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.

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