Tuesday, January 4, 2022

Widows of NYC first responders who died in line of duty must pay for health insurance after city changes policy - Daily News

HI Chris,

Great article!

What’s largely missing from the debate over this extremely unfair reduction in NYC retiree health benefits is the reason why the Medicare Advantage Plus plan has those 87 medical procedures that require prior authorization.  Traditional Medicare (plus a Medigap supplement) does not require prior authorization because it rarely denies coverage.  There’s no need to pre-authorize.

It’s obvious that this private insurance conglomerate (Emblem Health and Empire Blue Cross Blue Shield) needs the prior authorization because they know they will be denying these procedures at a much higher rate than Medicare does.  That information is being hidden.  Nowhere does it tell the retirees or their spouses how likely it is that these procedures will be denied, while Medicare practically never denies them.  Where is the comparison of the expected denial rates between Medicare Advantage Plus and Medicare?  Nowhere!

And where is the estimated cost of these procedures that retirees would have to pay themselves or go without the care their doctors say they need?  NO  WHERE!!

I recently had a heart monitor surgically inserted in my chest, as my cardiologist felt it was important for me to be continuously monitored.  If I had to pay for it myself, it would have been over $85,000.  Just ONE procedure.

So it’s not just the inconvenience of having to wait for authorization, although that can sometimes be a very serious problem, it is the likelihood that we will end up with one or more important procedures being denied, and then being forced to bear an extraordinary cost or go without important care.

The older and sicker you are, the more important this hidden information is.

Thanks for “listening.”

Retired NYC Teacher / UFT member since 1968

 

 

 

Widows of NYC first responders who died in line of duty must pay for health insurance after city changes policy

New York Daily News
Jan 02, 2022 10:00 PM

Elderly spouses of cops, firefighters and other New York City workers who died in the line of duty are being told they will have to start paying for health insurance if they opt out of a new Medicare plan the city is forcing on them and thousands of municipal retirees, the Daily News has learned.

After the 9/11 attacks, state legislators passed a law allowing line-of-duty spouses — widows or widowers of uniformed city employees who died on the job — to remain on their late loved ones’ health insurance for life, free of charge.

Now, survivors age 65 and older will be responsible for a $191 monthly premium starting in April if they decide to stay on their current coverage instead of being automatically enrolled in the new Medicare plan, emails from ex-Mayor de Blasio’s administration reveal.

“Unfortunately not,” a representative of de Blasio’s Office of Labor Relations wrote in a Dec. 23 email to a widow who asked if she would still have free insurance if she kept her current plan. “When the premium changes in April, the new cost will be $191 for all members with no RX coverage.”

The labor relations worker noted that the new so-called Medicare Advantage plan will still be free and urged the woman to enroll.

Survivors age 65-year-old and older
                    will be responsible for a $191 monthly premium
                    starting in April if they decide to stay on their
                    current coverage, emails revealed.
Survivors age 65-year-old and older will be responsible for a $191 monthly premium starting in April if they decide to stay on their current coverage, emails revealed. (Shutterstock/Shutterstock)

Therese Fay, an 89-year-old retired nurse who has relied on the free insurance since her FDNY firefighter husband died, said she feels betrayed because she doesn’t want to give up her current plan.

“There was a promise they were supposed to keep that we wouldn’t have to pay no matter what,” said Fay, who has lung cancer and undergoes regular treatment. “With my old plan, I didn’t have to worry about finances or what’s covered. With this new plan, I don’t know. They haven’t told me.

“I’m shocked,” she continued. “I never expected the city to do this. They were always very good to us.”

Last fall, de Blasio’s administration started the process of switching the city’s 250,000 Medicare-aged municipal retirees and their dependents over to a Medicare Advantage plan, saying the shift would not impact their benefits but save taxpayers $500 million a year thanks to a larger influx of federal funds.

Therese Fay
Therese Fay (Courtesy Therese Fay)

But the NYC Organization of Public Service Retirees — comprising retired cops, firefighters and other city workers — sued over the move, alleging the new Medicare plan could water down overall coverage by, among other things, imposing complicated pre-authorization processes for certain medical procures.

The group also blasted the city for sending out incorrect enrollment information to retirees, prompting a Manhattan court to push back the opt-out deadline until April and order the city to clarify its “irrational” rollout of the plan. De Blasio’s administration initially wanted to set the opt-out deadline for November.

With de Blasio now out of office, Mayor Eric Adams, a retired NYPD captain, could rescind the new Medicare plan and let retired city workers and line of duty spouses keep their old benefits without a financial penalty.

Adams has not said how he plans to deal with the thorny issue, and his spokesman did not return a request for comment.

After his November win, Adams said he would look at the new plan “and make sure it’s not a bait and switch” for retirees.

De Blasio’s team insisted until the bitter end of his administration that the Medicare Advantage plan is the best option for everyone involved — including surviving spouses.

“The NYC Medicare Advantage plan is free and includes even more benefits for retirees than the previous plan,” Danielle Filson, de Blasio’s press secretary, said last week. “This plan follows the law and will ensure line-of-duty families are taken care of.” 

Sheila, an 80-year-old widow who asked to be identified by only her first name, said she has seen nothing to corroborate Filson’s claim and doesn’t trust that the new plan will be better for her because she’s received contradictory information. Sheila said she was initially told that only seven medical procedures would require pre-authorization before hearing that the actual figure is 87.

“I’m very happy with my health coverage. If Medicare Advantage will be close to what we have then maybe it would be acceptable, but the problem is that we don’t know because we haven’t been given the right information,” said Sheila, whose husband, an FDNY firefighter, died in the line of duty in 1992.

“The unknown is the big elephant in the room.”

Marianne Pizzitola, a retired FDNY emergency medical technician and president of the NYC Organization of Public Service Retirees, said she asked to meet with Adams for weeks to urge him to roll back de Blasio’s Medicare Advantage push.

So far, Pizzitola said she hasn’t heard back from the new mayor’s team.

“Adams has the power to change this,” she said. “He needs to know all sides of this before he makes a decision.”

 

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