Wednesday, April 28, 2021


The PSC put this out for their retirees. The PSC is part of the Municipal Labor Committee as is the UFT. What's missing are questions about if prior approval will be needed for procedures, surgeries or tests. That is where it looks like the changes might be. Norm is likening these union negotiated changes to death panels as the unions would be helping to ration care. Is this too dramatic a description?

Frequently Asked Questions About the Proposed Medicare Advantage (MA) Plan 

What follows are questions sent to the Welfare Fund by participants in the recent PSC Retirees’ Chapter meeting. The answers given by Welfare Fund Executive Director Donna Costa reflect what is presently known. More details will be available when the bidder/vendor of the MA plan is selected. 

Q: Will all doctors accept the new Medicare Advantage Plan? 

A: All physicians who accept Medicare must continue to accept Medicare B coverage under the MA plan. 

Q: Will the coverage be equivalent to GHI SeniorCare? 

A: The table below details the current GHI SeniorCare coverage, deductibles and limits. All of the prospective vendors contractually agreed to offer the same or better coverage.

Q: Will the other Medicare Advantage plans that are currently in force remain or will they be replaced by the new Medicare Advantage plan?

A: The City has not yet determined whether it will offer the Medicare Advantage as the only plan option or offer both a Medicare Advantage and the option to purchase GHI SeniorCare. 

Q: Will there be two MA plan options? 

A: The possibility of two plan options is slim because all of the vendors have said they cannot guarantee the savings if members are allowed to pick from a variety of health care plans. 

Q: What is the cost to the City for the current health insurance program for retirees? 

A: The approximate current medical and hospital projected savings for all New York City ‘s retired Medicare eligible participants and their spouses is approximately $500 to $600 million. We assume a Medicare Advantage plan will reduce the City’s spend materially through efficiencies and moving to a single program. 

Q: Will the new MA plan be accepted anywhere in the US? 

A: Yes, you are covered anywhere in the US or US territories as long as the urgent care physician and/or hospital accepts Medicare. 

Q: I have GHI Emblem health for myself and my husband. My monthly cost is $2.00 for me and $2.25 for my husband. What will the monthly cost for the new MA plan be for me and for my husband?

A: The monthly cost you are referring to is the cost of the optional 365-day hospital rider. There is no cost for current GHI SeniorCare coverage. There will be no cost for any MA plan currently being considered. All plans will include the 365-day hospital coverage at no additional charge. 

Q: My primary care physician does not accept Medicare. I am currently reimbursed according to Medicare rates but pay extra to see him. Will this remain the same or will I not be reimbursed according to the Medicare schedule? 

A: If your primary care provider accepts Medicare but does not accept Medicare Assignment of Benefits (in which Medicare pays physicians directly), you will still be able to see the physician under the MA plans. 

Q: Will the $50 deductible, no-copay feature still be available under the Medicare Advantage plan? 

A: All of the plans being considered must meet the same coverage as the GHI SeniorCare Plan now offered. GHI SeniorCare currently has an annual deductible of $248 per participant, plus a $25 deductible for ambulance, durable medical equipment, and private duty nursing after the Medicare Part B deductible has been reached. 

Q: My wife is under 65, is on the Affordable Care Act, and has supplemental coverage under my Empire Blue Cross plan. Will I know for sure whether she will be covered as well under the Medicare Advantage plan being proposed before I have to decide whether to join city's Medicare Advantage plan?

 A: Spouses over 65 are eligible for coverage under the proposed MA plans. Spouses and/or dependents under 65 will also be covered, but details are pending the selection of the vendor.

Q: If I choose to remain with traditional Medicare, do you have a ballpark figure on how much I would have to pay for me and my wife if I wanted to retain the supplemental plan I have now? 

A: The option of purchasing the current GHI SeniorCare program has not yet been decided and will depend on which vendor is selected.

Q: What will the timing be for the transition from traditional Medicare to Medicare Advantage? 

A: No vendor has been selected yet so the timing of the transition is still being decided. 

Q: Can such a large-scale conversion occur by July 1? 

A: At this point none of the bidders can meet a July 1, 2021, implementation. 

Q: How can continuing participation by Medicare doctors and other providers in the new Advantage plans be demonstrated and assured? 

A: The only requirement is that a doctor must be a participating Medicare provider. Currently 97% of all doctors accept Medicare patients. 

Q: If I remain with regular Medicare next year, can I join the Medicare Advantage plan the following year without penalty?  

A: If you opt out of the proposed Medicare Advantage program you will have to wait until the next Medicare open enrollment period before changing again. The same goes if you take the MA plan and want to switch back. 

Q: My spouse is not eligible for Medicare because he has fewer than 5 years legal residence in the US. He is a dependent on my GHI plan for medical and Empire for hospital. How would this plan affect him? 

A: Since your spouse is not eligible for Medicare, he would not be eligible for the MA plan. Your spouse would be covered under a GHI type plan. Details are still pending the selection of the vendor. 

Q: If my husband and I choose to stay with Traditional Medicare and purchase our own supplemental coverage, will NYC still reimburse us for our Medicare premiums? 

A: I believe so but that is not yet confirmed. 

Q: Is there any way that they would grandfather those already in standard Medicare since that was what we were told we would get at the time of retirement? 

A: Since the new plan is offering the same or better coverage than GHI SeniorCare, I do not think NYC will be open to continue paying for the current plan. 

Q: Will there be a way to pull out if they go through with this and it dosen’t work well? 

A: There are contractual guarantees and penalties that will come into play if the plan does not meet its obligations to provide the same or better coverage than the current plan. 

Q: What kind of coverage does the MA plan provide for when we are out of the US? 

A: You are covered in full from the 1st through 60th day, except for the Medicare deductible amount, and from the 61st through 90th day, except for the Medicare coinsurance amount. 

Q: My husband is a dependent on my health coverage. If we are moved to an Advantage plan, what will happen to his coverage if I die before him? 

A: Whether you move to the MA plan or not, your spouse’s health care will cease on the last day of the month in which you die. Your death is a qualifying event and will trigger a special Medicare open enrollment period that will allow your spouse to select traditional Medicare A & B or another Medicare Advantage program.

Q: Will he have to re-register with Medicare to get the traditional Medicare restored, with the appropriate card, or would this be automatic? And will the procedures for this transition be addressed in detail? 

A: When an MA vendor is selected all the procedures for the transition will be addressed in detail. 

Q: How do Medicare Advantage plans make money? 

Here is Donna’s overview: Medicare Advantage plans act as both Medicare A & B and Medicare Supplemental insurance. Medicare pays the vendor a monthly amount to manage the Medicare A & B claims and pays them an administrative fee to do so. CMS funding to MA’s is based on “Star” rating and “risk” of membership. Higher ratings equal more CMS funding. The star rating also has a direct impact on their Quality Bonus Payment (QBP). In 2018 Health plans with an Overall Star Rating of 4.0 and received up to a 5.0% QBP. Star ratings are also a tool to assist Medicare beneficiaries in selecting high quality plans. See below for a description of the five main star categories: 

• Staying Healthy: Plans are rated on whether members had access to preventive services to keep them healthy. This includes physical examinations, vaccinations like flu shots, and preventive screenings. 

• Chronic conditions management: Plans are rated for care coordination and how frequently members received services for long-term health conditions. 

• Member experience: Plans are rated for overall satisfaction with the health plan. 

• Customer service: Plans are rated for quality of call center services (including TTY and interpreter services) and processing appeals and new enrollments in a timely manner. 

One benefit of the MA plan is that since it is responsible for Medicare A, B and supplemental care issues, our members and/or the welfare funds have a single go-to entity to reach to for help on any issue related to Hospital, physician and/or other covered treatment. 

Another way the MA program is incentivized to help members is to help them better manage their conditions by identifying these members and offering them additional help. This is in no way similar to a managed program which restricts members to certain providers. An example would be in identifying a diabetic and offering them better tools to help manage their condition (more current blood glucose monitor perhaps?). The MA provider is betting that by identifying at risk members early they can help the members to remain healthier longer which means there will be less related hospitalizations thereby recognizing a savings in claims dollars spent and an additional savings in improving the member’s risk score. See the slide below for examples:


Shelley said...

I'm glad the retirees are voicing their grievances and they seem to be having an impact, though the outcome may not be any different. And, as James intimates, the Union will surely rig the public airing of said grievances and then steamroll them and spin it as if they were looking out for the retirees.

We in-service members are not even give as much.


Maybe someone should inform Mulgrew and his negotiating partners that the grievance system plays a major role in lowering turnover rates.

AND, that, contrary to the common misunderstanding of high teacher turnover rates, low turnover lowers costs and also raises productivity.

Yup, we older teachers with all those years in, and all that experience and skill, are actually cheaper and more productive.

Of course, technology is the game changer in education as in almost everything else.

And we all know how much technology has been added to the job recently.

Pre-pandemic we were living on another planet. We were like the Flintstones in the Jetson's Orbit City.

Sure, there were computers, lap-top carts, Smartboards and so on, but a lot of our work was still done with old tools, like pens and pencils and books.

Look at us now! Wow! Are we zooming into obsolescence or what?

Anonymous said...

The retirees want Mulgrew’s head on a stick displayed in front of 52 Broadway. He’s not used to people who fight back.

Anonymous said...

Not quite directly on the substance of your post, but worth thinking about in response to your first paragraph:

PSC and UFT are actually very different unions. Many years ago they were more similar, but while the majority of school chapters are dominated by Unity, several of the CUNY college threw out theiry Unity equivalent in favor of an opposition caucus, thus the opposition has much more power within the PSC than within the UFT. And it shows: the PSC doesn't put with the same shit we do because they're not afraid of a fight with the mayor or governor (and to some extent, they have it harder, because they have to negotiate with both the city and the state at the same time).

Anonymous said...

Speaking of uft victories. Another week gone by..

No calendar
No jobs on Open Market
No spring break pay...With no uft comment
12 years waiting for retro
Medical coverage worsening

Anonymous said...

I am a retiree, just called to complain. You won;t believe what they told me. The uft will do a great job like how they divided the last retro payment so people get the 2nd half in July. Wow. A race to the bottom. As has been stated 1000 times, uft is horrible, so they say they are better than nothing. How awful. Any in service member should opt out. that was the last straw. That is how they help.

Anonymous said...

The uft said delaying the retro by an additional year was a victory? Sounds like them.

Bronx ATR said...

The UFT is laughing all the way to the bank ,same
as usual. Nothing ever changes for the better, only gets worse. We have been in a downward spiral since 2005. I know some savage retirees that have clamped on their fangs for Mulgrew and friends. They make that cannibal with the tusks look like SpongeBob. Don’t mess with our pension or our healthcare, Mulgrew. They’re coming for you.

Bronx ATR said...
This comment has been removed by the author.
Anonymous said...


Mulgrew is throwing you under the proverbial bus with his unforced concessions on you retiree health coverages.

Has it never occurred to any of you that Mulgrew is a renegade who has spent his
entire working career pandering to the DOE?

Mulgrew thrives in the UFT echo chamber. supported by his group think Unity lackeys who are individually equipped with UFT embossed rubber stamps.

Anonymous said...

I understand that CSA held a forthcoming zoom earlier this week, with an open unlimited chat period so anyone could ask any and all of their questions, and I hear that the recording of the zoom will be available to their members As we see the UFT cannot do right by their members. Actions of the past few weeks, including shutting down anyone asking questions should make it apparent that they know they’re giving us shi...Oddly enough much of the answered presented are different than what it says here.

James, why else would they hold a “conference call”, if not to control who asks a question and the question that is asked? Mulgrew doesn’t want any open questioning.

Wondering if all those full time UFT employees who receive a double pension have their own healthcare plan that continues once Medicare eligible?

Anonymous said...

Good question 732. Does UFT leadership have additional/different options for healthcare than the rest of us? Anyone know?

Anonymous said...


You are being manipulated and lied to by Mulgrew.

Anonymous said...

They don't care about you. That's why I don't pay them anymore.

Anonymous said...

@8:32. This information about THEIR health insurance should be available to us, since we'd be rooting the bill through our dues.
What are the, if any, downsides of stopping surs payment? I think it may only be losing right to vote in the rigged election, I maybe wrong though.

Anonymous said...

I emailed and worded it similarly to what W4S suggested. I can’t vote for a caucus that messes with retiree healthcare. Retirement healthcare and the TDA are the only good things about the UFT . Without good health coverage they will lose the retiree vote and the vote of anyone planning retirement and paying attention. Seeing the downfall of Unity would console me if retiree health coverage decreases.

waitingforsupport said...

@3:11 pm...The truth is not in them. When I used the word "rumor" I expected them to at least acknowledge that talks are happening. The response "don't believe rumors" speaks for itself. I will vote for anyone but Mulhoo. Bunch of crooks.

caprice240k said...

James, will the city reimburse me if I buy a medicare part G plan

Unknown said...