Court Blocks Medicare Advantage Switch The Retired Public Employees Association (RPEA),…
Following up on our successful inquiry last year which led to the Department of Civil Service reversing the improper practice of UnitedHealthcare by which they were denying Empire Plan benefits to Medicare eligible retirees for certain covered Durable Medical Equipment, RPEA is now seeking equity regarding three specific health benefits where Medicare retirees receive a lesser benefit than other NYSHIP Empire Plan enrollees.
RPEA President Jack McPadden has written to the members of the Council on Health Insurance (consisting of the heads of the Governor’s Office of Employee Relations, Department of Civil Service, and Division of the Budget) requesting relief regarding three specific instances where Medicare primary retirees enrolled in the Empire Plan receive a lesser benefit than other NYSHIP members. This occurs even though Medicare retirees pay the same premium as other enrollees.
The three instances cited by RPEA are:
- Skilled Nursing Facility Care
- The benefit is not covered
- Coordination of Benefits
- Medicare primary retirees receive lower reimbursement than Empire Plan enrollees with other types of primary coverage
- Radiology, Anesthesiology and Pathology Physician services (RAP) provided in a hospital setting (inpatient and outpatient).
- When the provider is out-of-network Medicare primary enrollees do not receive the paid-in-full benefit that is provided when the Empire Plan is primary
In his letter, Jack McPadden noted:
“Given that NYSHIP premiums are not reduced for State retirees when Medicare becomes primary despite the fact that the claims cost to the Plan are substantially reduced, we maintain that there should be no reduction in the overall benefit level when the Empire Plan is secondary to Medicare. As a member of the State’s Council on Health Insurance, we are bringing these inequitable and discriminatory practices to your attention for resolution.”
The letter is the culmination of research and analysis conducted by the RPEA Health Benefits Task Force, chaired by Mary Frye and consisting of Jack McPadden, Edward Farrell, Diana Hinchcliff, Richard Rice, Patricia Walsh, Frosine Stolis, Sharon Beauregard and Louise Mabin.
If any of you have experienced discrimination regarding the administration of these benefits, please contact us. Specific examples would be helpful as we move forward.
This action represents our commitment to protect the benefits you have earned and is yet another example of the benefit of membership in RPEA.