(Click here to read the latest on what is happening to our healthcare)
March 16, 2023
To: All PSC members and retirees
From: James Davis, PSC President
Subject: Senior Care slated for elimination – what you need to know
Dear PSC members and retirees,
The Municipal Labor Committee voted on March 9 to approve the City’s tentative agreement with Aetna for a Medicare Advantage PPO plan for NYC retirees aged 65 and over – including CUNY retirees – and their Medicare-eligible dependents. The City intends to move forward on approving the contract. PSC’s efforts were instrumental in increasing the number of unions voting “no” from 11 (the number that opposed the Emblem/Empire Medicare Advantage plan in 2021) to 25 this time, but we did not prevail.
The plan is scheduled to take effect on September 1, 2023. The period to opt-out is May 1-June 30, 2023. Retirees and their Medicare-eligible dependents who do not opt-out during this period will be automatically enrolled in the new Aetna City of New York Medicare Advantage (CONY MA) plan. Once enrolled, retirees and their dependents retain their right under federal regulations to opt-out during the first 12 months without penalty, as long as the Aetna CONY MA plan is the first Medicare Advantage plan in which they have enrolled.
At this point, the only NYC-provided alternative is to enroll in HIP-VIP, a Medicare Advantage HMO administered by Emblem, which is available only in NYC. The City intends to eliminate GHI Senior Care. Retirees who choose to go outside the NYC-provided retiree health program and enroll in a Medigap plan on the open market will not be eligible for reimbursements for Medicare Part B expenses or IRMAA expenses or for participation in the PSC-CUNY Welfare Fund.
The PSC continues to advocate that the City preserve GHI Senior Care, and that it be preserved at no cost to retirees and their dependents. This has been an uphill battle, never more so than now. The City’s Office of Labor Relations will hold a public hearing on March 21 at 10 am to hear from members of the public regarding this contract, prior to approving it. Please call in to testify. We are also urging all retirees, in-service members and community allies to demand that the City Council and the Mayor preserve premium-free Senior Care as an option. Stay tuned for further opportunities to take action.
We will also be circulating Aetna’s presentation slides about their MA program and its comparisons to Senior Care, as well as a summary of Aetna’s responses to questions that MLC union leaders raised.
PSC opposed the approval of the Aetna CONY MA contract because
o MLC member unions, including PSC, had not reviewed the contract.
o Aetna still requires preauthorizations that Medicare doesn’t require, despite a reduction in preauthorizations.
o All providers who accept Medicare do not accept Aetna’s MA plan, despite improvements to the scale.
o And the move fosters privatization of a vital national public health care program.
However, the Aetna CONY MA PPO negotiated by the City and the MLC does represent a significant improvement over the Emblem/Empire MA program proposed in 2021.
The improvements, which are in large part a result of your efforts, include “a very limited” Prior Authorization program. According to the City, the only services requiring Prior Authorization will be hospital inpatient stays, skilled nursing facility stays, long term acute care stays, acute physical rehabilitation stays, services that could be experimental, investigational or cosmetic, and a limited list of Part B and Part D drugs. Among the prior authorization requirements that have been removed are all Radiology procedures, such as MRIs, PET scans and CAT scans, diagnostic cardiology, and physical and occupational therapy. A list of specific services that will require a prior authorization can be found on Aetna’s dedicated website for the City’s retirees. In addition, the City states that the Aetna CONY MA plan has a deductible of $150, lower than the $276 deductible in the current Senior Care Plan.
For now, please read the NYC Office of Labor Relations letter to retirees here. If you want to know whether your healthcare provider accepts the new plan, check here. The NYC Office of Labor Relations has posted information about the Aetna CONY MA plan here. Aetna is offering informational webinars for retirees. Although PSC has not supported the Aetna MA contract, it is important for our members to receive the information that other City retirees are receiving, and we will seek to host informational sessions.
But the struggle to preserve free, public health insurance for municipal employees and retirees is not over. Despite the improvements in the Aetna CONY MA plan over conventional MA plans, Medicare Advantage is not Medicare, and the city’s shift of 250,000 retirees into a privately administered program is an entering wedge to further privatization of health insurance, here and elsewhere, for retirees and for active employees. We must maintain pressure on the Adams administration to do the right thing and preserve cost-free Senior Care.
In solidarity,
James Davis, President
(Click here to read the latest on what is happening to our healthcare)
Published: March 16, 2023 | Last Modified: March 17, 2023
