Decision of the Day: NYC Did Not Breach Administrative Code When Switching Retiree Medicare Supplement Plans | New York Law Journal (2024)

FAQs

What was the court decision on Medicare Advantage in NYC? ›

The appeals court voted unanimously to reject the city's plan to switch retirees from traditional, government-funded Medicare plans to a Medicare Advantage plan, administered by a private company contracting with Medicare.

In his decision, Frank ordered the city “permanently enjoined from requiring any City retirees, and their dependents from being removed from their current health insurance plan(s), and from being required to either enroll in an Aetna Medicare Advantage Plan or seek their own health coverage.”

May 31, 2023: The NYC Organization of Public Service Retirees files suit seeking a temporary restraining order against the City's move to the Aetna MA plan, arguing that NYC violated the city charter by not offering choice, violated state and city human rights laws which prohibit discrimination against disabled people, ...

“The respondents are permanently enjoined from requiring any city retirees, and their dependents from being removed from their current health insurance plans and from being required to either enroll in Aetna Medicare Advantage Plan or seek their own health coverage,” read Judge Lyle Frank's ruling.

KFF's research showed the vast majority (82%) of appeals were successful, resulting in Medicare fully or partially overturning the initial prior authorization denial. Given their high success rate, pursuing a Medicare coverage denial appeal is worth the time and effort for your clients.

To opt out of the NYC Medicare Advantage Plus Plan and remain in your current health plan, please complete and sign the form on the next page and return it via mail, fax or email. Each Medicare-eligible participant (i.e., retiree, spouse or dependent) must complete a separate opt-out form.

NYSHIP automatically begins reimbursem*nt for the standard cost of original Medicare Part B when Medicare becomes primary to NYSHIP coverage at age 65 for retirees, vestees, dependent survivors, and enrollees covered under Preferred List provisions, and their dependents who turn 65.

If you retired from a New York State agency and enrolled in a health insurance plan through the New York State Health Insurance Program (NYSHIP), you are reimbursed for the usual cost of the Medicare Part B (medical insurance) premium through your retirement benefit, unless you receive reimbursem*nt from another source ...

First thing's First: Is New York a Good State to Retire In? According to a recent study highlighted by the New York Post, New York ranks among the worst states to retire in 2024, primarily due to its high cost of living, including taxes, healthcare costs, and overall expenses associated with day-to-day living.

At any point during your first year in a Medicare Advantage plan, you can switch back to Original Medicare without penalty for the following reasons: If you left Medigap for Medicare Advantage, your trial right allows you to switch back to your Medigap policy.

What was Judge Frank's decision? ›

Frank. Decision and Motion Order. ORDERED that the Respondents are permanently enjoined from requiring any City retirees, and their dependents from being removed from their current health insurance plan(s), and from being required to either enroll in an Aetna Medicare Advantage Plan or seek their own health coverage.

The City reimburses retirees and their eligible dependents for Medicare Part B premiums paid, excluding any penalties. You must be receiving a City pension check and be enrolled as the contract holder for City health benefits in order to receive reimbursem*nt for Part B premiums.

All current health plans remain in effect. No retiree will be moved into the new Medicare Advantage PPO Plan. No opt-out requests made through Aetna via their call center or website will be processed at this time.

Affordable Care Act in California v. Texas

In a 7-2 decision, the Court dismissed the lawsuit on the grounds that the plaintiffs lacked standing to sue. The Court did not reach the merits of the challenge, thereby leaving the ACA intact.

There are 280 Medicare Advantage plans available in New York in 2024. (There were 288 plans in 2023.) All Medicare-eligible people in New York have access to a $0-premium Medicare Advantage plan.

The Justice Department continued to pursue cases alleging false claims in the Medicare Advantage (or Medicare Part C) program, including allegations that organizations participating in the program knowingly submitted or caused the submission of inaccurate information or knowingly failed to correct inaccurate ...