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!

1 comment:

  1. Check out IBM Tampa Bay Retiree Club website for materials from 2012 IBM Medical Benefits Seminars. Note: Medical eligible retiree with non-Medicare eligible spouse only has 4 IBM Supplement Plans available. Prescription Drug Supplement is very expensive and has no Medical coverage. Medical/Prescription Drug Supplement is also very expensive and you always lose money because of the drug benefit limit.