Opt out of Aetna?

“Should I opt out of Aetna?” – it’s a question I hear a lot. I think a lot of us are hearing it a lot.

Big hint: I am not going to answer the question in this post.

First, to be clear, it is not about me. I am not medicare-eligible. This will not be my choice.

Second, the way New York City Office of Labor Relations (OLR) set things up, they want you to “waive NYC health benefits” and they are reserving the phrase “opt out” to mean “choose HIP VIP, not Aetna/CVS Medicare Advantage.” This is confusing. And given OLR’s record, I think it is intentionally confusing.

“Should I opt out of Aetna?”
I don’t know.
Different people may have different answers

Third, it’s a really important question, whether to opt out (waive benefits) or not. Read on.

“Savings” means taking money and services from regular people – and transferring it to banks and big business.
“Savings” is horrible, national, and bipartisan

There is a large battle taking place in New York City right now. It is part of a battle taking place across the country.

The financial branch of New York City government (appointed, not elected, and tend to stay in power from administration to administration) wants to pay NYC workers, and people in general, less. They call denying funding, denying support, denying assistance to regular New Yorkers “savings.” What does that mean? They close a library for an extra day. That “saves” the cost of heating and the cost of paying the staff – so that the money can be shifted to a big real estate developer for a tax abatement (fancy name for a hand-out). NYC “saves” money by denying service so they can “shift” the money to a big company. From the point of view of regular New Yorkers, the City closes their library. (No savings, and a loss of service). From the point of view of the library staff, the City pays them less, or doesn’t hire additional staff. (Not a savings). Which is a long around way of explaining: New York City’s financial handlers want to SHIFT money away from regular people, HAND it to bankers or big business, and CALL that SAVINGS.

It’s not just NYC. This kind of reverse Robin Hood math is taking place across the country. It has been going on, sometimes more actively, sometimes in the background, for a good 40-45 years. The election of Reagan in 1980 was an ugly milestone on this path. A lot of “public good” – physical infrastructure, programs, etc – were put in place during the New Deal, and then the Great Society. And there were plenty of state and local initiatives from those same periods. And the banks and federal government, and state government, and local government have been working to undo much of that public good. Sometimes they nibble around the edges. And sometimes they aim at the heart.

Medicare and Medicare Advantage

Medicare is a case a point. And it’s the case we care deeply about, today, now, because it is being threatened. At the federal level, we can just about ignore Florida Republican Senator Rick Scott. His open threat to Medicare won’t fly, even among Republicans. But pay more attention to Trump’s initiative to switch seniors from Medicare to Medicare Advantage.

Pause for a second. Medicare Advantage is part of the same law that creates Medicare. So what’s the big difference? Well, Medicare Advantage was not part of the original law that created Medicare. Medicare Advantage (with a different name) shows up in 1997 (Clinton). It gets its name in 2003 (Bush). Under Trump there were several initiatives to shift people out of Medicare, into Medicare Advantage, including big financial incentives, for, say, a large municipal employer, like, perhaps, New York. And Biden has doubled down on the Trump regressive reforms.

Medicare Advantage is not Medicare. It is part of the same law, sure enough, but Medicare is publicly funded and administered health care for senior citizens – the Medicare Advantage plans are private. I am going to baldly assert here that the privatization of public services is a Bad Thing, without arguing that MA is worse for the individual than Medicare is. (Advantage IS worse, I’m just not laying out the case here).

New York City and “Savings”

So here’s our specific story. The feds will reward New York City’s financial agencies and their backers for “saving money” (shifting money out of the hands of regular folks, into the hands of big business) – specifically if this “shifting” (which they call “savings”) involves giving retirees less health care. And the NYC financiers, and their bargaining agents in the Office of Labor Relations found willing partners in some of the leaders of big municipal unions, including my UFT.

And so for the last two plus years, OLR and the Municipal Labor Coalition (MLC) have been trying to shift municipal retirees out of Medicare, into Medicare Advantage. Opposing them have been regular retirees. We have slowed them down, stalled them, diverted them. At times it looked like we had them beaten. We want to stop this “healthcare savings” (taking of money away from our health care). But they fought back. Dirty, and hard. Today OLR and the MLC and the UFT leadership – it looks like they are winning the battle with retirees. And retirees are currently scheduled to be shifted to Medicare Advantage on September 1 of this year.

Should you fight against the NYC implementation of Medicare Advantage?

Absolutely. I hope you have been part of the effort – lobbying city council, contacting your union leaders, getting the word out.

And it’s not done yet. In the coming days, or weeks, or months, there may be further opportunity to fight, to reverse the current situation.

This is a fight about principle. It is a fight about our own personal health. We should all have been part of it. We should be part of anything that comes next. We should be shouting “No to Aetna/CVS!”

Should you opt out of Aetna/CVS? (waive NYC health benefits)

So while you should be part of the big fight, you should also be looking out to protect yourself. September 1 – we might be able to stop it – but right now it’s looming. And the “opt out” or “waiver” period is now – May 1 – June 30.

I think the process is a mess. I just heard that OLR removed its old form and has put out a new one. Soon, I hope, the UFT leadership will issue some guidance on filling this out.

But that doesn’t get to the decision. For each of us (well, not me. For each medicare-eligible retiree), you need to be preparing to make a choice. It is a personal decision, based on what is best for your health care and your family’s health care. The fight to stop this thing is collective, social. But this moment, the choosing, has fallen unfairly on medicare-eligible retirees as individuals.

I wish I could offer advice. I don’t know that I can. You need to know which doctors will accept which coverage, and which networks and which hospitals. It would be useful if this information was widely shared – but if it is not, you will need to do your best to figure it out. There is information about copays and coverage. You will have to read some of it. There are rules about giving up NYC health benefits, and then claiming them again. (I think I know how that works, but want to be certain before writing). There are rules about giving up traditional Medicare and then trying to return to it. These rules have exceptions in four states – New York, Massachusetts, Connecticut, and Maine (again, I want to be certain before writing). There is the cost of lost reimbursements. There is the cost of different Medigap plans.

And I’m not going to start on drugs today – although I have big questions about Aetna’s drug plan that I want to ask.

There is a lot to figure out. And the opt out period has 7½ weeks left. (unless it is delayed, which it should be, since even OLR knows its first form was bad. And all of us know that there is not yet enough information). But as of today, 7½ weeks left. You should be supporting efforts to stop this – but today, you should also be doing research on whether to let them switch you into Aetna/CVS City of New York Medicare Advantage, or whether to waive NYC Health Benefits.

If you decide to opt out of Aetna/CVS, when should you do it?

I got a strange comment here two days ago. I have been reporting on problems with the process. I have not encouraged anyone to opt out. But Marianne Pizzitola asked me to stop encouraging people to waive their benefits. To be clear – I have never written anything to encourage anyone to waive their benefits.

You SHOULD be doing your research. But there is potentially more information coming. There is potential to delay the process. There may even be the possibility of upending this process. So do your research, but, if you decide that waiving benefits is your choice, I would recommend you wait before filing. Not until the last day – who knows what will go wrong with the form or the website or the phones – but until later in these 7½ weeks, to let any developments that may be coming, actually develop, and to avoid prematurely cutting off options.