Bob Bentkowski, a retired New York City firefighter, has a rare, painful disease that caused his kidneys to swell almost to the size of basketballs. He needed a transplant, and in the fall of 2021, he found a donor after waiting for years — but he was unsure whether Medicare would cover his surgery. New York City has long provided its retired employees with comprehensive health benefits that pay for most of their Medicare costs. But with his transplant approaching, the city, and a coalition of i
President Joe Biden delivers remarks on Social Security and healthcare costs at University of Tampa, Fla. on Feb. 9, 2023.
The fight in New York City is a highly visible example of a nationwide shift in the way some retirees receive health insurance benefits from former employers, both in the public and private sector. It pits the drive to control health care costs against retired workers’ pocketbook and health concerns.
The shift will also mean higher costs for taxpayers and all Medicare beneficiaries, some experts say. Payments by the federal government to Advantage plans average 102% of its spending on the fee-for-service traditional program, and that contributes to higher overall Medicare spending. This occurs in part because a bonus system awards extra dollars to plans that achieve high quality ratings from Medicare.
Insurers argue that Medicare Advantage group plans are simply one choice available to retirees. “Medicare rules require that retirees always have the option to opt out of enrollment in a group Medicare Advantage plan in favor of other forms of coverage that may be available,” said Heather Soule, a spokesperson for UnitedHealthcare, one of the largest providers of Advantage plans.
In New York City, labor unions representing retirees have been working with the city on its planned shift to Advantage. They promoted the projected savings and their ability to use their bargaining clout to negotiate for far more generous features than those in plans available for individual purchase.
In a statement Thursday, Mayor Eric Adams said the new arrangement “improves upon retirees’ current plans,” and includes a lower deductible, a cap on out-of-pocket expenses, and new benefits. “We also heard the concerns of retirees and worked to significantly limit the number of procedures subject to prior authorization under this plan,” Adams said. “This Medicare Advantage Plan is in the best interests of retirees and taxpayers.
“The Medicare Advantage plan might be good for some people,” Bentkowski said. “But you just can’t squeeze everyone into one plan and say it’s going to work.” “Most plan sponsors include language in their plan documents explicitly reserving rights to amend the plan,” he said. Some retirees were outraged by that tactic, and by the announcement of the planned transition with relatively short notice in September.
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