Garrido just sent a message or should I say scare tactic to us about this as well. I forwarded to Marianne so she would be aware even though she probably already was aware of Garrido as well, thank goodness for people like you and Marianne who speak truth to power. She removes any fear tactic we face.
Mulgrew’s “very smart people” told retirees at a Town Hall that medigap or Medicare supplement policies are subject to the Affordable Care Act (“ACA”) or ObamaCare and that they could not be denied coverage. This is totally false. Medigap or Medicare supplement policies are expressly excluded from the ACA. They are regulated by the respective states and in most jurisdictions can deny coverage based on pre-existing medical conditions.
I asked Mulgrew to issue a correction. He did not.
You know, yesterday I had to put out a correction after a graphic I posted proved to have bad information. Sometimes I made mistakes in my classes, or was corrected by a student. It's the easiest thing in the world to say, "You're right. I apologize." I don't think it hurts you at all. But some politicians, like Mulgrew, just can't seem to do it.
When Mulgrew decided to say he didn't back the Aetna plan anymore, he blamed the city. He never stepped up. And he never did a thing to help us. I don't understand how that helps him, unless we're as stupid as he seems to assume we are.
Luckily, the courts preserved traditional Medicare and Medicare supplement at no cost for retirees but if the courts had not intervened and retirees or their dependents opted out of Medicare Advantage thinking that they could not be denied medigap or Medicare supplement insurance the outcome could have been catastrophic.
Mulgrew or “his very smart people” owed a correction to his retiree members.
He owes us way more than that. These cases are STILL going through the courts, and he has the ability to a. support us, and b. get legislation passed that would protect us.
Totally correct that the ACA has nothing to do with MEDIGAPS (though in the “background,” the ACA does have clauses relating to Medicare itself, like admin caps in Advantage plans, anti-fraud mechanisms, payroll tax adjustments to increase funding, some free visits, screenings, and vaccines, etc.). So if Mulgrew’s “very smart people” said those exact words, they may have been confused, and no surprise there. But it’s also possible that they said something else at the meeting and the retirees heard it wrong. Who’s to say. As for the “exclusion” you mention, it’s Medicare itself, not the Medigap: generally speaking you can’t get a marketplace plan once you’re eligible for Medicare (exceptions exist). And where you say Medigap plans are regulated by the states (though federally designed), it’s not as clear-cut as you say. You can always get a Medigap in the first 6 mos. after turning 65 and in periods of “guaranteed issue right,” like after you lose certain types of coverage. Outside these periods you definitely can be denied coverage, but they can also accept you through underwriting, charge you a higher premium, and/or subject you to a 6-mo. waiting period. It’s a very difficult subject, and it’s hard to counsel people on any of this unless you’re really steeped in it.
Mulgrew’s “very smart people” made a flat out statement that there was no underwriting for medigap policies.
Most of the retirees currently in the NYC’s
Plan have already turned 65 so they can be underwritten and coverage can be denied. In some cases the insurer can issue higher rates rather than outright deny.
My point was that Mulgrew’s “very smart people” misrepresented that Medigap policies are “ guaranteed issue” which was not retracted or corrected.
(a) In NYS, CT, and MA you can buy a Medigap at any time no matter what. (b) Interesting situation if the city turns Sr Care into a paid deal. The law says that you can get a Medigap for 63 days if your employer coverage ends: it would fall under guaranteed issue right. But if the city keeps Sr Care and just makes you pay a premium for it, would that allow you to purchase a Medigap under “guaranteed issue right”? Maybe not.
Again, Marianne’s conflated terminology does not help to clarify the situation. She says at
01:00: “You have Medicare-eligible retirees … this does not impact them. Your Medicare Part A is your primary insurance. Your city health plan, your Anthem plan, is a supplement.” She said Anthem confirmed that this restriction “does not impact any Medicare person.” Why, she continues? She explains: “Because there is no network in Medicare.” I’m already confused. I have Medicare, and for a decade I was in the union’s HMO. That HMO had networks. Did Marianne thus misinterpret Anthem’s response? Anthem, she says, says the restriction “does not impact any Medicare person.” Since everyone in the union’s HMOs and PPOs is also in Medicare, and Medicare pays first for all of us, Anthem seems to be saying that ALL OF US in ANY of the union’s plans would be okay at this hospital — whether you have Sr Care supplement or a union HMO/PPO. But you can’t tell from this video what Marianne means because she and others are always conflating “Medicare” (which is what we all have through Social Security) with “Original Medicare” (which is the arrangement most retirees have if they opt for the Sr. Care plan, namely Medicare + supplement). So I still don’t know the answer to whether this hospital is thinking of preventing people in the union’s HMO/PPO plans — which do have networks, and concomitantly do have Medicare — from using that facility.
One thing Marianne does say is that this is a good reason to keep us out of Medicare Advantage. Companies that are not standard Medicare do have agreements with hospitals. If I were a person in an HMO/PPO plan, I would call, just as Marianne did, and find out. If that's you, please let us know what you find out.
Totally agree that network facilities is one reason to stay out of Advantage plans, but not necessarily a game-changer. I had a lot of procedures done in various facilities in the decade I was in the HIP HMO, none of which were denied.
I have friends who swear by HIP, and I'd understand if they wanted to continue when they retired. I was mostly happy with GHI for decades. Still, I really do believe we need to cut the parasitic middleman out of health care as much as we possibly can. Regardless of how good HIP, or GHI may be, we need to do better. Keeping us in Medicare plus supplement is good. NYHA is better. And Medicare for All would be even better.
Garrido just sent a message or should I say scare tactic to us about this as well. I forwarded to Marianne so she would be aware even though she probably already was aware of Garrido as well, thank goodness for people like you and Marianne who speak truth to power. She removes any fear tactic we face.
Thanks for your kind words and yes, Marianne does amazing work.
Mulgrew’s “very smart people” told retirees at a Town Hall that medigap or Medicare supplement policies are subject to the Affordable Care Act (“ACA”) or ObamaCare and that they could not be denied coverage. This is totally false. Medigap or Medicare supplement policies are expressly excluded from the ACA. They are regulated by the respective states and in most jurisdictions can deny coverage based on pre-existing medical conditions.
I asked Mulgrew to issue a correction. He did not.
You know, yesterday I had to put out a correction after a graphic I posted proved to have bad information. Sometimes I made mistakes in my classes, or was corrected by a student. It's the easiest thing in the world to say, "You're right. I apologize." I don't think it hurts you at all. But some politicians, like Mulgrew, just can't seem to do it.
When Mulgrew decided to say he didn't back the Aetna plan anymore, he blamed the city. He never stepped up. And he never did a thing to help us. I don't understand how that helps him, unless we're as stupid as he seems to assume we are.
Good thing we aren't.
Luckily, the courts preserved traditional Medicare and Medicare supplement at no cost for retirees but if the courts had not intervened and retirees or their dependents opted out of Medicare Advantage thinking that they could not be denied medigap or Medicare supplement insurance the outcome could have been catastrophic.
Mulgrew or “his very smart people” owed a correction to his retiree members.
Amen!!!!
He owes us way more than that. These cases are STILL going through the courts, and he has the ability to a. support us, and b. get legislation passed that would protect us.
Totally correct that the ACA has nothing to do with MEDIGAPS (though in the “background,” the ACA does have clauses relating to Medicare itself, like admin caps in Advantage plans, anti-fraud mechanisms, payroll tax adjustments to increase funding, some free visits, screenings, and vaccines, etc.). So if Mulgrew’s “very smart people” said those exact words, they may have been confused, and no surprise there. But it’s also possible that they said something else at the meeting and the retirees heard it wrong. Who’s to say. As for the “exclusion” you mention, it’s Medicare itself, not the Medigap: generally speaking you can’t get a marketplace plan once you’re eligible for Medicare (exceptions exist). And where you say Medigap plans are regulated by the states (though federally designed), it’s not as clear-cut as you say. You can always get a Medigap in the first 6 mos. after turning 65 and in periods of “guaranteed issue right,” like after you lose certain types of coverage. Outside these periods you definitely can be denied coverage, but they can also accept you through underwriting, charge you a higher premium, and/or subject you to a 6-mo. waiting period. It’s a very difficult subject, and it’s hard to counsel people on any of this unless you’re really steeped in it.
Mulgrew’s “very smart people” made a flat out statement that there was no underwriting for medigap policies.
Most of the retirees currently in the NYC’s
Plan have already turned 65 so they can be underwritten and coverage can be denied. In some cases the insurer can issue higher rates rather than outright deny.
My point was that Mulgrew’s “very smart people” misrepresented that Medigap policies are “ guaranteed issue” which was not retracted or corrected.
(a) In NYS, CT, and MA you can buy a Medigap at any time no matter what. (b) Interesting situation if the city turns Sr Care into a paid deal. The law says that you can get a Medigap for 63 days if your employer coverage ends: it would fall under guaranteed issue right. But if the city keeps Sr Care and just makes you pay a premium for it, would that allow you to purchase a Medigap under “guaranteed issue right”? Maybe not.
Again, Marianne’s conflated terminology does not help to clarify the situation. She says at
01:00: “You have Medicare-eligible retirees … this does not impact them. Your Medicare Part A is your primary insurance. Your city health plan, your Anthem plan, is a supplement.” She said Anthem confirmed that this restriction “does not impact any Medicare person.” Why, she continues? She explains: “Because there is no network in Medicare.” I’m already confused. I have Medicare, and for a decade I was in the union’s HMO. That HMO had networks. Did Marianne thus misinterpret Anthem’s response? Anthem, she says, says the restriction “does not impact any Medicare person.” Since everyone in the union’s HMOs and PPOs is also in Medicare, and Medicare pays first for all of us, Anthem seems to be saying that ALL OF US in ANY of the union’s plans would be okay at this hospital — whether you have Sr Care supplement or a union HMO/PPO. But you can’t tell from this video what Marianne means because she and others are always conflating “Medicare” (which is what we all have through Social Security) with “Original Medicare” (which is the arrangement most retirees have if they opt for the Sr. Care plan, namely Medicare + supplement). So I still don’t know the answer to whether this hospital is thinking of preventing people in the union’s HMO/PPO plans — which do have networks, and concomitantly do have Medicare — from using that facility.
One thing Marianne does say is that this is a good reason to keep us out of Medicare Advantage. Companies that are not standard Medicare do have agreements with hospitals. If I were a person in an HMO/PPO plan, I would call, just as Marianne did, and find out. If that's you, please let us know what you find out.
Totally agree that network facilities is one reason to stay out of Advantage plans, but not necessarily a game-changer. I had a lot of procedures done in various facilities in the decade I was in the HIP HMO, none of which were denied.
I have friends who swear by HIP, and I'd understand if they wanted to continue when they retired. I was mostly happy with GHI for decades. Still, I really do believe we need to cut the parasitic middleman out of health care as much as we possibly can. Regardless of how good HIP, or GHI may be, we need to do better. Keeping us in Medicare plus supplement is good. NYHA is better. And Medicare for All would be even better.