Monday, November 28, 2011

No Aetna Offering Details!!!

I just spent about 40 minutes trying to get a detailed plan description for the Aetna A Integration plan.  It is not available to me until I am enrolled!  I called Aetna and asked for the details and they said everything that is available was already sent to me.  I called IBM and the representative said the details would be available in January if I am enrolled in the plan.

I registered a complaint with IBM.  It is outrageous that detailed information is not available for people who want to do detailed comparisons.  I urge you all to similarly complain.  How are we to make informed decisions unless we know exactly what is and is not covered?

Sunday, November 27, 2011

Full program descriptions

I had a little time tonight to try to find a full program description for the Aetna Integration A plan.  I thought I would be able to easily find it on the website providing by Aetna which is (password=IBM65).  I just wanted you to know that I was wrong because I thought full plan details were on this site.  The website says (in small print) that it is a marketing website.  If I want a full plan description I need to call Aetna.  That's really annoying.  Even IBM's medical plan is fully documented in the resource library at  I am probably going to give them a call tomorrow to get the complete plan description just because I want to see what they say.

It doesn't change my decision because I know enough to know I want to try this plan in 2012  but it really does make me feel like they are trying to hide the details of this plan.  If you are considering their HMO or PPO offerings don't just go by their "marketing" brochures.  The detailed documents are really important.  I know this because I volunteer on a medicare helpline and a large number of the "issues" callers have are because of denials of coverage or billing problems they have with medicare advantage plans. 

Someone commented that if your spouse is not medicare eligible you only have 4 choices and have to use the IBM medical and prescription coverage plans.  It's true but at least you do have choices.  A friend tried to get coverage for his spouse separately and the best he could find was a private plan for $17,000/year for his spouse and that didn't include drug coverage.  What IBM offers may not be as good as you want but it sure is better than anything else you can buy - assuming you can even buy a plan.  If Obamacare sticks the problem might go away in 2014.  It's up to the Supreme Court now. 

I also wanted to mention that this year I decided to try the vision plan coverage because it is so inexpensive.  It seems to me it sort of pays for itself since they pay $35 for a doctor when the doctor is out of network and the prescription glasses discount coverage is better that the free vision card offering.  I needed new glasses next year and the provider I like to use is included in the plan so I am giving it a try.

Monday, November 14, 2011

Choices, choices, choices

Either I am getting confused more easily or this year it was harder to sort through the choices.  Probably it is a bit of both.  I took another look at the Aetna Integration offering and there is a summary sheet on one of the brochures that had several items regarding what is not covered that were a bit disconcerting:
  • No coverage for Durable Medical Equipment. That means if you need something like a wheel chair there is no copay.  A lot of DME items are big ticket items so this will mean you have to do a lot of comparison shopping before buying equipment. Make sure you buy from a supplier that sticks to Medicare's fee limits so you really are only stuck paying  20% of the cost.
  • No coverage for experimental procedures.
  • A blanket statement that they only cover what is in the plan documents for medical and hospital services.  How do you get the document? You have to go to the Aetna website.
  • No coverage for preventative benefits beyond Medicare at no additional cost.  I honestly don't know what that means.  A big part of my annual checkup is the blood work.  Medicare doesn't cover those tests.  IBM supplemental medical did.  I don't know if Aetna Integration does. 
I haven't gone to the website to find the specific plan document for Aetna Integration to get more information.  It won't change my decision to try the plan in 2012.  A number of friends have been very satisfied with the plan so I am going with that assessment.  However, if you do have significant medical problems it is important to find that document and then compare what is covered to the specific plan document for IBM medical coverage because there are differences in the two plans.

I spent a great deal of time verifying that we had selected the right prescription drug plans.  Although had good planfinder tools it, I kept jumping from plan finder to formulary finder to compare plans to make sure I got a complete picture of the plans I was selecting. It took a lot of time.

It looks like Aetna is pushing the PPO plan pretty hard.  I cannot emphasize enough that if you go that route you will have to use their doctor and hospital network to get the full benefit of the plan.  If your doctors and hospital are already in the network then it is worth considering.  Just remember, the participating health providers can decide to drop out any time during the year but you cannot change health plans until January 2013. 

Oh, one more thing.  If you are selecting a PDP do it soon as it is best to enroll via Medicare to be sure that your records are updated (versus enrolling via the private insurance company and having them notify Medicare).  Medicare is advising on that it takes up to 10 days to get the verification that you are enrolled.  That means you will be close to the enrollment deadline when you get your verification if you enroll this week.  Do it now!

Saturday, November 12, 2011

More 2012 Analysis

I spent a few hours going through the new plan offering and I still feel like I don't know enough.  I did learn a few things.  The switch to CVS Caremark is not great for me as they will not cover three of my drugs AFTER next year and they will make my husband go through step therapy for one of his drugs.  Ugh.  I decided it was time to pick a Medicare part D plan (also called a PDP or Prescription Drug Plan) and not use IBM's prescription offering. 

I did look at the Aetna PPO offering because someone told me they heard you can go to any out of network doctor that accepts Medicare and you'll still pay 20%.  Well, that's not quite true.  I finally found it on the PPO fact sheet.  You can go to any out of network doctor that accepts medicare AND agrees to accept the PPO.  That makes more sense because that is how PPOs usually work. I've had a few health problems this past year and am really glad I was not confined to specific doctor networks or having to contend with having a doctor agree to take both Medicare and the PPO plan. It's enough of a hassle to find a doctor that will accept Medicare.

The HMO offerings are even more restrictive. However, the positive aspect of an HMO is you will have access to all the doctors who are part of the HMO.  They cannot tell you they are no longer accepting patients.  And if they quit the HMO you will be assigned to another doctor.  If a PPO doctor decides to no longer be with a plan it is up to you to go hunt for another doctor in the PPO network - and even if they are in the network I believe they can stop accepting new patients - it is something to ask of Aetna.  If you live in a remote area that might mean your replacement doctors are not nearby.  I tried to figure out whether you could get coverage if you wanted  multiple opinions in the HMO or PPO plans (something I needed to do this year as I was getting conflicting opinions).  I couldn't find it and since it is not what I will choose I gave up looking.  In original Medicare you can get as many opinions as you want.  I am not sure I see a lot of advantages to the PPO unless the drug coverage suits your needs.  I do believe that HMOs are effective at containing your medical costs.  Just realize the trade-offs. 

So, I decided to switch from IBM's supplemental medical/drug plan to Aetna's Integration plan A.  I can do that because both my husband and I are Medicare eligible.  I am doing it because I know I will have several doctor visits next year and there is a small chance I may need to go to the hospital.  The Medicare deductibles and copays will be covered by Integration A making the plan a real winner for me.   If your spouse is not Medicare eligible then you are stuck with IBM's supplement plans and the switch to CVS unless you can buy spousal coverage some other way. The Health Care Reform Act provides insurance exchanges in 2014.  Not much help for 2012.

I spent quite a few hours on looking for a PDP for me and a PDP for my husband.  It turns out he can get a PDP with Medco for $36.80 a month and they cover all his drugs. Since he has had a good experience with them and there is no step therapy involved he is using them.  The annual cost and the consumer ratings are good.  His drugs will cost more but I believe that the cost savings from Integration plan A will counterbalance that.  I need to go with a different PDP because Medco will not cover one of my drugs (which is interesting as they covered it as an IBM provider) and found one for $30.10/month that has a good rating.

At first I tried to look for drug plans that have robust formularies but decided they were too expensive.  It just wasn't worth the monthly fee.  If we have to take different drugs next year we will change plans in 2013.  If we are prescribed a drug that is not on the formulary of the plans we are selecting in 2012 we will appeal the decision to not cover the drug.  Sometimes the plan will cover the drug on an exception basis until you can switch to a different plan the next year.  Also, if a drug is not covered on your plan the drug company might work with you to get the drug at a lower cost until you can switch to a different plan in 2013.  It's worth the risk to try this approach.

As best I can tell, all the analysis I did in 2010 and 2011 still applies so if you want more information read through the rest of the blog. There are suggestions on websites to use for more information.  I also urge you to go to the websites for the 2012 IBM plans, ask what-if questions, make sure your doctors and drugs are covered by the insurance.  Do the math.  You are buying insurance.  The insurance company wants to make money and you want to not have to spend money!  Try to find a solution that is a win-win.

Monday, November 7, 2011

IBM Prescription drug coverage for 2012

I just took a quick look at the IBM medical coverage selections for 2012 so my observations are going to be brief. I will try to provide better insight later in the week.

I was surprised to see that Medco will no longer be the prescription drug plan provider. It is changing to CVS Caremark. It is really important to determine if CVS will cover your drugs if you decide to use IBM for your drug coverage. It was similarly important to do that if Medco continued to be the provider but at least Medco would have notified you about the change if they would no longer cover your drugs. Also, some of the issues with the donut hole are continuing to ease because of the Health Care Reform act so it is worth the analysis to decide if it is time to get a separate drug plan and not use IBM's offerings. has a spectacular plan finder.

I also wanted to reiterate that if you decide to use a Medicare Advantage PPO or HMO be sure you really understand ALL the potential costs of that plan. The literature mostly describes coverage for hospital and doctor visits. All these plans are required to cover whatever original Medicare covers but they sometimes pay less than original medicare for a give procedure such as an ambulance. Do the detailed comparison!

Finally, there is an aspect to Medicare for Durable Medical Equipment (DME) that is important to understand. Medicare does not set limits for what a DME provider can charge for, say, a wheel chair. It only sets limits for what the reimbursement level will be. So, make sure to understand how DME works with your HMO or PPO should you decide to go that way. If the PPO makes you go specific suppliers you will be stuck with what they charge and cannot shop around.

More to come as I study the options for 2012