Tighten up the messaging, please!

Updated 6/25: I had to add a no. 7 below . . .

I want to comment on some things in the press release Norm included in advance of the rally yesterday against the new Aetna plan.

It’s only a C+, and that's because of the lousy messaging. You can’t tell if they really know what they’re talking about, for example here:

This legislation is a simple bill that requires the City to offer ... a Medigap plan to supplement Federal Traditional medicare as they have had for 56 years.

What Pizzitola and her organization almost get right is their demand that the city offer a plan to supplement what Medicare doesn’t pay for.  What is dead wrong, though, is that that the current Senior Care is not a Medigap plan. It is a hybrid, chunks of which smell very much like an Advantage plan.

Medigaps are issued by private companies to cover some or most of the deductibles, copays, and co-insurances that Parts A and B of Medicare have never covered from the get-go. As you can see in the chart on p.2 here, there are 10 Medigap designs, created by the feds and administered by the states in various ways.

Employers and unions negotiate various types of supplemental coverage for their retirees, but these are not Medigaps.  In fact, the Senior Care plan that so many city retirees have has been called “GHI/CBP” for at least a couple of years. “CBP” stands for “Comprehensive Benefits Plan” – not a Medigap at all, but a plan the city negotiated with GHI and Empire that equates to some, but not all, of the coverage that the most expensive Medigaps offer. 

Here’s the description of Senior Care from the OLR website:

And here’s how Senior Care is not a “Medigap.” 

• One. There’s a $50 deductible above Medicare’s annual Part B deductible.  Medigaps don’t have deductibles in themselves. Their job is to cover some or all of Medicare’s deductibles. 

• Two. There’s a $300 hospital deductible per admission ($750 max for the year).  Medigaps don’t work that way. Some cover the whole Part A deductible ($1600 this year), others cover a percentage of it. 

• Three. You enhance your Senior Care hospital benefit to 365 days with a rider. All Medigaps give a 365-day benefit, it’s how they’re designed. 

• Four. Senior Care included an annual physical. Neither Medicare or Medigaps cover an annual physical.

• Five. In late 2021 members got a letter saying there would be $15 copays for common services. Medigaps DEFINITELY don’t do that. (And I know, the city rescinded these later, but they negotiated this and wanted these to happen.)

•  Six. On a phonecall last spring, the UFT Welfare Fund referred to Senior Care as a “PPO.”   PPOs are Medicare Advantage plans, not Medigaps.

• Seven. Senior Care is premium-free, the city negotiated it that way for union retirees.  But all Medigap plans have premiums. The most comprehensive ones cost the most, particularly in NYS.

Getting back to that darn press release . . . 

To preserve retiree health care choice, the City shall offer . . . at least one Medigap plan with benefits equivalent to ...

Medigaps do not have benefits, at least not in the form of services.  They only pick up remaining costs.

For months, retirees have ... rallied to bring attention to the fact that they will be forced off their current Medigap plan and Traditional Medicare losing access to their doctors, physicians, and treatment facilities.

A. Retirees don't have a Medigap at the present time. They have a negotiated plan with some elements of Medigaps.
B. The implication that retirees are going to lose their doctors, physicians (same thing as doctors in my book – what’s with that?), and treatment facilities is a grossly hyperbolic. Not one person who authored this release knows what will happen. All they're doing is terrifying you.

This legislation will allow them to maintain access to Federal Medicare and their doctors ...  This legislation ... also preserves Medicare,

We will all maintain access to our Medicare, and we don’t need new legislation to “preserve” it. We’ll keep paying premiums into Social Security, and CMS will continue to determine what the plans must cover and must do. What Pizzitola meant is that city retirees want to keep Original (or Traditional) Medicare and have the city pick up the remaining costs with the equivalent of a standard Medigap.

Remember, Advantage plans like the new Aetna PPO can (and frequently do) offer more than what’s in Original Medicare. Annual physicals and SilverSneakers are two easy examples, and pp. 123-56 of this .pdf list many benefits not covered by Medicare that will be covered by Aetna (e.g., meals after inpatient discharge, monetary rewards, transportation, allowance for OTC items, some money for a hearing aid,  etc.).

... they are enabling a for-profit insurer access to NY taxpayer dollars at the expense of the retirees! 

Honestly, who do the Pizzitola protesters think the insurance company behind Senior Care is? It’s EmblemHealth, and sure, the company bills itself as a non-profit, but CEO Karen Ignagni is “working to benefit health insurance companies” and in 2021 made $3,095,534 (Crains). 

You tell me what defines a not-for-profit company these days. One contributor to medium.com writes:

Not distributing its profits to any private individual is the crucial difference between nonprofits and for-profits. Besides that, the executives of the system still get salaries and salary raises. In reality, the term “nonprofit” is misleading, as numerous nonprofit organizations even take in millions of dollars annually and consistently run in the dark. 

and Elisabeth Rosenthal reported in Stanford Medicine several years ago:

To some extent insurers do better if they negotiate better rates for your care. But that is true only under certain circumstances and in a limited way. “They are methodical money takers, who take in premiums and pay claims according to contracts — that’s their job,” said Barry Cohen, who owns an Ohio-based employee benefits company. “They don’t care whether the claims go up or down 20 percent as long as they get their piece. They’re too big to care about you.

 As far as I can see, it’s all just one big game. 

Our job is to push for reform – that’s where I do agree with the press release. But for heck’s sake, please do something about the messaging. I’m so tired of reading stuff that looks more like Swiss cheese.