Retirees challenging New York City's Aetna Medicare Advantage plan in court

A group of retired New York City employees are suing Mayor Eric Adams and other city officials in an attempt to block the city's planned switch to an Aetna Medicare Advantage plan for the 250,000 retired city workers and dependents the city provides health coverage for. 

In a lawsuit filed in New York County Supreme Court May 31, nine retirees and the NYC Organization of Public Service Retirees allege providing Medicare Advantage as the only option for retirees violates the city's obligation to provide health benefits to its retired workers, according to court documents obtained by Becker's

The city approved the Aetna-run plan March 9, and the plan is set to take effect Sept. 1, with prescription drug coverage set to begin Jan. 1, 2024. 

The NYC Organization of Public Service Retirees has challenged previous Medicare Advantage proposals in court. A court ruled a plan to charge retirees a monthly premium to opt for Medigap coverage over Medicare Advantage violated city law. 

In the final approved plans, retirees who opt out of the city's coverage will have to pay for any supplemental coverage on their own. 

In the lawsuit, the retirees alleged they could face coverage denials, out-of-pocket costs and lose their current providers if they are not in Aetna's Medicare Advantage network. 

"Among other injuries, [the city's] false promises will cause retirees to collectively incur millions of dollars in unexpected medical expenses, including but not limited to the cost of Medicare-plus-supplemental insurance (for those who opt out of the Aetna MAP) and various increased out-of-pocket expenses incurred under the Aetna MAP (for those who are automatically enrolled in that plan)," the plaintiffs said in court filings. 

A spokesperson for Mr. Adams told the New York Daily News May 31 the city is reviewing the lawsuit and said the Medicare Advantage plan is in the "best interests of our city's retirees and taxpayers." 

Mr. Adams' administration estimates Medicare Advantage can save the city $600 million annually, according to the Daily News. 

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