$55M SUIT OVER $15

NYC retirees say new copay is illegal

Retired New York City government workers, who enjoy among the most generous taxpayerprovided health benefits in the US, are suing the city for $55 million — over $15 copays for doctor visits.

The Manhattan Supreme Court class-action suit, filed on behalf of 183,0000 retirees, claims the city and Emblem Health/GHI are violating a court order to not impose additional costs on retirees for the 20% supplemental coverage not covered by Medicare, the federal health program for senior citizens 65 and over.

The copays — which are far less than the standard $40-$50 fee required by private insurance — were imposed in January. Retirees previously were not charged a copay.

Separately, Mayor Adams has thrown down the gauntlet. He said the City Council must agree to allow his administration to switch retired city workers to a private Medicare Advantage plan — with an option to opt out in exchange for a high out-of-pocket price — or he will unilaterally move all retirees into a Medicare Advantage plan.

‘A horrible impact’

Retirees have argued that Medicare Advantage provides less medical care than their current supplemental “Senior Care” plan.

“Copays are simply the city and Emblem’s poorly disguised way to pass along their costs,” charged Marianne Pizzitola, president of the NYC Organization of Public Service Retirees, one of the plaintiffs.

“It violates the contract, the law, and the judge’s order and is outrageous,” she said. “These copays are having a horrible impact on seniors who typically have to see several doctors every month.”

The plaintiffs are seeking $55 million in damages in the lawsuit, filed by Steve Cohen of Pollock Cohen.

But one health care expert said it’s time for Gotham retirees to help the city rein in costs.

“New York City taxpayers are paying for the most expensive version of retiree health care to its city public employees of anywhere in the country — in the public sector, let alone the private sector,” said Peter Warren, research director for Empire Center for Public Policy. “New York City taxpayers are paying for a level of health care for government retirees they don’t get.”

Private-sector retirees typically have to rely on Medicare and personally cover additional benefits, Warren noted.

He said the city has a staggering $126 billion in retiree health care liability.

Medicare picks up 80% of the costs for hospital and doctor visits. Under an agreement with the unions, the city picks up the remaining 20% under the supplemental “Senior Care” plan.

The lawsuit claims the $15 copays cause “irreparable harm” to retirees.

“Imposing a $15 copay illegally transfers a portion of the 20% provider cost from the Defendants to Retirees,” Cohen said. “This seemingly minor fee is extremely onerous for elderly individuals living on small, fixed pensions.”