NYC Public Service Retirees, 9/11 Survivors, Hit With Costly Copays in Medicare Fight

NYC City Hall and unions push cuts that leave retirees paying the price, forcing hard choices on food, travel and even selling their cars.

Margaret Ann Bianculli, a retired New York City school teacher who lives on Long Island, was in a “state of panic” when she learned that the city had reached a deal to impose a $15-per-service copay with the health insurer that supplements Medicare coverage for her and her husband.

Bianculli, 73, waved a thick binder of their copay bills from three years ago before she and other retirees went to court to successfully block City Hall’s first attempt to implement the fees. In January, Mayor Eric Adams’ administration, Anthem Blue Cross and municipal unions changed the language in their agreement so that once again retirees are paying $15 for every doctor’s visit, blood test, physical therapy and other services.

And the bills are piling up. Again. Rapidly.

The former business teacher said doctor visits for her and her husband, a retired forklift operator, meant spending $500 out of pocket for their medical bills in January, including an annual deductible they reached in just two weeks. The hundreds of dollars they will spend going forward will eat deeply into her monthly pension check of roughly $2,100. The 2025 cost-of-living increase is only $324 for the year.

Bianculli said plans to spend more time with their grandchildren in Maryland are on hold, and “We may have to sell one of our cars.” The couple has even gotten food from a local pantry, a dismaying turn of events for a retired professional with advanced degrees who’s long been active in her local community.

“The thing I worked for is turning against me,” said Bianculli, who stayed on her job in Queens public schools for decades in part because she trusted that her future health needs would be covered. She’s angry that union leaders have signed off on the changes to retiree insurance in deals meant to gain raises for current members. “I can’t understand the union,” she said.

Margaret Ann Bianculli, retired New York City school teacher, and Princess Onyx, her service dog.

Bianculli is one of a growing number of retirees across America facing a double-edged sword: increasing political pressure to abandon traditional senior health coverage, which combines traditional Medicare with supplemental, or gap coverage, in favor of Medicare Advantage plans that bring all the pitfalls of private health insurance, along with little if any say in the negotiations that are driving these decisions. 

That fight has been especially acute in New York City, where roughly 250,000 retired civil servants and their representatives have been laboring for three years to prevent City Hall, working for the most part in sync with municipal labor unions, from switching their health coverage from traditional Medicare with gap coverage to an Aetna-managed Medicare Advantage plan.

The good news for the NYC Organization of Public Service Retirees has been a string of legal victories over the Adams administration that has so far prevented that shift – which was part of a deal between the city and its unions representing teachers, sanitation workers and other municipal employees. The retirees were all but shut out of those negotiations.

But the organization and its feisty president – Marianne Pizzitola, a retired Fire Department  EMT – have been unsuccessful since the start of the new year in preventing the Adams administration from its backup plan, which city officials believe will save money by imposing the copays in its current supplemental Medicare coverage, which for medical expenses is provided through EmblemHealth and through Anthem Blue Cross for hospital expenses.

After a similar plan was blocked in court two years ago, city officials changed the contract language so that retirees are now charged $15 for every doctor’s visit – a fee that adds up rapidly for seniors who might have multiple rounds of chemotherapy or regularly see a physical therapist. What’s more, Pizzitola noted, many physician visits now also include a hospital facility fee, which can mean an additional $15 charge.

“They just didn’t understand what they were doing to this population,” Pizzitola said. She described her members as seniors as old as 102, mostly living on modest fixed incomes, as well as first responders disabled in the line of duty, or widows and family members – including many receiving benefits because of injuries or death linked to the Sept. 11, 2001, terror attacks or its toxic cleanup.

Pizzitola noted that New York City retirees received a 1.8% cost-of-living increase in their pensions this year – or $324 annually for most – which for anyone who requires significant medical care likely will be erased by the multiplying copays. That worries her, but so does the other motive behind imposing copays, which is to make would-be patients think twice about seeing a doctor.

Marianne Pizzitola, President of NYC Organization of Public Service Retirees.

She said that one leader from the United Federation of Teachers, “said that he was fine with copays because they allow for ‘behavior modification’” – an idea that Pizzitola finds “pretty ugly” when applied to real-world health needs of seniors. “The older people – they need the emergency room.”

In early 2023, the Pizzitola-led retirees’ group successfully stopped an initial effort to impose the copays by arguing in a lawsuit that the contract between the city and its supplemental insurer, which pays for the roughly 20% of medical costs not covered by traditional Medicare, didn’t allow for such payments. But with the retirees winning a string of courtroom victories to defeat City Hall’s desired outcome – the switch to Medicare Advantage – administration officials rewrote the contract with supplemental that triggered the copays.

The four-year-old battle between the New York City retirees and the city government highlights a broader predicament for millions of retired union workers: In an era of growing privatization, a lack of leverage gives this aging population little say in consequential decisions over their health care. In most cases, their benefits are negotiated between currently working union members and their leaders and City Hall. Retirees don’t have a seat at the bargaining table.

In the nation’s largest city, the government of then-Mayor Bill de Blasio reached an agreement with the largest municipal unions, such as the United Federation of Teachers (UFT)  and the Teamsters, that would move the retirees into the Aetna Medicare Advantage plan, over the retirees’ strong objections. The move promised as much as $600 million in cost savings, which would largely pay for raises for current city workers.

“Retirees are not in unions,” Pizzitola said. “We don't vote on contracts. We don’t elect officers.” She added that the current union leaders “made these decisions for people not in their unions and then passed the cost to retirees, to benefit them. We call it a premium transfer.”

The retirees are resisting the switch to a Medicare Advantage plan because it exposes them to the bottom-line pressures familiar to millions of other Americans covered by private insurance, such as the need to gain prior authorization for necessary medications and procedures, outright denials of care, and limiting patients to specific hospital networks.

In New York City, the retirees have been able to rebuff the switch to Medicare Advantage in a string of courtroom victories powered by past legislation that requires the city to cover all health insurance costs, up to a statutory cap, for its retirees. New York State’s highest court turned down an appeal about the language on the books from the Adams administration in December. A related lawsuit – in which Bianculli is the lead plaintiff – seeking to cover the copays that retirees paid in 2022 is still pending.

For the New York retirees, fighting these changes has been a multi-front war, including efforts to convince union leaders that cuts in retiree benefits are actually a bad deal for currently working members. That effort earlier this year led the head of the powerful UFT, Bianculli’s former union, to pull his support for Medicare Advantage, when a rebel slate defeated his allies in an election for the union’s Retired Teachers Chapter.

But much of the battle has been waged in courts as well as the New York City Council chambers, where the retirees have gained sponsors for proposed bills that would effectively  end the Medicare Advantage push but have been unable to get a majority to oppose the Adams administration and other unions.

The New York retirees are not alone in fighting against cost-cutting governments seeking to force them into Medicare Advantage plans that use tactics like prior authorization to reduce health care costs. In Delaware, for example, some 25,000 retired state workers blocked such a move in the lower courts, only to see the state’s highest court reinstate the switch last April.

Pizzitola said her group’s pushback against Medicare Advantage has been more aggressive than in other states or municipalities because New Yorkers are “savvy as hell” and naturally suspicious of any changes. But the four-year battle has been exhausting for her and members like Bianculli.

“What they are selling out is the people who built our city, who rebuilt our unions after 9/11 and who rebuilt our city,” she said, asking: “What happened to the respect of the elders? There is none.”