Tuesday, September 5, 2017

IBM Medicare One Exchange Medicare Fall Enrollment Time for 2018

Medicare Fall Enrollment is about a month away.  It starts October 15 and ends at midnight Dec 7.
   
As usual, I strongly urge you to make sure your 2017 health insurance policy choices will provide the best coverage for you in 2018.  Insurance companies CHANGE their policies every year. They add or remove doctors.  Doctors quit accepting plans.  Drug costs change and/or some drugs will no longer be covered.  Companies must update All plan information on October 15th. There is no point checking before that day because companies wait until then to do it. Use the plan finder option on medicare.gov to determine which plan is best for you.
   
Also, a reminder for those of you who have Medicare supplemental insurance or medigaps, this enrollment period DOES NOT apply to that type of insurance.  Change windows for medigap insurance are determined by the state you live in and range from "never" to "whenever you want". Consult your state department of insurance to find out the rules.
 
If you have traditional or original Medicare, your action in October is to examine the prescription drug insurance plan (PDP) coverage for 2018.  If you bought the PDP through One Exchange to qualify for your HRA/FHA benefit, then look at the plans they offer to determine if there is a better plan available.  You might find it is cheaper to forego the HRA/FHA funds because the subset of plans they sell will cost you substantially more in copays versus having the funding.
               
Reminder, the set of insurance plans One Exchange sells are EXACTLY the same plans that are available to anyone on Medicare in your zip code but they don't sell ALL the plans that you could buy. They only sell the plans for which they get commission as an insurance agent.  It may actually happen that there is a better plan available in your zip code for your drug coverage not sold by One Exchange.  You have to weigh the benefit of staying with One Exchange and having funding from your HRA/FHA and IBM catastrophic drug coverage versus NOT using One Exchange because you might actually pay less out of pocket by using a non-One Exchange plan and fore-fitting the subsidy. If you face that situation, tell someone at One Exchange what is happening.  They might have an exception process.

If you have a Medicare Advantage (MA) plan that does not include prescription drug insurance then you have to look at both your MA plan and your PDP plan.  Make sure your MA doctor network is still giving you access to your providers.  If not, ask your provider what plans they will accept in 2018 as the first step to information gathering.  Then look to see if One Exchange sells that plan. Once again, if the MA plan is how you gain access to your HRA/FHA you have to make a decision over what takes priority.  Is it the doctors or the HRA/FHA money.
 
If you have a Medicare Advantage plan that does include prescription drug insurance (MAPD) you may have to switch to a different plan if there are drug coverage changes or if there are doctor changes. This is the hardest plan to change since it involves trying to find a better plan that includes both components and buying it through One Exchange. It might be, that you decide to revert to traditional Medicare with a supplemental policy.  BE CAREFUL because state rules apply.  You might not be able to get a supplemental policy.  Once again, you also need to decide if the money you get from your HRA/FHA is worth you sticking with an MAPD plan that does not meet your needs.
 
Take action in October!  It's important to your health!

Thursday, May 25, 2017

IBM Medicare OneExchange Lowering Prescription Drug Copay Cost

We are almost half way through the year and often at this point Medicare recipients encounter cost or coverage problems for new prescriptions or price increases on existing prescriptions that significantly drive up the cost of their medications.  Here are a few suggestions on how to cope with unexpected drug costs:


1. Don't assume a prescribed drug is the only drug available to treat your condition.  If a prescription is expensive, ask your doctor if there is a generic alternative or another drug that will do the same thing.  Better still, show the doctor your drug plan's entire formulary and ask if any of those drugs will be suitable for your condition.

2. If there is no flexibility in the drug you need to treat your condition but the cost is high or there was a price increase, try to appeal to your plan for a pricing exception and/or ask them to lower the pricing tier for the drug for the rest of the year.  If you get an exception or a tier change it will only last until the end of the year.  Be sure to pick a "better" part D plan during fall open enrollment.

3. Make sure you are getting your drugs from a "best price" pharmacy if you buy drugs from a pharmacy.  Ask the insurance plan what pharmacies provide the best prices for their plan.  These are called preferred pharmacies.  You might have to travel a few more miles to get a prescription filled but the price difference can be significant. Even if there are no preferred pharmacies in your plan, the prices will often vary - particularly for independent pharmacies - but also for the chains so ask different pharmacies in your area what they will charge to fill a prescription before you fill it.

4. Ask your pharmacy if there is a  prescription discount card that can provide a lower copay. However, if you do use a prescription discount card, the cost of that prescription will not be included in any doughnut hole calculations.

5. Ask your local pharmacy if they will provide a "better price".  Some pharmacies will sell you drugs at their cost if you do a lot of business with them - particularly if they are not part of a big chain.  Again, if you don't use your insurance to buy a drug, those costs are not included in doughnut hole calculations.

6. Many older people shy away from mail order suppliers and prefer to use local pharmacies.  Give mail order a try! Mail order (if available through your current plan) - often significantly lowers your copay.  However, you will likely have to buy larger quantities of drugs to get the lower price. If you can afford the cash flow it is worth it.

7. EVERY YEAR in October, look on plan finder in medicare.gov or call 1-800-MEDICARE and ask them to help you find a better plan

Thursday, March 16, 2017

IBM Medicare OneExchange Future Healthcare Legislation

   
Although the legislation to change the ACA (aka Obamacare) did not pass, it does not mean that legislative actions to modify the ACA, Medicaid and Medicare insurance will not occur.  There will  likely be modifications that will be embedded into other acts and budget proposals that will affect Medicare.
 
I urge you to pay REALLY close attention to ALL legislative actions to be sure you understand the impact to Medicare. As an example, the legislators, in 2013, enacted a "doc fee structure fix" which was good because doctors were increasingly not accepting Medicare.  But that legislation also included disallowing the sale of medicare supplement F plans after 2019 because it is a "first dollar pay"policy.  That means when someone buys an F plan Medicare Supplement they never pay a doctor bill in trade for paying a substantial insurance policy premium.  As I said in the past, legislators believe people who have F plans use doctors more than people who don't.  There is no data behind that assertion to determine if it is true and, if so, why.  Typically people who buy F plans have more health issues.  Nonetheless, it was included as a bargaining chip.

I believe a good way to stay informed about healthcare legislation is to look at nonpartisan advocacy agency analysis (albeit no group is purely nonpartisan). Many do an excellent job of analyzing pending legislation and executive orders about healthcare.  The agencies I suggest are AARP, Medicare Rights, AMA, the American Hospital Association, and the Kaiser Family Foundation. Links to their websites follow:
         

https://press.aarp.org/press-releases

https://www.medicarerights.org/newsroom/press-releases
                                               
https://www.ama-assn.org/

http://www.aha.org/press-center

http://kff.org/medicare/


Tell your legislators how you feel about pending and/or enacted changes.


Monday, March 13, 2017

IBM Medicare OneExchange Over 65 Still Employed

People who continue to work past the age of 65 often keep using employer insurance as primary insurance instead of using Medicare.  Typically, employer insurance is more comprehensive (for example it might include acupuncture coverage which is not covered by Medicare) and is also subsidized by IBM.   However, if you leave IBM and join a company with fewer than 20 employees you must enroll in Medicare to have primary coverage.
     
Generally, there is no advantage to enrolling in Medicare if you work for IBM past 65.  Some people do choose to enroll in Medicare part A (hospitalization coverage) because there is no premium payment for part A and it might provide secondary coverage in some circumstances (e.g., part A might permit an overnight stay in a hospital for a given procedure where IBM's insurance might not).  However, if you have a Health Savings Account (HSA) with a High Deductible Health Plan (HDHP)  DO NOT enroll in Medicare part A if you want to be able to contribute to your HSA.  Contributions stop as soon as you enroll in part A.
         
Also, be careful of when you start taking Social Security if you have an HSA. Enrolling in Social Security causes up to a six month retroactive enrollment in part A if you also enroll in Medicare.  You will pay a tax penalty for any HSA contributions you made in the prior six months if you were Medicare eligible. I know, it's complicated.  If you want to keep it simple, just remember to stop contributing to an HSA six months before you retire if you plan to immediately collect Social Security.  The good news is the money remaining in your HSA will be available to use tax free for your Medicare expenses until it is depleted.
     
When you (or IBM) decide it is time to retire there a a few things you must do to guarantee a smooth transition.  Generally, I recommend you enroll in Medicare part A & B a month before you leave your job to be sure you have no enrollment problems. It will cost you a month worth of your part B premium payment but that's a whole lot better than having no insurance coverage while you try to sort out a problem.
                             
You actually have 8 months from the last day of your employment to enroll into Medicare.  DO NOT take 8 months to do it.  Also DO NOT take COBRA unless the COBRA coverage includes something that Medicare does not cover and you need that coverage.  COBRA is expensive SECONDARY insurance coverage if you are over 65.  That means if you get sick, it will only pay your co-pays  and you will be responsible for the bulk of the provider costs if you do not have Medicare.
 
There are two forms you need to bring to Social Security (which is how you enroll in Medicare) when you are about to retire.  Yes, I am recommending you physically go to a Social Security office. You can easily find the forms online:

  • Form CMS 408 (Application for Enrollment into Medicare) to be filled out by you
  • Form CMS L564 (Request for Employment Information) to be filled out by IBM HR.

    The second form is the proof  you had continuous employer health insurance after you turned 65 so that you will not have late enrollment penalties.  Why do you have to "walk it in"? Social Security has been significantly impacted by federal budget cuts. Mailing it in is a little risky because of the cuts. If it gets lost you will have no proof of who actually processed the form.

    When you walk it in, get the name of the agent who takes the forms and the date they processed your application.  That is important information to have in case any mistakes are made.   

Wednesday, February 1, 2017

IBM Medicare OneExchange Medicare Supplement F & F-HD GONE after 2019

In 2015 there was a "Doc Fix" law passed by congress to improve the fees paid to doctors (which hadn't been raised in years so doctors were starting to opt out of Medicare).  The congress decided to counterbalance that remedy by eliminating medigap plan F effective 2020.  I wrote about this when it happened: http://ibmmedicare.blogspot.com/2015/10/ibm-oneexchange-medicare-doc-fix-law.html

There is a subtle consequence of this change.   I didn't realize the F High Deductible plan will also no longer be available in 2020 because it is a derivative of the F plan.
 
I really like the F-HD plan.  The K plan is good but I think an F-HD plan from a solid insurance company is better.  I will probably switch to an F-HD plan in 2018.  I don't know what I will do.


Added 2/2/17:
 
I did a little more reading on and thinking about the F plan longevity.  Even if I do enroll and have the F or F-HD before 2020, over time it is highly likely the premium for F plan types will increase more rapidly than for other medicare supplement plans,  I write that because the insurance pool for the F or F-HD plan will shrink after 2020 as people die and the age demographics in the pool will keep increasing without "younger people" in the pool.  Also, there might be new Medicare Supplement options available that are better price performance.

In the comments section of this post, a viewer was kind enough to provide information about what is being proposed by the National Association of Insurance Commissioners.  In particular the "G" plan is being proposed to have a G-HD option:

http://www.naic.org/documents/committees_b_senior_issues_exposure_medigap_plans_sold_after_200101.pdf
   
This is a proposal.  It could change.  I also urge you to also pay really close attention to the new administration's actions regarding Medicare and make your voice heard if you do not like what is being proposed.  Paul Ryan has for years championed a Medicare "voucher" system and is eager to make that change.  If this administration adopts such a plan, it essentially means we will be given a stipend to go buy insurance.  The government insurance pool (aka original Medicare) might be one of the options to buy but it's not known. If it will be offered, it's not known at what cost.  If there is no government insurance pool, there is no need for Medicare Supplement insurance. I wince as I write that last sentence and will shout out loud and long to my representatives if it is proposed.
 
I have no crystal ball. I am keeping my K plan because it is a good price performer for me for right now and I will intently watch this evolution.  I also live in a state that allows me to change my medigap any time  to be effective the first of the next month. If your state doesn't, take action and press your state legislators to change the state laws regarding Medicare supplement plans.

Thursday, December 15, 2016

IBM OneExchange Medicare Supplement K plan working well

This is the second year I used a "K" Medicare Supplement plan with original Medicare.  I am pleasantly surprised with the "K" plan. I have written extensively about the benefit of original Medicare and a Medicare Supplement plan (aka medigap) in other posts if you want to know more about the kind of insurance I recommend.

When I first bought a Medicare Supplement plan (in 2013 when IBM threw us out of their group health insurance), I was sure the best option was an "F High Deductible" plan.  I had a low premium for a policy that would only provide benefit when my out of pocket coinsurance costs went beyond about $2100. Some people call this "disaster insurance".  It turns out it was "disaster insurance" because the insurance company made many mistakes and it took an act of congress to get them to "activate" the policy.  I won't relive that story but if you are interested here's a link to that post:

http://ibmmedicare.blogspot.com/2014/11/ibm-oneexchange-medicare-supplemental.html

After that experience I decided to try the K plan in 2015 because I wanted a reliable insurance company and AARP UHC has a good reputation.  Unfortunately they didn't sell a F-HD plan in my zip code. Turns out maybe that's not a bad thing. The K plan provides some insurance benefit (10% of coinsurance) until my out of pocket expenses are $4960 - then it covers all my coinsurance for the rest of the year.  That's a high deductible and it resets every year.  It takes a whole lot of being sick to reach that amount.  However, it took a whole lot of sick to reach the "F-HD" deductible of $2100 too. By the time it was met in 2014, the medigap year was almost up so there wasn't a huge amount of insurance benefit from the F-HD plan before it reset.

The premium for the "K" plan in New York is about the same as the "F HD" plan premium I purchased in 2014 and is about $80/mo.  However, this year the K plan paid about $500 of my coinsurance cost.  That's about $40/month I didn't have to pay out of pocket making the effective rate of my disaster policy about $40/mo. If I had used an "F-HD" plan I would have received NO benefit because my coinsurance and part B deductible costs for the year were about $1200 which is well below the F-HD deductible amount.
   
If you buy an F-HD deductible medigap it is likely your policy deductible will reset before you get much benefit unless you start accruing medical bills in the beginning of the plan year or you are chronically ill.  If you are considering something like hip or knee replacement, do it in the beginning of the F-HD medigap year to maximize your chances of receiving benefit for that year.  There is sometimes confusion over WHEN a medigap deductible year resets. It is on the anniversary of when you buy the policy.  (this was wrong - the deductible resets in January no matter when you buy the policy).

If you are reasonably healthy, the K plan is a nice option. However, if I could buy an F-HD medigap at the same premium price from a reliable insurance company I would switch back to it. I still think it is the best medigap policy to get unless you are chronically ill.  The bottom line is do the math to make sure you have the right policy and are not overpaying for medigap insurance.

Wednesday, November 23, 2016

IBM OneExchange.com Medicare 2016 Prescription Discount Cards

During Medicare open enrollment advertisements abound about Medicare Advantage Plans, Medicare Supplement plans, part D drug insurance plans and ... prescription discount cards.  What do prescription discount cards have to do with Medicare?  Absolutely nothing. Prescription discount cards ARE NOT Medicare part D insurance plans.  They are not insurance plans at all.  They are not regulated except for laws about false advertising and fraud. They are merely a way to maybe get prescription drugs at a discount.  You have to buy a part D insurance plan if you want Medicare drug insurance.  Reminder, if you don't buy a part D insurance plan you will pay a 1% per month penalty for every month you don't have the insurance and only can buy it during the fall to be effective January of the next year.
   
However, prescription discount cards might be useful for Medicare recipients.  What are they?  The best explanation I have come across was written by an organization called NeedyMeds. http://costsofcare.org/drug-discount-cards-liftin-the-veil-of-secrecy/.   This is an organization I often recommend as they are dedicated to helping people reduce their prescription drug costs.  The organization website is www.needymeds.org.  On that site you can get their prescription discount card.
       
When might you use a prescription discount card instead of your part D insurance?  The best reason is when you get a new prescription and it is not on your part D plan's formulary.  Another possible reason is the prescription discount card actually gives you a better price for the drug than the copay you'd have to pay using your part D plan.  However, if you do use the discount card instead of your part D insurance then the cost of that drug will not be included in your out of pocket cost calculation for your part D insurance and will affect when you enter or exit the doughnut hole.  I believe IBM's catastrophic drug benefit will similarly not include it.
     
Obviously, when a drug is not covered by your plan then the only choice you have is to try to get a discount to reduce your cost.  Manufacturer discount coupons are usually better than prescription discount cards.  However, they frequently have expiration dates.  You can usually find those coupons by googling the drug. There are also low income assistance programs offered by a lot of drug companies.  You can find them through the needymeds website.  Although your prescription discount card might not expire (I believe most don't), the discount you receive can vary from use to use and/or from pharmacy to pharmacy.  Not all pharmacies accept a given discount card.  I suggest trying several different discount cards with a pharmacy to see if one is better than another each time you refill a prescription not covered by your part D plan.  There is a wrinkle to that suggestion.  Some pharmacies won't do it. Try to go to the pharmacy when they are not busy and they might be willing to check several cards.

There is one more caveat about using a prescription discount card.  The pharmacy might make a mistake and use the discount card instead of your part D plan.  In one case, I helped someone whose pharmacy even told the part D insurance that the client was canceling his part D insurance because they thought the prescription discount card was his new insurance (the pharmacist was new). The client then faced a part D penalty as well as dramatic drug cost increases.  It took a lot of unwinding to fix the problem and get the pharmacy to reimburse the client.  After knowing that, I never use a discount card in the same pharmacy where I use my part D insurance.  The problem is you won't get any advice about drug interactions.
   
Who provides prescription discount cards?  As I said, needymeds.org has one.  So do AARP and AAA. There are LOTS of other discount card providers but I won't list them because I don't know anything about the organization nor the legitimacy of the card.  I do know that some have been sued for false advertising. NEVER pay for a prescription discount card.  They are always "free" for the user.

Here are some other sources of  information about prescription discount cards:





Saturday, October 8, 2016

IBM OneExchange Medicare 2017 prescription drug (Part D) plan idiosyncracies

I am learning a few things about part D plans idiosyncrasies.  In a post last year I wrote quite a bit about the medicare.gov planfinder (http://ibmmedicare.blogspot.com/2015_10_01_archive.html) but there is ever more to learn.  It's important to use the government planfinder to look at the plan you think you want to buy because the description of it is more detailed than what's in OneExchange plan details. Here's a few things to consider:

Part D penalty (added 10/23/16):

Many times I've heard people say they don't need part D insurance because they don't take any drugs.  It's your choice to not buy a part D policy but you will pay a penalty if you change your mind AND you can only enroll in a part D plan during fall open enrollment to have the insurance in January of the following year. The penalty is 1% per month of the average plan premium for every month you don't have a part D plan.  It adds up and the average plan premium is reset (higher) every year.  My recommendation, buy the cheapest plan available in your zip code and maybe pick one that doesn't have a deductible.  This way, if you do need to fill a one off prescription you won't have to meet the deductible.  It might be worth paying a higher premium.

Tier 1 Generic Drugs:
 
Medicare rules to drug insurance companies require there be NO copay for a drug classified as Tier 1 Generic.  A drug insurance plan can classify a drug into any tier they want.  Many now have Tier 1 Preferred.  Thereby, they put the drug in a category such that they can charge a copay.  Pay attention to how your drug plan classifies your drugs.  I found a plan for someone that had a deductible but the person's drugs were all Tier 1 Generic so there were no copays and therefore no deductibles come into play unless it applies to a new prescription not in that tier.
   
Deductibles (updated 10/23/16):

If you need regular prescriptions, and not a lot of one off prescriptions, the only reason to worry about deductibles is if you have a cash flow problem.  Otherwise, pick the plan that has the lowest annual cost.  It's rather sad that people who can least afford it because of cash flow issues end up paying more for their drug plans.  Government subsidies are available if your income dips below about $24,000/year for a married couple and you have few assets (ala cash in the bank).  If you tend to have a lot of one off prescriptions in addition to your regular medications then you might want to consider picking a plan with no deductible.

Search options:

In planfinder you can filter out plans that do not cover all your drugs by clicking on the "Drug options" on the left side of the screen and selecting that option.  That feature is available to you just before you continue to plan results.

Drug entry:

Make sure all the drugs you take are for FDA approved conditions.  In an earlier post I explained what this means.  If you are taking a drug (like Adderall) it won't be covered unless you are under 18 years old because that is the demographic the FDA approved.  There is no sense entering that drug and it may be misleading because the cost of that drug is included in the results but Medicare won't allow it to be covered by the drug insurance company unless it meets the on-label criteria. Also, don't enter drugs into plan finder that no plan will cover.  For example, Medicare does not allow coverage of hair growth drugs.  Plan finder will include the cost of those drugs in the results but I think it is misleading.  Any drug you buy which is excluded will not count toward the doughnut hole calculation.

Zip Code Drug Tiers (added 10/13/16):

If you are selecting a drug plan for a relative, make sure you enter the right zip code.  This is important for a couple of reasons.  Drug insurance plans are sold by zip code.  That means a plan might be available for purchase in New York City, but not in Syracuse.  Even if a plan looks like it is available in two different cities, it may not be structurally the same.  The drug costs of what I thought was the same plan turn out to be different for San Francisco than for New York City.  The insurance company put exactly the same prescriptions in different tiers.  In San Francisco the prescriptions were in tier 1 generic which has no copay.  In NYC they were in tier 1 preferred which has a copay.  It is bad enough that the tier a drug is assigned to varies widely from plan to plan.  Drug insurance companies also vary it from zip code to zip code.

One Exchange website plans (added 10/23/16):
 
The list of plans you see on the One Exchange website might not include all the plans they sell.  I know this is true for their Medicare Supplement plans particularly regarding AARP UHC plans.  If there is a part D plan on medicare.gov that is a better plan for you but doesn't show up on the One Exchange website, call and ask if they sell the plan.  This is also true for Medicare supplemental plans and for Medicare Advantage plans.  My guess is they show the plans on their website that provide the most commission to them.

Deductibles and Doughnut hole 2017 coverage changes (added 10/23/16)

The deductible plans are allowed to increase deductibles from $360 to $400 in 2017.  Not all plans have deductibles but that just means they make up the difference with higher copays. An Affordable Care Act (aka Obamacare) provision is gradually lowering until 2020 the copay cost in the coverage gap.  The 2017 percentage you will pay for brand name drugs in the gap drops to 40% (down from 45% in 2016) and the percentage you will pay for generic drugs drops to 51% (down from 58% in 2016).  Plan finder will reflect those changes in the plan cost calculations. Reminder, the ACA target copay for 2020 for both drug categories is 25% unless congress modifies the ACA.


I'll keep updating this list as I learn more.

Sunday, September 18, 2016

IBM oneexchange.com Medicare spouse access to HRA funding

People have asked me recently whether there is any advantage to using One Exchange services to buy insurance for their Medicare eligible spouse. The reason to do it is to more quickly spend your HRA money and/or make sure your spouse has easy access to the funds if you predecease your spouse.

The health insurance products you buy through One Exchange are EXACTLY the same products you buy when you search on medicare.gov.  The only difference is medicare.gov shows you ALL the products you can buy in your zip code.  One Exchange shows you a SUBSET of the health insurance products because they only show products for which they get a commission.  One Exchange is an insurance agent. IBM requires you to buy at least one product from One Exchange to access your HRA. IBM is forcing you to use an insurance agent to get the money.

If you get an allotment of money every year from IBM it is highly likely you will use up that allotment for a given year just on yourself for part B, part D premiums, medigap premiums, dental, glasses and coinsurance payments.  If your allotment is a one time amount you received at retirement (via an FHA), you spend that money until the account is depleted which may take a number of years. In the first case, once the annual allotment is spent out, you're done with One Exchange until the next year.  In the second case, you're done with One Exchange when your HRA is depleted.

Case 1:  The retiree gets an annual allotment.  He spent the entire allotment on himself for the past 2 years.  His wife is now turning 65.  He did not opt to have his benefit reduced to pass some money to his wife if he does not survive her.  The only reason for his wife to buy any of her Medicare insurance through One Exchange is because the retiree might expire before the annual allotment is spent. The spouse will be able to spend the rest of the funds until the end of that year. After that year, there is no more allotment and therefore no reason for the spouse to use OneExchange and have reduced insurance choices (and I am not sure the spouse is even allowed to use the services).

Case 2: The retiree gets an annual allotment.  He/she did opt to have a reduced amount to pass on the benefit to the spouse.  The retiree might want the spouse to buy one health insurance product (MA, medigap or part D) within the One Exchange system in case the retiree expires during the year so that it is setup and the remaining money is easily available to the spouse plus have an easier transition for the next year allotment.

Case 3: The retiree gets a fixed amount HRA at retirement through FHA funding to spend until it is depleted and it may take a number of years to do it.  The retiree might want the spouse to buy health insurance products within the One Exchange system to more quickly spend down that FHA/HRA account (as there is no guarantee it will be available until it is depleted) and also for the same reason as Case 2  - that is to make the transition easier for a surviving spouse by already having established access to the HRA funding.

Wednesday, August 24, 2016

IBM OneExchange.com evaluating 2017 Medicare health insurance choices

The time of year to reevaluate your Medicare health insurance options is rapidly approaching.  Between October 15 and December 7 you have the opportunity to switch to another plan.  In September, insurance companies that offer Medicare Advantage plans will mail out 2017 plan information to current recipients as well as do intense marketing to try to get people to switch to their plans. The TV ad campaign is almost as intense as it is for the presidential election!  Be sure to READ and KEEP the information you receive from your current insurance providers.

Don't wait until the end of November to consider your choices.

First and foremost - remember that you only need to buy ONE medical plan from OneExchange to get your IBM health insurance benefit.  It has to be a medical plan - dental and vision don't qualify as health insurance.  Medicare Advantage plans, Medicare Supplemental plans (aka medigaps) for original Medicare users, and Medicare prescription drug insurance plans (part D plans) are what they mean by medical plans.

Secondly, Medicare Advantage plans and part D plans CHANGE their plans from year to year.  They cannot change the medical procedures they will cover (that is dictated by the government) but they can change who provides services. Medicare Advantage plans add or delete doctors, specialty clinics and change copay amounts.  Part D plans add or remove drugs they will cover and/or change the tier pricing for the drugs they cover. MAKE SURE you know what your coverage will be and switch if you don't like their 2017 changes.

I continue to believe original Medicare, a Medicare supplemental (medigap) plan and a separate part D plan offer maximum flexibility.  You can go to any doctor or specialty clinic anywhere in the USA.  You can pick a drug plan that best matches your prescription needs.  If you want to switch away from a Medicare Advantage plan to original Medicare and a medigap plan it is important to know whether you can get medigap coverage in your state without underwriting for preexisting conditions or premium adjustment for preexisting condtions.  States like New York and Connecticut don't allow such stuff.  Contact your state agency for more information:    https://www.shiptacenter.org/

Insurance companies are going through a lot of reorganization and consolidation to maximize their profit to stakeholders. For example, Aetna is a FOR PROFIT company.  You may have heard the news coverage about them. They are loudly wailing about how much money they've lost providing Obamacare insurance plans in rural areas.  That doesn't mean they aren't making profit.  They are still very profitable.  However, it appears (from the volunteer work I do) they are now squeezing all their plan holders (Medicare or otherwise) by routinely denying claims for obscure reasons to try to make up for what they've "lost" in rural coverage costs.  Make sure you not only understand your insurance provider coverage, but also look at the Medicare star ratings and the online chatter about the service of your insurance provider.  The nice thing about original Medicare is it is the government insurance pool.  There still is pressure to reduce cost (by congress) but there are no stakeholders looking for maximium profits.