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NYC and EmblemHealth to return $53 million over retiree Medicare copays
The settlement freezes the $15 copay on medical visits through the end of 2027 after it was reinstated by a court order in January 2025.
New York City and health insurer EmblemHealth have agreed to refund $53 million to a quarter of a million retired municipal workers after a state court fight over Medicare-related copays, Insurance Business reports.
The payout settles a class action filed in 2022 by the NYC Organization of Public Service Retirees against the city and EmblemHealth over $15 copays for medical visits under EmblemHealth's GHI Senior Care Plan, a supplemental coverage layer for roughly 250,000 city retirees, with the disputed charges levied from January 2022 through January 2023.
As part of the agreement, the city and EmblemHealth will freeze the $15 copay at its current level through the end of 2027, after the charge was reinstated by court order in January 2025 following a period when it had been suspended.
The dispute is tied to the city's shelved effort to move Medicare-eligible retirees into a privatized Medicare Advantage plan, which officials had projected would save taxpayers about $600 million a year, and NYCOPSR said some members are still delaying care due to costs while the group calls for copays to be eliminated.