A new roadMAP: Switch to Medicare Advantage Program for retirees is complete [New York Daily News]

New York Daily News, The (NY)

That’s a wrap on the long-running process to switch city retirees to a new Medicare Advantage plan, with the deal now officially inked, as they retain their premium-free health insurance.

As we’ve said from the beginning, the caution around the move was certainly warranted, and the city’s hundreds of thousands of retirees were right to raise questions about the initiative’s overall cost and coverage, particularly given that this was part of the bargain of having spent decades in public service.

Medicare Advantage programs are not new, and their shortcomings well-known: pre-authorizations for medically necessary procedures, evaluated not by doctors but by insurance bureaucrats whose mandate is cost-cutting; networks that don’t necessarily encompass every doctor or facility that accepts Medicare; and other qualms often downstream of it being ultimately a privately-managed arrangement run by entities that have a duty to make profits for stockholders.

These were good questions to raise, and the sustained public attention probably got City Hall to negotiate a better deal with new provider Aetna. But negotiate it did, and the resulting plan seems to go a long way towards addressing the concerns that retirees have laid out. The insurer will require prior authorization for only about a fifth of the procedures that it typically does, and the network spans more than a million providers nationwide, including all but around 5% of the providers retirees use under the current plan. All those that accept Medicare will still be able to accept the Medicare Advantage plan.

Now, the deal is signed, agreed to by the Municipal Labor Committee, which is to say, by the unions that once represented the retirees. Can we say that no retiree will face an adverse consequence from this switch? We can’t. But what we can say is that the depleted insurance stabilization fund won’t be able to infill critical services for city workers without the savings this plan generates. It’s up to the city to keep a close eye to guarantee the program is working as promised. We’ll be watching, too.