'Screwing over retirees': Seniors forced into for-profit Medicare Advantage plans

[justaprogressive]

New York State's highest court on Wednesday ruled against city retirees who had sought to block an effort by Mayor Eric Adams' administration to move them onto a for-profit, privatized Medicare Advantage plan.

In a unanimous decision, New York Court of Appeals Judge Shirley Troutman wrote that petitioners in the case are not entitled to "promissory estoppel" cause of action, the argument that the retirees throughout their employment with the city were promised traditional Medicare benefits when they retired.

According to Gothamist, "the court also ruled that the retirees did not have a legally binding promise from the city that their coverage would remain unchanged." The Wednesday ruling overruled a state Supreme Court judge’s decision that had prevented the Adams administration from making the switch, though the Court of Appeals said there were still issues in the case that should be sent back down to the Supreme Court, a lower court in New York's state system.

Medicare Advantage plans are run by private health insurers who receive money from the federal government to provide Medicare-covered services. Medicare Advantage enrollment around the country is growing, though the Medicare Advantage system has been accused of offering poor care and boosting corporate profits. A 2022 investigation by The New York Times found that major health insurers have exploited Medicare Advantage to juice their profits by billions of dollars.

https://www.alternet.org/retired-workers-forced-into-for-profit-medicare-advantage-plans/

[SoFlaBro]

1. MAGA fuckstick turd love to screw over all constituency. Piss on those fucking turds.

[Sibelius Fan]

2. I've had Kaiser MA for the past five years. No complaints. No services ever denied,

and we’re talking tens of thousands of dollars. I pay $0 for most of my prescriptions.

But I’m in a unique situation as Kaiser is both the provider and the insurer. If a KP doctor orders a procedure/Rx they are not going to deny payment.

[Ms. Toad]

3. I need to read this case, since it makes no sense.

When you retire, you can (generally) opt out of whatever public retirement plan is available to you. So if they don't want Medicare Advantage, they just opt for traditional Medicare. (Ohio STRS has a medical plan - like a Medicare Advantage plan, but somewhat different).

So the only thing I can think of is that they were told it would be one of these public service retirement plans, not Medicare Advantage. And since you have to opt in to standard Medicare at 65, or later if covered by a work plan, they may have lost the option.

But - promissory estoppel isn't a good claim. Generally these benefits are never absolute. I kept my money in the STRS when I left teaching because I was promised access to medical coverage. That was an issue because I was uninsurable and it was long before either HIPPA or the ACA - and I might have been stuck without access to decent coverage. Well, about a decade after I left teaching, they changed the qualifying number of years from 5 to 15. At that point I had between 13 and 14 years. I was royally pissed, but I hadn't actually confirmed directly with STRS or with an attorney - and it turns out these things aren't actually guaranteed.

It turned out well for me, since I had the option to return to public employment and, for a 5-year investment, more than double my guaranteed retirement income. But after that I never relied on anything other than the basic retirement.

ETA: Sorted it out (probably). The issue is that NYC is paying the full premium for supplemental insurance, if that is the option retirees choose. They wanted to switch them over to a Medicare Advantage plan. They seem to have abandoned that plan - but I'm pretty sure that even if they hadn't, retirees could stay with Medicare + supplement if they pay their own premium. The issue is trying to balance the budget - same reason STRS upped the number of years for teaching retirees in Ohio to be eligible for insurance (even though we pay a portion of the premium - we don't pay all, so they changed the game mid-stream.)

[nilram]

4. Insurance brokers get a much bigger commission on Medicare Advantage

than on regular supplemental plans. This is per the broker I'm speaking with now, and she cites it as a reason that MA is growing -- because of the higher commission, brokers push it and advertise it more. (Not to mention that the insurance companies themselves are profiting on it, so they advertise heavily.)

My reason to not use MA is that they are effectively HMO plans where every medical referral needs to be approved by your primary care provider. I'm used to having the option to find my own specialists as needed, without a gatekeeper. Basic Medicare is very permissive at covering whatever a doctor orders. For example, a physical therapist told me of an HMO that pushed back after every 2 sessions even though 12 were prescribed. Medicare, and other decent insurance companies, would cover all 12.

[UTUSN]

5. K&R