Sunday, September 14, 2014

IBM OneExchange Medicare Supplement F High Deductible Experience

I'll start with a lament.  I still hugely miss IBM's retiree group plan for Medicare secondary insurance provided through Aetna Integration plan.  It offered such great coverage that went beyond what is provided by the government sanctioned Medicare supplemental plans and was so easy to use. It was a big, big take away.  End of lament.
     
I've written in early posts how I opted to stay with "Original Medicare" because I wanted maximum flexibility to be able to go to any doctor or clinic who would take Medicare anywhere in the country.  Another small reason I chose original Medicare is political.  Our federal government is using additional tax payer dollars to subsidize enrollees in Medicare Advantage plans versus enrollees in original Medicare.  Ergo, the government is subsidizing private insurance companies - another example of corporate welfare. The Affordable Care Act is trying to eliminate those extra payments but there is a slow phase out. 
   
Anyway, original Medicare is good insurance but medical copayments and deductible payments are limitless and can become exorbitant for catastrophic diseases.  Supplemental (aka medigap) insurance policies (offered by private insurance companies) provide insurance coverage for the copayments (known as coinsurance) and deductibles and thereby cap out of pocket costs. However, they offer no additional medical coverage (e.g., visits to an acupuncturist as was in Aetna Integration) and will only cover deductibles and copays for claims approved by original Medicare.
 
I decided my spouse and I would get  medigap F high deductible (F-HD) plans because the premiums are really low.  These plan do not provide any benefit at all until the client pays $2140 of copays and deductibles in a given year.  If those payments do exceed the $2140 the insurance then kicks in and  pays all deductibles and copays for the rest of the year. The counter resets every January.
    
This has been a complex medical year for my spouse. Even so, the total cost of copays and deductibles still hasn't even come close to $2140 so the medigap F-HD insurance has provided no benefit at all.  HOWEVER, the policy premiums are so low ($87/month - which is low for NY) that we are financially still way ahead by hundreds of dollars compared to buying a higher premium policy (e.g., medigap N) for a different kind of medigap that would have paid copays and deductibles immediately. We'll stay with F-HD plans for 2015.
   
As with any insurance coverage - car, house, boat ... the insurance premium paid goes up the more coverage you want.  Medicare Advantage plans sometimes obscure the fact that you are getting less (e.g., restricted doctor networks) for your premium payment - which might just be your part B premium.  Medigap plan premiums are high if you want copays and deductibles immediately covered.  During this fall enrollment time - I once again urge you to "do the math" and make sure your premium is worth the benefit you are receiving.  

Tuesday, September 2, 2014

IBM Medicare OneExchange 2014 fall open enrollment

For those of us already enrolled in Medicare, October 15 - December 7, 2014 is the annual open enrollment period.  This, by law, is the federal government's time of year when it allows Medicare recipients to make changes for Medicare Advantage plans and Medicare prescription drug plans to be effective for 2015.  It is NOT an official enrollment time to make changes to Medicare supplemental plans (aka medigap plans).  Medigap plans are regulated by state laws and your state determines when and whether you can switch from one medigap plan to another.  For example, in New York state you can change medigap policies any time you want to be effective the beginning of the next month.  It's called continuous enrollment.
 
What does all this have to do with OneExchange?  You are required to purchase at least one private insurance policy from OneExchange to get your HRA subsidy.  If you bought a Medicare Advantage plan or a drug plan and you are happy with the plan then you don't need to make any changes for 2015 and don't need to talk to anyone at OneExchange.  HOWEVER, you must RELOOK at your plan to be sure it will continue to provide the benefits you want in 2015 and take action if the plan is no longer meeting your needs.
 
This is the time of year private insurance plans make changes to benefits and to formularies (the list of drugs they will cover) for the plans they offer.  Your current plan should send you a notification of changes by the beginning of October.  I suggest that the best way to find out which prescription drugs your plan will cover is on the Medicare website (www.medicare.gov).  Plan updates will be posted on that website by October 15, 2014. That's when to do the "plan finder". Enter your drugs and look at available plans in your zip code that provide the best coverage.
 
If the plan you currently have through OneExchange is no longer suitable, you will need to switch to a better OneExchange plan. Unfortunately, that means going through the OneExchange enrollment process again.
 

Thursday, June 12, 2014

IBM Medicare HRA Claims for Uninsured Doctor or Dental Bills

I have been trying to get claims processed for two health provider bills that are not covered by my insurance.  It took several months, multiple denials and conversations with four different OneExchange agents before I got the right answer. It turns out there can be absolutely no reference to "insurance" anywhere on the provider bill.
   
In the case of the doctor services, I tried to submit evidence of doctor service and fees by using a uniform insurance form my doctor has always given to me.    He does not "accept" any insurance and requires payment by the client.  However, he does provide a bill on this form with diagnostic codes so the client can submit a claim to insurance for reimbursement (should it be a covered service).  Since he accepts no insurance - he obviously has opted out of Medicare. Because I provided that form to OneExchange as evidence of my doctor bill they immediately denied the claim. The claim denial said they wanted to see a copy of the insurance denial. They wanted a "pure" doctor bill on the doctor's stationary to remove that requirement.
    
I found this out because I recently submitted a bill from my dentist.  The dentist forgot I no longer had insurance and sent the claim to MetLife.  Of course, it was denied.  Then the dentist sent me a bill showing a claim had been sent to MetLife and $0 had been paid.  That line item caused OneExchange to deny my dental reimbursement claim because they again wanted to see the dental insurance claim denial.  When I called OneExchange to complain, the agent told me there can be no reference to insurance on the bill.  So, I whited out the line about MetLife and resubmitted the dentist statement.  Voila.  The claim was paid.
    
I complained to the agent that there was no way for me to know this "rule".  The agent said it is on the website.  Mea Culpa. I didn't read the entire website before submitting claims.  Of course, the denial reason couldn't explain that the reference to potential insurance coverage is the reason for the denial.  I mean, that is a lot to ask.
 

Wednesday, May 28, 2014

IBM Medicare HRA setup for IBM retiree couples

Yesterday a customer service representative at OneExchange further explained the account setup for married couples who have both retired from IBM.  I have never seen any documentation about why and how they setup those accounts.
  
The account is setup in the name of the person who is oldest.  In my case, that is my spouse.  The HRA subsidy for both people is put into one account.  Because we each have power of attorney for the other we are both able to access the account. 
 
The rep said there is huge benefit to having one account.  The amount of money in the account is available to cover the bills and premiums of either person to whatever amount is in the account.  So, it is possible to spend the entire account on just one person.
 
The rep went on to said if the accounts were separated then each person could only spend their own HRA money limit.  The couple would not have access to each other's money -  meaning if one underspent the HRA benefit the other could not tap into that remaining balance.
 
I have not seen that explanation written anywhere.  All I knew is when the account was setup it was one account in my spouse's name.  One customer service rep told me  I could split it apart when I questioned it earlier this year but did not tell me the ramifications.  I was concerned about what would happen when one of us dies but decided to not do a thing about it until next year. 
 
This customer representative told me they will settle it out when one of us dies and it is no issue. 
 
I haven't yet applied my rule of "ask 3 times" to be more confident that the answers provided are correct.  Maybe later in the summer I will ask again.

Saturday, May 24, 2014

IBM Medicare part D Drug Insurance Formulary Exception Request

One of the aspects of losing the group health and prescription drug plans provided through IBM is we lost the help of the IBM HR employees that were assigned to shepherd us through various negotiations with insurance company claim denials.  We are now on our own to figure out the myriad Medicare appeals processes.
      
My spouse's doctor just wrote a prescription for a new drug.  When we took it to the pharmacy we were told it was denied because the brand name version of the drug is not on their formulary.  The doctor was very specific - he wants the brand name version.  As it happened, the brand name version of the drug was actually on the formulary until a couple of months ago.  You may not know this, but part D insurance plans can change their formularies whenever they "want".  Yes, they have to file paper work but then they can drop a drug they formerly covered "mid stream" in the plan year.  Our illustrious congress passed laws in 2006 allowing them to do so.  They also passed laws forbidding the government from negotiating with pharmaceutical companies to get drug discounts.  The insurance lobby and pharma lobby are strong lobbies.
     
Anyway, what that means is even if you bought a part D plan that covers your drug - the insurance company can decide during 2014 to adjust their formulary any time they want and drop your drug from their list.
     
Because my spouse's plan dropped coverage for the brand name drug this year - they are required (by law) to provide a 30 day "transition refill" even though this is a new prescription for my spouse.  If the drug were not on their 2014 formulary they would have just outright denied the drug.  OK - so now what? In our case - the first step is to request an exception and ask that the brand name drug be covered for the rest of the year.  The doctor had to write a letter for such a request to be even considered by the insurance company.
   
How do I put this politely?  The letter the doctor wrote sucked.  It didn't provide a compelling argument for why my spouse must take the brand name drug.  I didn't tell the doctor it sucked as it would have been truly obnoxious - but I do believe the request will be denied because it was truly a lousy letter.   
   
If the exception request is denied we will then need to go through the formal part D appeals process.  If so, I will try to get the doctor's office to write a "better" letter at the next step.  This might turn out to be a multi-step denial/appeal process.  The truth is you do not get a fair decision until you get to the independent review board appointed by Medicare to review denials which will be the after the "3rd denial" for us.  Insurance companies bet most people will give up after the first or second denial.  DON'T DO IT.  At least 50% of the time denials are overturned when they get to the independent review board.
     
How come I am so smart as to know a lousy doctor letter?  Only because of the volunteer work I do at the Medicare Rights Center.  Otherwise I would think it was just fine.  Yesterday, ironically, I urged a caller to go back to her doctor to get a better letter for the next level of her appeal because the letter she read to me for her first appeal was truly lousy too.  The Medicare Rights Center has a sample doctor letter:
     
 http://www.medicarerights.org/fliers/Rights-and-Appeals/Part-D-Appeals-Packet.pdf?nrd=1
          
You would think doctors know how to write these letters - sorry to say - they don't.  The compelling argument has to be that there are significant health (and cost) implications to using a generic version of a drug.  What is interesting is doctors might even tell you those implications but when it comes to writing appeal letters they go brain dead.
    
So the bottom line of this post - we've lost IBM advocates to help us with an onerous appeals process created by our legislators that make the navigation of the Medicare maze very difficult.  It doesn't matter what your party affiliation might be.  Congress acts as one when it comes to satisfying lobbyists and maintaining campaign contributions.  You have to become your own navigator and expert.  It's not easy but it will save you a lot of anguish and money so -  just do it.
  
5/28/14 Update: A pleasant surprise!  The exception request was granted!  The insurance company left a message implying they talked to the doctor after getting the request so the letter wasn't an issue.  My compliments to Express Scripts for making it so easy.  The exception expires in May 2015 so we'll have to get another prescription plan in October to cover the drug unless Express Scripts is willing to extend the exception for all of 2015.  At least we know it is covered for the rest of 2014.  Nice.

Wednesday, May 14, 2014

IBM Medicare and OneExchange HRA claims payment processing saga

HRA payment process seemed to settle down for me after a few blips in January and February.  Unfortunately, it didn't last and today I spent 45 minutes on the phone with the claims payment department trying to resolve two claim denials.
 
I file my claims by filling out the OneExchange form and then faxing the form and documentation to them.  I set up an email conformation of the fax. To set that up -  go to the PayFlex site and select the notification option. I use faxes so that I will have a complete picture of what I have submitted every month.  I attach my fax to the payment documentation when I receive checks to have a complete picture.  It was invaluable to have this information for today's call because I could quickly reel off dates and payments.
 
The confirmation email tells me what has been processed and what is denied before the check arrives.  This month they denied two claims.  One was for our proof of medigap F premium payments.  I provided a checking account statement I generated online  showing the premium payment deductions from our account.  It is exactly the same statement I have submitted for the same claim for the 3 prior months and all those claims were paid.  This time OneExchange said there was not enough proof. The second denial was for a claim for a payment to a doctor that doesn't take Medicare. There was no proof it was not paid by Medicare.
  
The first representative I spoke to said she would stay on the line and bring in a funding department representative for a 3 way call.  As soon as the funding representative came on the line the inital representative was gone!  The funding representative said the medigap insurance problem was that I didn't provide a copy of the bill from the medigap insurer.  I don't get a bill.  She said I needed to get one.  I said - but it was paid for the prior 3 months without a submitting a copy of a bill. She said the claims were never paid.  I countered that they were paid and gave exact dates when the claims were paid.  Then, she said she didn't know why those claims were paid but still insisted I needed a bill this time. 
 
For non-Medicare doctor fee claim, the denial said I needed an EOB showing the claim had been denied. As an aside - I don't get EOBs - I am in original Medicare so I get MSNs.  But I am quibbling. I told the representative the doctor doesn't accept Medicare so he is not going to even submit a claim to Medicare.  Then, the representative said what I needed was a letter from the doctor saying he does not participate in Medicare. At that point I felt like she was making up answers.
 
I then asked to talk to a supervisor.  The supervisor's analysis of the denials was completely different.
    
 The supervisor said the claim denial for  medigap premium  was because the online bank printout I provided didn't include my name.  The online generated statement only shows the last 4 digits of our checking account and does not show our names.  I told her that the prior claims were paid.  I also said the first time I submitted a premium claim I provided a copy of a check I wrote to the insurance company to pay the January premium and it did  include both our names and account number.  Nonetheless, she is now, in May, saying it may not be enough to generate a printout that has the last 4 digits of the same account that was shown on the January check for the follow-on months claims to be paid.  She said maybe they were wrong to even pay for 3 months. She said she would send the May denial back to claims processing for a review. 
 
The supervisor said for the non-Medicare doctor claim I needed to write on the doctor bill that he does not accept Medicare.  I did write it on the bill but it was at the bottom.  Apparently their fax machine cut off the bottom of that page.  She could see some of the writing but didn't get it all.  She said write it at the top of the bill and retransmit it. 
  
I don't trust that she is right about the non-Medicare doctor claim solution.  So, just in case, I went online to medicare.gov and got the form to submit the claim to Medicare myself and get an MSN denial.  I am truly annoyed to have to do so - the IRS rules for HRA are quite clear - you just have to show you paid the doctor for the employer to reimburse the fee. If I am trying to cheat the system I will be the one liable - not IBM.
 
I continue to be underwhelmed by the knowledge and helpfulness of the OneExchange call center representatives. I feel they  "make up answers" and want to just to get us off the phone.  I suggest that if your claims are denied, when you call to resolve the problem don't trust the answers you are getting and, if it is at all complicated,  ask to talk to a supervisor.

5/20/14 Update: The supervisor was right about the medigap F premium reimbursement.  I resubmitted a different printout - a screen shot of the payment from my checking account that also showed my name.  The claim was paid. However, she was wrong about the non-Medicare doctor claim.  I did what she said but it was denied again with the same reason -- they want an "EOB" denial.  I sent in the claim to Medicare so I'll get a denial MSN from Medicare in a couple of weeks and then I'll try to submit the claim again. I feel really lucky that I know what to do - OneExchange is absolutely clueless about giving Medicare administrative advice. I also get really aggravated that we have to jump through hoops to get our health benefit.
 
5/28/14 Update:  OneExchange almost got the medigap F premium reimbursement right.  They reimbursed one premium for May.  However, the second premium was tagged as a duplicate even though they were the ones who setup an account to handle TWO people.  I called yesterday and even the customer representative was baffled as to why the second premium was tagged as a duplicate.  He said the easiest way to fix it was to just setup recurring premium reimbursement and sent me the forms to do it.  I was perfectly happy submitting all my claims each month so I could easily track what I had filed.  At this point - I just want to get it fixed.
  
6/7/14 Update:  I continue to have trouble getting reimbursement for claims paid when the medical services are not covered by insurance.  This time my claim was denied for dental services.  They wanted to see an insurance statement because my dentist's bill showed he'd submitted the claim to MetLife and it was denied (of course).  And, of course, I threw out the MetLife denial statement.  Anyway, the answer du jour is doctor/dentist bills not covered by insurance can have NO reference to insurance on them.  So, now I need a new bill from the dentist without the reference to insurance. 

Wednesday, April 9, 2014

IBM Medicare and OneExchange - Know Your Rights

Several months ago IBM mailed out a thick manual titled "About Your Benefits: Post-Employment Summary Plan Description". The terms of this document were effective January 1, 2014.  THIS IS AN IMPORTANT DOCUMENT.
  
Most of what is in that manual is not applicable to IBM Medicare eligible retirees and you may have not bothered to even open the manual. However, there are several sections that are very important to Medicare eligible retirees.  Start from page 165 and try to read all the way through to the end of the manual.
 
In the Legal Information the manual describes the appeals process if your claims are denied by Towers Watson (page 227).  It's important to know that process because there are timelines associated with appealing denied benefits claims.  Basically, it is a 60 day window from the time of denial for you to appeal.
  
In the world of Medicare - it is also important to know the appeals process for all your claims handling.  If your insurance denies a claim there are also timeframes within which you must appeal or you can be denied again just based on the fact that you appealed "too late" even though your appeal was improperly denied and you would have succeeded in overturning the ruling had you done it on time.  Timeframes depend on the kind of insurance you have - Original Medicare or Medicare Advantage.
  
The net of this post is that we now have to know the process of how to appeal when an insurance company denies a claim - Towers Watson does not handle that.  And we also have to know the process of how to appeal when Towers Watson denies a reimbursement. 
 
Each time a claim is denied by an insurance company they are required to legally tell you the process.  The same does not apply to Towers Watson denying reimbursement claims. Dig out that IBM manual and put it in a place where you can reference it so you know what to do if you have a problem with Towers Watson claims. 
  

Saturday, February 1, 2014

IBM Medicare OneExchange - Use the IBMsupport.OneExchange@TowersWatson.com email address

4/6/14 - I edited this post because of the name of the health insurance service Towers Watson provides as an IBM contractor for Medicare eligible retirees is now called "OneExchange" instead of "Extend Health". Originally, we were told they would use the name Towers Watson in 2014 but then they change the name of their "heath exchange" services department to OneExchange a couple of months ago. It amazes me how hard they work to keep things confusing.  In the future, I will use "OneExchange".  I also edited the text of this post to try to reinforce this name change in our brains. 

Towers Watson setup the email address IBMsupport.OneExchange@TowersWatson.com (it used to be IBMsupport@extendhealth.com) specifically for IBM retiree issues.  Maybe if we use this email address as the way to resolve problems and/or to describe Extend Health OneExchange interactions, IBM will be able to get an accurate picture of the issues we encounter.  I don't have a clue whether IBM does look or even cares about the service we are receiving from OneExchange.  I will guess it is low on their priority list.
 
Towers Watson's OneExchange is providing services to many companies - not just IBM.  Remember the original flyer that said they are supporting over 500,000 retirees. So, when you call you are just a member of that large client pool serviced by their agents. They record the call because they are insurance agents and, by Medicare law, they are required to keep accurate records of their client interactions but the likelihood that IBM will listen to our calls is low probability.
    
Towers Watson acquired Extend Health a year or so ago to get into the "health exchange" business so in addition to the name change to OneExchange -  there is also likely a consolidation going on within that superstructure.   I also keep putting "health exchange" in quotes because, as I have written many times, the services we are getting are the services of an insurance agent - so this name change is totally misleading.  Think INSURANCE AGENT any time you talk to them. There are NO special products being offered by Towers Watson that are unique group plans. Anything you buy from them is a product you can buy in the open market place. Frankly, it is really onerous that we are forced to buy at least one product from OneExchange but that was baked into the contract IBM has with Towers Watson so that Towers Watson could get the insurance agent commission. They don't even do the actual claims processing to give you HRA/FHA reimbursement.  Extend Health  Towers Watson uses a company called PayFlex to process claims.  PayFlex is not customer facing.  When you call to discuss claims with an Extend Health  OneExchange representative - they will either try to answer you (inadequately has been my experience) or they will talk to  PayFlex  and then come back to you to give you the answer. I personally have found the PayFlex processing site to be clumsy and the navigation to get from the Extend Health OneExchange site to the PayFlex site and then back again to be awkward. 
  
Calling Extend Health aka Towers Watson OneExchange to resolve an enrollment problem or a  reimbursement issue is hit or miss.  In addition to calling, send an email to the IBMsupport address to either document your call or to use as a first step to resolving your issues.  I believe you will have a more positive experience and that Towers Watson will be forced to present an accurate picture to IBM of our experiences. It may not change anything about our level of service but it is worth a try.

  

Monday, January 27, 2014

IBM Medicare Extend Health - Medicare and medigap (aka supplemental) claims crossover

If you are using Original Medicare and have a secondary medigap supplemental insurance policy the medigap usually will have a crossover agreement with Medicare to get your claims from Medicare. How the crossover agreement works will depend on the secondary insurance company that issued your policy. Automatic crossover claims processing is really easy.  After I set it up,  I never had to file any claims with Aetna.  Medicare automatically sent claims to Aetna.  Do not assume your new medigap insurance company will do the same.
 
I have a user account on www.medicare.gov so I can see claims filed by doctors and also see my insurance profile without having to call Medicare or wait for a Medicare Summary Notice (aka MSN) which is mailed out once a quarter.  I looked at my secondary insurance profile on www.medicare.gov  today and it still showed Aetna as my secondary insurance.  There is no capability for a Medicare recipient to change that field.  Only insurance companies are authorized to notify Medicare of changes and it takes approximately 6 weeks for a change to be implemented.
  
If you have a medigap policy, your secondary insurance company may be willing to work with both the old IBM plan and Medicare to make the change. Call your insurance company and ask if they will do it or if they have already done it. When I first used Aetna Integration, it took one call to them and they worked with both Medicare and United Heath Care to make the change. 
   
This time, my insurance company would not do changes because of how they do crossover. It is not automatic.  I am paying a really low premium for a medigap F high deductible insurance plan so  I had low expectations. Also, Aetna did not notify Medicare that my 2013 policy terminated which is sort of crazy because it means Medicare would keep sending claims until Aetna told them to stop.  Aetna would have to keep denying those claims -- all of which has to have some administrative cost. Anyway, I called Aetna to have them notify Medicare my plan terminated.  Then I called my new insurance company to find out how their crossover works. 
 
By way of example, this is how my company does it - which is not great but worth the low premium:
 
  • I ask the doctor's office to put the insurance company code on the Medicare claim form (in position 9D).  That code tells Medicare to fax or mail a copy of the claim to the insurance company. If there are Medicare employees involved in the process, I bet it doesn't work very well but it's worth trying.
        
  • If the doctor's office cannot, I could ask if them to fax or mail a copy of the Medicare insurance claim directly to the insurance company. Since that does require human action, I won't ask.
        
  • If the doctor's office cannot put the code on the claim,  then I will fax or mail a copy of the MSN to the insurance company when I get it. That is the official copy.  Print out of a claim from the medicare.gov website is not an "official" copy.
         
Even if there were automatic crossover, an F high deductible plan doesn't start paying until your out-of-pocket is $2110 for Medicare deductibles and copays. I will keep track of my Medicare deductibles and copays because I will submit them to Extend Health for HRA reimbursement. I'll also track it to be sure my insurance company starts paying if I hit the $2110 (and I sure hope that doesn't happen).  Even the IBM medical supplemental insurer United Heath Care was not good about keeping track of my out-of-pocket amounts (it was $4000 last time I used that plan) and made mistakes.

Friday, January 24, 2014

IBM Extend Health Reimbursement Account Rebate Process

The gods do not want me to have an easy time with Extend Heath for either enrollment or for HRA claims.  I just successfully submitted my first claim request to Extend Health after 3 weeks of trying. Don't read that sentence as I will be paid for the claim.  It just means they finally got the claim after several attempts, multiple phone calls and several emails.
   
In the beginning of January I faxed a claim to Extend Health.  I heard nothing for 3 weeks.  I called them last week and they said they never got my claim.  They blamed my fax machine even though on the same day I sent the fax to EH, I successfully sent a fax to Acclaris.  On Monday I sent another fax.  I called EH on Tuesday to ask if it had arrived and was told Monday was a holiday so they wouldn't have gotten it. After being on hold for 20 minutes they told me they had no fax from me but it would take a day or so to go through faxes they received.  On Wednesday I sent another fax and an email to the IBM support address  IBMSupport@Extendhealth.com asking for help.  I was then told by email that it takes up to 5 days to just enter a faxed claim into the system for processing. No one on in the call center told me that - they just led me to believe my faxing capability was not working.  In the meantime, I also found on the claims processing site there is a notifications setting to ask to have an email sent to you when a claim is received.  It is not on the main website for Extend Health where your profile is stored but on the website you are redirected to for the actual claims process.  I also found an email address - enotify@payflex.com. I sent an email to that address and it bounced back that the mailbox was full.
  
Today, I was finally notified my claim has been received because I had set the notification setting to do so.  Yay.
 
Friends told me to just mail in claims.  That means spending printer ink to make copies and stamps to mail it.  I didn't want to do it online either because I want rock solid evidence of claims I have submitted.
  
Here is my observation - people who pay the whole year's premium for their insurance up front in January, and send in a paper claim to Extend Health to get their money back are clever devils.  They only have to front the money to pay the entire year of premiums for a few weeks and then they get a check.  In one case, the IBMer and the spouse insurance premium costs for medigaps and part D plans for the year was the entire subsidy and the HRA account was drained in January.  That person has the money and doesn't have to deal with Extend Health again until next year.  How smart!