City retirees fighting to preserve Medicare coverage

Municipal retirees are fighting a city plan to shift their health coverage from traditional Medicare to a privately administered Medicare Advantage plan run by Aetna. In Riverdale, that fight is heating up.

Under the current system, city workers who qualify for Medicare are enrolled in the federal program, which covers 80 percent of medical expenses. For decades, New York City has paid the remainder through a city-funded supplemental plan. But in a bid to cut costs, the Mayor Adams administration pushed to enroll hundreds of thousands of municipal retirees into Medicare Advantage -- an alternative managed by private insurers that critics say often delays or denies care.

Established by Congress in 1997, Medicare Advantage was intended to reduce federal spending by allowing private insurance companies to compete in offering Medicare plans. While some retirees choose Medicare Advantage voluntarily, many opt to remain in traditional Medicare due to concerns about narrower provider networks, increased administrative hurdles and the need for prior authorizations and referrals.

The groundwork for the switch began under former Mayor Bill de Blasio in 2018, but implementation has been repeatedly halted by lawsuits. State courts have sided with retirees, ruling that the city cannot force them into a new plan or deny them the supplemental coverage they were promised. 

For Donald Bluestone the issue is personal. The 78-year-old is one of several  Riverdalians fighting to preserve healthcare choice for others like him, who are also enrolled in traditional Medicare. But he’s never been a city employee. As the spouse of a former CUNY professor, he receives health coverage through his wife’s retiree benefits. The program has been a lifeline as her health sharply declined.

“Her health is a mess right now,” he stated. “She’s in really bad shape. If not for the benefits we have - you know, being in traditional Medicare – I would be literally up the creek without a paddle with Medicare Advantage.”

Earlier this year, double pneumonia sent Blustone’s wife to the hospital for a week –  a stay that resulted in a bill upwards of $100,000. Nearly the entire bill was covered by Medicare, supplemented by the city’s health plan.

He feared had she not been under a Medicare Advantage plan, it would not have been as simple. Private plans usually require prior authorization for hospital stays, procedures and specialist care – policies that can lead to treatment delays and administrative backlogs. For retirees dealing with urgent or complex medical issues, such delays can be fatal.

“With Medicare Advantage I have to get back to them with documentation, and then more things, and they still don’t cover it,” Bluestone told The Press. “That’s why traditional Medicare is critical. What are you supposed to do? My wife is having so much trouble breathing with double pneumonia.”

In March, he spoke at a Community Board 8 meeting in support of legislation that would preserve municipal retiree’s right to select their own healthcare coverage.

Intro 1096, introduced to City Council last year, would guarantee retirees the right to remain in traditional Medicare with city-funded supplemental coverage. It also would prohibit automatic enrollment into Medicare Advantage and safeguard healthcare choice for future retirees.

Bluestone said he was one of a dozen retirees who recently visited Councilman Eric Dinowitz to seek his endorsement of the bill – and ask why he has not yet signed on as a co-sponsor.

Dinowitz has spoken out against mandatory enrollment in Medicare Advantage but has not explicitly relayed his support for Intro 1096. 

In a letter to the editor, he urged those running for mayor to eliminate Medicare Advantage as the required health care plan through new union contract negotiations within all public sectors.

“I want to be clear – I will never, ever, allow those who don’t want Medicare Advantage to be forced into it, and I will fight like hell to protect seniors from extremist threats of all kinds – whether standing up to Trump and Musk’s threats to Social Security and Medicare, or to bureaucrats at Tweed or City Hall who threaten union retirees. Period,” he wrote.

But missing from the submission is any reference to the bill.

“I keep saying to him, you cannot keep saying you support retirees and using your op eds or letters to the editor as a method of campaigning your support for this, for seniors and the disabled, 9/11 widows, survivors – and yet not do a darn thing to help us,” Marianne Pizzitola said, president of the NYC Organization of Public Service Retirees and former member of the FDNY.

The fervent advocate is among those on the legal frontlines fighting to preserve their healthcare benefits. Her nonprofit has filed multiple lawsuits blocking the transition to Medicare Advantage from going forward. But so far, the city has appealed each of those court decisions.

Next month, Pizzitola will return to the New York State Court of Appeals – for the twelfth time.