna Medicare Advantage PPO Plan – August 11, 2023
There is no Opt-Out or Waiver deadline in effect due to a preliminary injunction issued by the court.
- All current health plans remain in effect. No retiree will be moved into the new Medicare Advantage PPO Plan.
- No opt-out requests made through Aetna via their call center or website will be processed at this time.
- No waiver of City health benefits, enrollment into the Aetna Medicare Advantage PPO Plan or adding the prescription drug rider that have been submitted on the Retiree Special Enrollment/Waiver Form will be processed at this time.
Please check back frequently for additional information and updates.
New FAQs
With information for retirees turning 65 & those retiring in the next few months.
Updated August 14, 2023
with information for retirees turning 65 & those retiring in the next few months.
To be updated further as new information becomes available.
- What’s happening/What has changed with retiree health care?
-
- August 11 – Judge Lyle Frank permanently enjoined NYC from removing NYC Medicare-eligible retirees and their dependents from their current health plan(s) and from requiring those retirees and their dependents to enroll in Aetna Medicare Advantage or seek their own health coverage. The City has expressed its intention to appeal this decision to the NY State Appellate Division.
- Therefore, Medicare-eligible NYC retirees and their dependents will not change health insurance plans on September 1st. No one will be enrolled in the Aetna MA PPO Plan. Those who are 65+ will continue to be covered by traditional Medicare and whatever supplemental plan in which they are currently enrolled. Those under 65 will also remain in their current plans.
- What action should retirees take in response to this change?
-
- Do nothing unless you have formally signed up for a Medigap plan (See Q #4 below.) or dropped a dependent from NYC coverage. (See Q #5 below)
- Check the PSC website and the Office of Labor Relations (OLR) website periodically to see if things have changed. Note: as of July 11th, OLR has not removed all the Aetna MA materials, nor have they eliminated the July 10th deadline from their statements.
https://www.nyc.gov/site/olr/health/retiree/health-retiree-responsibilities-assistance.page
- What about the deadlines and other actions I might have taken?
-
- There are no deadlines in place at this time.
- No waiver requests on the Special Form submitted May 1st or later will be processed.
- No opt-out requests through Aetna will be processed.
- No requests to change coverage from HIP VIP to Aetna will be processed.
- All current Medicare supplemental health plans remain in effect.
- What if I already formally signed up for a Medigap plan starting 9/1/23?
-
- Notify the plan (or your health insurance broker) right away that you are withdrawing from it. You should face no penalty because federal Medicare mandates a 30-day “free look period”. Even if you signed up more than 30 days ago, press to withdraw.
- If the Medigap insurance company resists your effort to withdraw or cancel your coverage, contact your State Health Insurance Assistance Program (SHIP). SHIPs are funded by the Federal government and have local offices in every state. You can find a locator by state online at https://www.shiphelp.org/ or call 877-839-2675. They are excellent resources for retirees involved with Medigap policies; you should use them. The Medicare Rights Center is also a useful resource. See: https://www.medicareinteractive.org/get-answers/medicare-health-coverageoptions/supplemental-insurance-for-original-medicare-medigaps/medigap-purchasing-detailsenrollment-periods-guaranteed-issue-and-more
- What if I submitted a form to drop my spouse from NYC coverage so s/he could stay in traditional Medicare?
-
- You need to cancel that request by sending a letter to the NYC Employee Health Benefits Program saying: “I rescind the application to drop my dependent (name of dependent) from NYC retiree health coverage effective 9/1/23.” Sign and date the letter.
- Include your (the retiree’s) name—last name, first name—and the last 4 digits of your social security number.
- You can email it to: [email protected] and then print a copy of the sent email for your files.
- Or mail it (keep a copy) to:
NYC Employee Health Benefits Program
NYC Office of Labor Relations
22 Courtlandt St, 12th floor
NY, NY 10007
- How long will this temporary injunction last?
-
- No one can predict.
- On July 17th, NYC filed its intent to appeal the judge’s decision to impose the preliminary injunction. We will post more information when we have it. Presumably, it will take at least a couple of months before the appeal can be argued and a decision rendered. The written and oral arguments on the underlying lawsuit will likely be scheduled sometime during fall 2023.
- What if I am already retired and turning 65 over the next few months?
-
- First of all, you should apply for Medicare if you have not already—both Part A and Part B—go to medicare.gov starting 60 days before your 65th birthday.
- Medicare takes effect the first of the month you turn 65.
- The HR Dept. of your former college should send you the paperwork to apply for a Medicare supplemental plan offered by the City. If you have already filled out a Form, it will not be acted on, because there is an injunction against the implementation of Aetna MA. If you applied to waive benefits, that will not be processed either. If your college HR Dept. does not contact you, you should contact them.
The Application/Change Form for NYC retiree health benefits through the NYC Employee Benefits Program at the NYC Office of Labor Relations is at: https://www.nyc.gov/assets/olr/downloads/pdf/health/retiree-health-benefits-application.pdf and the chart showing the different available plans for Medicare-eligible retirees—the bottom set of boxes labelled “Monthly Medicare” is at:
https://www.nyc.gov/assets/olr/downloads/pdf/health/retiree-rates-july-2023.pdf (See Q #9)
You should have already filled out an application form for retiree benefits from the PSC-CUNY Welfare Fund, so that coverage will take effect during the month you turn 65. For more information, contact [email protected]
- What will happen if I am 65 or older and I am retiring this summer or fall?
-
- Be sure to apply for Medicare Part A and Part B at medicare.gov
- Your college HR Dept. should provide you with the necessary paperwork for health coverage in retirement if you are eligible for it.
- If you already filled out a Retiree Application/Change Form, you would likely need to fill out another one in order to change your coverage to a Medicare supplemental plan, because of the injunction against the implementation of Aetna MA. Check with your college HR Dept. because the new Form will need to be certified by them. Here is the NYC Employee Benefits Program Form:
https://www.nyc.gov/assets/olr/downloads/pdf/health/retiree-health-benefits-application.pdf
-
- If you already waived NYC retiree health coverage because you did not want to be enrolled in Medicare Advantage, that waiver will not be processed at this time.
- You will need to choose a Medicare supplemental health plan, among those currently offered by the City. See:
https://www.nyc.gov/site/olr/health/retiree/health-retiree-choosing-a-health-plan.page
and the chart showing the different available plans for Medicare-eligible retirees—the bottom set of boxes labelled “Monthly Medicare” is at:
https://www.nyc.gov/assets/olr/downloads/pdf/health/retiree-rates-july-2023.pdf (See Q #9)
CUNY will also give you a form to fill out for retiree benefits from the PSC-CUNY Welfare Fund.
- If I am just retiring now, or am already retired and just turning 65, what health plan should I select?
-
- The vast majority of retirees choose the plan called “GHI Senior Care.” This is the plan that the PSC and thousands of city retirees have been fighting to keep. It provides a premium-free supplement to traditional Medicare. Because of the judge’s injunction, it is still available.
- When you select Senior Care, in order to have complete health insurance coverage, you must sign up for the 365-day hospitalization coverage rider for $3.25 per month for an individual and $6.50 per month per family.
- You do not need to pay for retiree drug coverage because you will have an Rx drug benefit from the PSC-CUNY Welfare Fund.
IMPORTANT CONTACT INFORMATION
- LETTER FROM OLR: Letter to NYC retirees from the NYC Office of Labor Relations, dated March 10, 2023.
- DOES OLR HAVE YOUR CORRECT MAILING ADDRESS? Be sure the NYC Employee Benefits Program has your updated mailing address.
- THE NYC AETNA MA PLAN EVIDENCE OF COVERAGE document on the OLR website spells out the Aetna MA plan rules for how provider coverage works, how to make complaints, etc., as well as the services covered (at the end). This document is updated each calendar year to reflect changes in the plan. NOTE: PSC retirees are not covered by the Aetna Silverscripts prescription drug plan. PSC retirees who stay in NYC sponsored coverage continue to be covered by the PSC-CUNY Welfare Fund Silverscripts prescription drug plan.
- AETNA MEDICARE ADVANTAGE PPO PLAN
- AETNA VIRTUAL AND IN-PERSON ORIENTATION sessions about the plan. For information check Aetna’s website. Aetna call center for NYC retirees: (855) 648-0389, 8 a.m. – 9 p.m. ET, Monday – Friday
- MEDIGAP PLANS:
- For information about Medigap plans in NYS, begin with “Protections For Medicare Beneficiaries Residing in New York State”
- To price both Medigap and Medicare Part D drug plans around the country, start with this Medicare page https://www.medicare.
gov/plan-compare - For help in understanding Medigap options in NY and other states, contact the Medicare Rights Center at 800-333-4114
- CONTINUITY OF CARE DURING TRANSITION TO AETNA MA
- For retirees who have surgery, hospitalization, testing or treatment scheduled after 9/1/23 or are receiving ongoing medical treatment, review Aetna’s Continuity of Care brochure and submit the Continuity of Care form to discuss your needs with an Aetna nurse case manager in advance of September 1st.
- Aetna representatives say that, while they can collect information about ongoing treatments and scheduled procedures, federal CMS rules do not permit them to coordinate patients’ care with providers until patients are enrolled in the plan. Enrollments effective September 1st will not be finalized until August, so more complete interactions will not happen until then.
IN A NUTSHELL: How this all happened?
NYC announces that it will begin negotiations with the second-place bidder, Aetna, to provide an MA plan for Medicare-eligible NYC retirees, because the “Alliance” MA plan which NYC and the MLC had negotiated will not be implemented due to the withdrawal of Anthem, the national sponsor, from participation in the plan in July.
NYC proposes, with the support of the MLC, an amendment to the NYC Administrative Code to permit Medicare-eligible retirees and their dependents to be treated as a separate “class” for the purpose of establishing a benchmark health insurance plan at a cost below the full cost of HIP HMO. PSC and other unions oppose such a change because it could undermine the legal right to future premium-free health care coverage for all NYC employees and retirees. The City Council held a hearing on the change in January 2023 but did not vote on it.
PSC proposes both an alternative approach for funding the NYC Health Insurance Stabilization Fund such that savings from forcing NYC retirees into an MA plan would not be needed and the establishment of a stakeholders’ commission to identify ways to reduce the growth in NYC spending for health care with a focus on hospital pricing
PSC testifies at City Council against proposed change to Administrative Code.
MLC local union leaders vote to accept the Aetna MA plan as the only plan available to Medicare-eligible retirees, other than HIP VIP. PSC voted NO. The full Aetna contract was not made available before the vote, only a summary, and more locals voted No or abstained than in the past.
The full Aetna contract was posted on the NYC OLR website. (See the bottom of the page when you click the link.) The contract contains a provision in Addendum B to permit continuation of access for NYC retirees to traditional Medicare plus a supplemental plan. NYC has not sought to establish a supplemental plan to replace Senior Care.
NYC Office of Labor Relations Commissioner Campion sends a letter to all Medicare-eligible retirees announcing that as of September 1, 2023 all Medicare-eligible retirees and Medicare-eligible dependents will be automatically enrolled in the NYC Aetna Medicare Advantage (MA) PPO Plan, except retirees already enrolled in HIP VIP, a Medicare Advantage HMO. GHI Senior Care and all other retiree health plans except the Aetna MA PPO and HIP VIP will be discontinued as of 9/1/23. (Non-Medicare-eligible dependents will be enrolled in the GHI CBP as of 9/1/23, regardless of their current coverage, except dependents of retirees in HIP VIP who will be enrolled in HIP HMO.)
PSC testifies against proposed NYC/Aetna contract at OLR hearing.
NYC signs the contract with Aetna, and the OLR Commissioner states to the MLC that the City will exercise the options in Addendum B (see above) “…only in the event a change in circumstances in the future, whether due to litigation, legislative action, or some other event, mandates a different approach….”
Nine Plaintiffs and the NYC organization of Public Service Retirees filed a lawsuit challenging the implementation of the NYC Aetna MA plan and also seeking a temporary restraining order and preliminary injunction from forcing Medicare-eligible NYC retirees and their dependents off their existing health insurance pending a determination on the case. In early June, the parties to the case agreed to extend the deadline for the Special Enrollment/Waiver Form submission to July 10, 2023, to permit preliminary argumentation and the judge’s consideration of the request for a preliminary injunction.
Judge Lyle Frank granted a preliminary injunction such that the Respondents [NYC et al.] “are temporarily enjoined until further order of this Court from requiring any City retirees, and their dependents from being removed from their current health insurance plan(s), and from being required to either enroll in an Aetna Medicare Advantage Plan or seek their own health coverage.” This order is not a final disposition in the case, but the judge ruled that the burden for preliminary injunction was met because of the likelihood of ultimate success of the case on the merits and the prospect of irreparable injury if retirees and dependents were forced to change coverage before the case is decided.
Judge Lyle Frank permanently enjoined NYC from removing NYC Medicare-eligible retirees and their dependents from their current health plan(s) and from requiring those retirees and their dependents to enroll in Aetna Medicare Advantage or seek their own health coverage. The City has expressed its intention to appeal this decision to the NY State Appellate Division.
For a longer term history of how this transpired, going back to June 2018, click here.
