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OLR makes avoiding Aetna/CVS Medicare Advantage tricky

May 3, 2023 pm31 1:05 pm

[Note – There is a dispute about an important detail in this post. I have received comments saying that the call to Aetna IS necessary, and others that say the call to Aetna IS NOT necessary. Until I have a definitive answer, I will leave the post as is. It is, in the absence of a definite answer, safer to call than not to call – jd]

The battle over Medicare Advantage in NYC may be coming to a close. On September 1, municipal retirees who are Medicare-eligible will be shifted to the Aetna/CVS Medicare Advantage Plan. Unless…

That “unless” should be straightforward. But it’s not.

Unless they opt out. But the City has defined “opt out” to mean “switch to HIP VIP.” That is counterintuitive language. Instead, retirees who wish to opt out should “waive city benefits.”


Is there a form to “waive city benefits”? Sure. Right here. But notice, it says at the top “This is not an Opt-out form.” Is it just me, or is that intended to be confusing. In fact, the whole form looks more confusing than necessary. But at least a retiree just has to fill out the form and that’s it? Nope. There’s more.

A quick grammar-related excursion: the spelling of “Opt-out Form” including the hyphen and the capitalization is, well, weird. And if you want to insist that “Opt-out Form” is fine, or even normal, and that I should not question the smarter-than-me geniuses at OLR, look at the start of the sentence below the line: “Only Complete this application for any of the following reasons:” See that? Capital randomly appearing mid-sentence? Not sure how the author could have become an Ivy genius if they couldn’t have passed a third grade capitalization quiz. (Did they have those? Do they still? I don’t think I ever took a Capitalization Quiz.)

Aside from filling out the “Retiree Special Enrollment/Waiver Form” a medicare-eligible retiree seeking to avoid Aetna Medicare Advantage would have to call Aetna, or contact them online. See, it says so: “… you must contact Aetna directly…” It is the sentence after they write “This is not an Opt-out form.”

To “opt out” (which they call “waive city benefits”) a retiree would have to do both:

  • Fill out this form, and check off Part 3
  • AND contact Aetna by phone or online.

Doing one without the other won’t cut it.

Explanation Page

OLR actually has a page that purports to explain. It is called Responsibilities and Health Benefits Assistance. Here’s the key paragraph:

Retirees who do not wish to be enrolled in the Aetna Medicare Advantage PPO Plan or HIP VIP can waive City health coverage. Retirees must complete the Health Benefits Program Retiree Special Enrollment/Waiver Form to waive City health coverage. Completed forms should be returned to the Health Benefits Program….

Notice what’s missing? They don’t mention that you need to contact Aetna. Now, when you fill the form, if you carefully read the heading, you might notice. But I’m not sure that everyone will.

It gets worse. Here’s how the page looks:

See it? There’s a subheading for opting out of Aetna and going to HIP VIP, but there’s no subheading for opting out of Aetna and waiving City coverage.

See what else? New ideas are introduced with a larger space between paragraphs. There is not a larger space before the paragraph that explains how to opt out and waive City coverage.

OLR tries to trick our members

It is clear that the City has intentionally made it tricky to opt out

  • They call it “waiving benefits” instead of opting out.
  • The opt-out form says “This is not an Opt-out form.”
  • The instructions to contact Aetna on the form are not where we would expect them (part 3, with the waiver), but “hidden in plain sight” in a block of white on black text, after a discouraging sentence.
  • Next to the “waiver” there is no “hint” that Aetna must also be called.
  • Next to the “call Aetna” part there is no hint that the “waiver” must also be checked off.
  • The explanation page does not have a subhead for waiving coverage.
  • The explanation page does not help the reader find the paragraph on waiving coverage, but spaces the paragraphs inappropriately.
  • The explanation page does not indicate that the retiree must contact Aetna to waive coverage.

Look – I’m not advising anyone to opt out, or not opt out. Or waive, or not waive. Or whatever they want to call it. But for retirees who decided they don’t want Aetna, it looks damn clear that OLR has created an unnecessary two-step process to trip people up. It also is damn clear that OLR has organized the page and the form to obscure information, to maximize the chance that a retiree seeking to avoid Medicare Advantage makes a mistake.


UFT leaders, these are your members. They are not trying to violate the law. They are not trying to violate the contract. I know you would prefer that they get moved into Medicare Advantage – we’ve had a 2+ year fight over that – but now this is endgame – this is not the fight over setting up an MA.

These are your members. And they are attempting to exercise their rights. And the OLR is trying to trick them, block them, cause them to make mistakes. You have an obligation to your members.

  • The two-step process for avoiding Medicare Advantage is unnecessary. There should be one step a member needs to take. You should address this immediately with OLR.
  • OLR has issued a form that is counter-intuitive and that does not plainly give instructions. You should address an immediate revision of the form with OLR.
  • OLR’s instruction page has been organized to confuse members seeking to avoid Medicare Advantage. You should address an immediate revision of that page with OLR.

And if it takes OLR unreasonably long to make these changes, you must appeal to extend the “opt out” period past June 30.

In the interim, you should immediately set up a hotline for members seeking to avoid Medicare Advantage, helping them navigate this unnecessarily confusing process.

Again, you may not agree with the choice that some members are making – but these are your members, and they are making a legitimate choice, they are violating no rules or laws.

You have an obligation to represent us. All of us. Live up to it.

20 Comments leave one →
  1. Samuel Noel permalink
    May 3, 2023 pm31 1:32 pm 1:32 pm

    It’s fascinating that the powers that be chose Aetna which sold policies that “reimbursed slave owners for financial losses when their human chattel perished.” Who wouldn’t want to join such a fine organization?

    • May 4, 2023 pm31 11:00 pm 11:00 pm

      I don’t know an insurance company that I would consider a friend of working people – but this one is particularly ugly. Thanks for filling us in.

  2. Arthur Goldstein permalink
    May 3, 2023 pm31 2:15 pm 2:15 pm

    Wow. How utterly creepy. It’s also prohibitively expensive.

  3. Sean Ahern permalink
    May 3, 2023 pm31 3:51 pm 3:51 pm

    Thanks for paying close attention.

  4. Anonymous permalink
    May 3, 2023 pm31 4:58 pm 4:58 pm

    What if you just want to opt out of the MA plan and not waive your benefits?

    • Cindy permalink
      May 3, 2023 pm31 6:15 pm 6:15 pm

      Then you get HIP-VIP

      • Anonymous permalink
        May 4, 2023 am31 10:39 am 10:39 am

        Don’t want either. Just want to opt out of all MA plans, obtain a supplement plan, and keep all of my other benefits. The ability to put people in a MA plan without their authorization was done in the year 2000 by then President Clinton. The law gave people the ability to opt out of the MA plan not all of their benefits.

  5. Cindy permalink
    May 3, 2023 pm31 6:14 pm 6:14 pm

    It has been explained in various places that opting out is only available to those who want to change their future NYC health care coverage from this new CONY Aetna Medicare Advantage to HIP-VIP, which is not an option for me and most others.
    This form is to totally WAIVE/ turn down/ give up one’s health coverage, including any dependents, from NYC. Some retirees might be able to get supplemental insurance and a drug plan from a spouse or on their own. Unlike last time there is only HIP-VIP as an opt out option.
    Mulgrew doesn’t really care if UFT retirees take Aetna MA or waive all City coverage because NYC will save money either way.
    In fact they will save more money from those who waive their NYC health benefits.
    Mulgrew gave up protecting retirees long ago.
    For now suggests educating ourselves about individual supplement plans for
    purchase and then holding tight as the lawsuit is coming. In the meantime, one can also call/email the controller, the mayor and the City Council and tell them to give us the choice of Original Medicare with a supplemental plan, and why.

  6. Charles permalink
    May 4, 2023 am31 4:22 am 4:22 am

    I am planning to “waive” NYC health benefits in order not to be moved in Aetna MA effective 9/1/23. I know you are trying to give guidance, but I don’t agree with your assessment that waiving NYC health benefits is a two-step process that will require the retiree to also contact Aetna to “waive” NYC health benefits. Although it is awkwardly stated, opting out is not a waiver of NYC health benefits. It is merely opting out of Aetna MA and taking HIP VIP instead if you live in the metro NYC counties serviced by HIP VIP. The Retiree Special Enrollment/Waiver Form is not for that purpose. Option 3 of the form states the retiree can “waive” NYC health benefits by completing the form and submitting it directly to OLR as directed on the form. Aetna should be contacted for opting out only (moving into HIP VIP) and not waiving NYC health benefits. That’s my interpretation of the waiver form and instructions. I just don’t see that a waiver request is a two-step process. Sorry, but I just don’t agree with your interpretation. Thank you for the opportunity to comment.

  7. Anonymous permalink
    May 4, 2023 am31 9:19 am 9:19 am

    also note that if you go to the OLR website to send in your waiver electronically, it is unclear which of the 9 choices you should upload your document to, and if you don’t upload to the correct category, your waiver might not be processed properly

  8. Anonymous permalink
    May 4, 2023 am31 9:26 am 9:26 am

    I’m not sure I agree that it is a two step process. I believe if you do what is said in the blog, send in the waiver and also call aetna it might screw up your waiver as calling aetna to opt out is to get you into hip, and thus you have done two conflicting things at the same time, waived city benefits and opted into hip vip…I believe you will then end up in HIP VIP rather than waiving city benefits and keeping traditional medicare.

  9. Anonymous permalink
    May 4, 2023 am31 10:58 am 10:58 am

    I just want to opt out of all MA plans, obtain a supplement plan on my own, and keep my other benefits. In the year 2000 a provision in the statute was made regarding employer or union sponsored plans which led to automatic enrollment but they had to provide advance notice and a mechanism to opt out. It would seem that to opt out was meant to opt out of the MA plan and not all benefits. Please go to- -page three. If this is correct then it would seem that we should be able to opt out of the MA plans and keep our benefits.

  10. Charles permalink
    May 5, 2023 am31 3:38 am 3:38 am

    I called a random Aetna MA rep yesterday and it was clear to me that she did not know the difference between “waiving NYC health benefits” and “opting-out”of Aetna MA. If you live in one of the eight metro NYC counties and also call Aetna to waive NYC health benefits (in addition to submitting the required form to OLR), I believe there is a chance that the Aetna MA rep will enroll you in HIP-VIP instead by processing an opt-out action. The Aetna MA rep I spoke didn’t seem to understand what I meant by waiving NYC health benefits in order to prevent automatic enrollment into Aetna MA. She thought I wanted to “opt-out” of Aetna MA. Yes, she was only one rep but I suspect many other Aetna reps might give the same response. It’s possible they have not been properly trained or they just simply don’t understand that there is a significant difference between the NYC health benefits waiver process and opting-out of Aetna MA (to join HIP-VIP). Be careful if you live in the NYC metro area and you call Aetna to “waive” your NYC health benefits. You need to be certain you are speaking with a knowledgeable, properly trained representative or you might regret making the phone call to waive NYC health benefits and end up enrolled in HIP-VIP.

  11. Barb permalink
    May 9, 2023 am31 9:55 am 9:55 am

    Yes take your time and read everything. If possible have someone check instructions. Isnt it terrible that those of us that have worked and contributed have to go through these changes so others can get raises!

  12. Anonymous permalink
    May 11, 2023 pm31 2:00 pm 2:00 pm

    Jayapal and Sanders will be reintroducing the Medicare for All bills in Congress tomorrow. I STRONGLY URGE everyone to call the offices of their Congressional reps to sign on as a co-sponsor.

  13. permalink
    May 11, 2023 pm31 5:44 pm 5:44 pm

    I have been  trying to get the NYC DOE to acknowledge the maintenance of schools under “custodial review.” My understanding is that these are schools in great distress  wherein the average Math and Reading scores are three years below average.

    How can I get the DOE to acknowledge the maintenance of such schools?


  1. The process for avoiding Aetna IS tricky | JD2718
  2. Opt out of Aetna? | JD2718

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