Some retirees can’t afford new health plan 1

The new Medicare Advantage healthcare program would force thousands of retirees to pay drastically higher out-of-pocket prices for prescriptions or hundreds of dollars a month to remain in their current plan.

Alan Odze, a retired NYPD officer and 9/11 first responder, would not be able to pay his medical bills under the city’s new health insurance plan.

Odze was diagnosed with melanoma of the eye in 2014 as a result of his bravery at the World Trade Center. Since then, he’s been visiting his doctor every six weeks for an injection. Odze only pays a few hundred dollars per visit, but would have to pay as much as $7,500 for both the visit and the treatment under the new Medicare Advantage program, which his doctor is not accepting.

Because of his condition, Odze was forced to opt out of the insurance he had been using for decades. His pension wouldn’t even begin to cover his healthcare costs, and finding another doctor who accepted the plan was not an option, Odze said, because he was seeing the best melanoma specialist in the area and is unwilling to take the risk of trusting someone new.

“That’s the deal. I’m being treated for melanoma and it’s a form of cancer, so I can’t play games with this,” Odze said. “I can’t afford to play games with this or the end result is 6 feet under.”

Odze is one of about 250,000 retired city employees whose healthcare program is due to be changed under an agreement between the administration and the Municipal Labor Committee. Retirees can choose to opt-out and stay in their current plan, but at a cost of nearly $200 a month.

A Manhattan Supreme Court justice, however, ruled in favor of a lawsuit by the NYC Organization of Public Service Retirees Oct. 21 that delayed the opt-out or -in deadline for city retirees. The original Oct. 31 deadline was not appropriate, the court ruled, especially because the choice is irreversible once decided by a retiree.

“The Court feels that the method of implementation of this plan at present has been irrational, and thus arbitrary and capricious,” Judge Lyle Frank wrote in his decision. “It is not in dispute that currently, in the midst of a pandemic, that has been hardest on the elderly and infirm, retirees have been given a deadline of October 31 to either do nothing in which case their health care plan will change, or to stay in their current plan in which they will likely have to pay what can only be described as a penalty.

“At the same time, there is little clarity as to which health care providers will be accepting this new Medicare Advantage Plan. It is simply irrational for retirees to have to make this decision as circumstances currently stand.”

Frank concluded that retirees required to opt in or out by the original deadline would be faced with “irreparable harm,” and ordered that they remain in the current plan until the defects of the proposed new Medicare Advantage Plan are cured.

Despite the court’s decision, Odze did not withdraw his opt-out request. He believes the city will continue moving forward with its implementation regardless of opposition and he will just be forced to opt out again before the end of the year. Odze said the recent lawsuit had more to do with the deadline than the plan change itself.

The Medicare Advantage program is scheduled to go into effect Jan. 1, and it is not clear whether further legal action will affect that implementation date.

“I’m hoping there’s a restraining order put in place by the judge or the court to stop this thing from moving forward,” Odze said.

The group that filed the Article 78 action, the NYC Organization of Public Service Retirees, was created in August to counter the Medicare Advantage plan change. The group hired its attorney using donations from some of the 250,000 city government retirees who would be affected by the switch.

Under the program, private companies contract with the federal government to offer the public health benefits. The new plan would save the city $600 million, but would drastically increase some retirees’ out-of-pocket costs because it would not cover the supplemental insurance retirees buy for areas Medicare doesn’t take care of. Each retiree’s union would have to accept such supplemental programs instead.

That vital exclusion prompted William Shenton, a retired city Housing Authority manager, to consider opting out of the new Medicare Advantage program. He has yet to decide, however, because he feels there is not sufficient information available for him and his family to make a decision.

His wife, who suffers from a chronic immune disease that affects her lungs and other internal organs, requires a monthly medication priced at $12,000. With the family’s insurance, as well as the supplemental insurance his wife purchased herself, the prescription only costs $640 per month. Under the new plan, she’d be forced to pay full price, which the family would not be able to afford.

“It would bankrupt us,” said Shenton.

Shenton has prescriptions of his own that he needs to take monthly. When the prices are combined with his wife’s, as well as the additional $200 per month in opt-out fees, the Shentons would be shelling out well over $10,000 every month.

The 70-year-old retiree said the city has been “sloppy” with its former workers. Not only is the Medicare Advantage program itself not ideal for hundreds of thousands of retirees, Shenton said, but the city has been doing a poor job of explaining what options are available to them.

“It’s all convoluted. It’s difficult for us,” said Shenton. “We’re not spring chickens anymore.”

Shenton said he was only made aware of the situation by a friend who had been following the news. The city didn’t alert retirees as a whole until August, which didn’t leave much time for those who would be affected to weigh their options.

“There’s a lot of stress involved and they may have taken years off our lives. We worried about it and worried about it,” Shenton said.

(2) comments


I am a 70 year old public service retiree, having worked for the City for 37 years. I recently witnessed the court hearing about how to implement the proposed NYC Medicare Advantage Plus Plan for 250,000 NYC public service retirees.

The lawyer for the NYC Municipal Labor Committee falsely claimed that the MLC was acting on behalf of NYC retirees and that the unions had our "best interests" at heart. How is this possible when we were never consulted about what WE thought was best for us or what our needs were? And how is being blackmailed into accepting this subpar and restrictive Medicare DisAdvantage program or worse, being extorted by having to pay a substantial monthly premium for our current healthcare plan that was always premium-free, a GOOD DEAL? The City is trying to fund its bloated $99 BILLION budget by taking $600 million out of the pension checks of its former employees who are living on fixed incomes and food out of the mouths of retirees' families.

Part of the bargain we made when we decided to dedicate a substantial portion of our lives to City service was good benefits in lieu of a salary commensurate with the private sector. Healthcare was and continues to be the most important benefit, especially for an elderly, infirm and sickly population. To threaten or diminish our healthcare now when we are the most vulnerable is the ultimate betrayal.

The only way to ensure that we will continue to receive quality healthcare at an affordable price and to make sure that we will not be irreparably harmed would be threefold: 1. Do not impose an unaffordable monthly PENALTY on the health insurance we now have premium-free; 2. Do not impose the expensive new co-pays, another PENALTY; and 3. We should not have to "opt out" of an imposed Medicare Advantage plan in order to stay in the Supplementary plan we are currently enrolled in, which is yet another PENALTY. In other words, Medicare Advantage for those who want it, with a carve out for those retirees who are happy and well cared for in their current plans, with no premium financial burden nor co-pay penalties. This is the only equitable solution for NYC retirees.


This isn’t just about NYC retirees. Current NYC union members should take note that once they retire they aren’t going to have the free Medigap coverage promised to them during their years of service to the people of NYC.

In addition to the retirees, the majority of the unions negotiating this “deal” sold their current members down the river, too. Yet, there are plenty of savings to be found elsewhere. NYS spends considerably less to insure its employees than NYC does with no diminution of benefits. How come NYS can find necessary savings on health insurance, but NYC can’t?

Some City and union leaders, and the insurance companies, would like to pit retirees against current employees, encouraging retirees to advocate for having our free medigap coverage at the expense of future raises. But, I think we all need to stand together on this by fighting for raises AND free medigap insurance for current employees AND retirees.

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