Sunday, November 15, 2009

Why are the Aetna Integration plans so cheap?

When you compare the coverage and monthly premiums for the Aetna Integration plans versus official medigap plans such as A, C or F, the Aetna plans seem to provide same coverage except they are really cheap. When you compare them to the IBM Medical plan although it costs more it seems a lot better. As Bernie Madoff clients might say ... when it seems too good to be true maybe it is too good to be true. Here are some things to consider:
  • You will not be able to get prescription drug coverage through IBM if you pick an Aetna Integration plan. Whether that is important depends on your prescriptions. Remember that donut hole. The most restrictive IBM drug plan caps at $3500. That's about $5000 worth of prescription drugs available to you. The Medicare D plans go into the donut hole at $2830. There is a potential exposure of about $2000 worth of drug costs you might have to pay. Plus the D premiums at about $30/month adds another $360 of cost.
  • Since this is not a traditional medigap plan if you appeal a denial decision the appeal is between you and Aetna. There is no government agency that will mediate nor will IBM get involved.
  • The Aetna plan is as a result of an HR consortium called Retiree Health Access (SM) that IBM joined with other companies to try to lower health insurance costs. Maybe that translates to more difficulties getting reimbursements or more denials. That is just a guess and it might be wrong.
  • The maximum out of pocket you will have with the IBM medical plan is $4000. That sounds terrible. However, there are some things that IBM Medical covers like Home Health aide assistance that is better covered than the Aetna plan. If you need that coverage the IBM plan starts to look really good. Again, depending on your needs it may be that the IBM Medical plan turns out to be a better deal. You have to go through each line item to figure out what is best for you.

1 comment:

  1. Another difference is that all IBM retiree plans do NOT pick up the Part B excess. Medigap F and G do.

    On drugs, the donut hole is reducing. Also, Part D Humana-Walmart is only $15 a month. If you take drugs, the CVS Part D may be better, or not.