The administration of New York City Mayor Zohran Mamdani and health insurer EmblemHealth have agreed to pay up to $53 million to reimburse retired city workers who said they were unlawfully charged copays for medical visits.
The settlement resolves a 2022 class-action lawsuit filed in the New York State Supreme Court in Manhattan. The suit alleged that the city improperly required retirees enrolled in EmblemHealth’s GHI Senior Care Plan to pay $15 copays for medical appointments under a supplemental plan designed to cover costs not paid by traditional Medicare.
Marianne Pizzitola, president of the NYC Organization of Public Service Retirees, which filed the lawsuit, welcomed the settlement but said the broader fight over retiree healthcare was far from over.
She said rising healthcare costs had forced some retirees to skip cancer treatment, occupational therapy and other medical services. Pizzitola highlighted the case of 100-year-old retired firefighter Dan Stromer, who she said survives on a $26,000 annual pension.
“We need to roll back these regressive copays,” she said. “I want what we had: traditional Medicare with the supplemental benefit.”
The settlement covers copays charged between January 1, 2022, and January 31, 2023.
A spokesperson for the city’s Law Department said the $15 copay was reinstated in January 2025. Under the settlement, the Mamdani administration and EmblemHealth have agreed not to increase the existing copay until 2028.
EmblemHealth said it would notify eligible members about the reimbursement process. According to the retirees’ organisation, as many as 250,000 former city employees could qualify for compensation.
“We are pleased that a settlement has been reached that avoids litigation,” EmblemHealth spokesperson Alex Gomez said, adding that a reimbursement process had been established to guide members through the next steps.
The retirees first sued the city and EmblemHealth in November 2022 after the administration of then-Mayor Eric Adams introduced the $15 copay in January of that year. Before then, retirees had not been required to pay copays under the plan.
The lawsuit argued that the city violated a 2022 court order barring it from imposing additional costs on retirees for their supplemental healthcare benefits. That ruling also allowed the Adams administration to pursue a transition to Medicare Advantage, provided retirees could opt out and remain on the GHI Senior Care Plan.
The proposed shift to Medicare Advantage sparked years of legal challenges from retiree groups, which argued that the privately managed plan offered inferior coverage and that the city was legally obligated to provide premium-free healthcare. Although New York’s highest court ultimately ruled in favour of the Adams administration, the city abandoned the plan in June 2025.
During his mayoral campaign, Zohran Mamdani pledged to reject Medicare Advantage if elected. However, he has not yet outlined how his administration intends to address the collapse of the proposal, which had been expected to save the city about $600 million annually.
A December 2025 audit by the city comptroller found that a key fund covering insurance premiums for city employees, retirees and their dependents had become insolvent, citing the failed Medicare Advantage initiative as one of the contributing factors.
New York City Council member Christopher Marte said he plans to reintroduce legislation that would prevent the city from requiring retirees to enrol in what he described as lower-quality private healthcare plans, including Medicare Advantage, or from increasing their healthcare costs.
“We are being really careful on how we define ‘diminished’ healthcare,” Marte said. “Forcing someone to pay a higher copay could discourage people from seeking the care they were promised.”
