Friday, December 20, 2013

IBM Extend Health Check Your Enrollment Status

After you enroll using Extend Health services, they send your application to the insurance company that sells the policy.  If the insurance company accepts your application they will notify Medicare of your enrollment.  Medicare then either accepts or rejects the enrollment.  If it is accepted, the insurance company will notify you that the plan has been accepted and they are also supposed to notify Extend Health that you have successfully enrolled because they then have to pay Extend Health a commission for the policy you purchased.
A reason an enrollment might not be accepted by an insurance plan is mostly for medigap insurance.  If you try to enroll without any special enrollment period and have preexisting conditions in most states they can deny you. A reason Medicare might do it is if they think you already have coverage a different way.  So, for example, if you tried to enroll in a Medicare Advantage plan that included prescription drug coverage and also a part D insurance plan - Medicare would reject one of those enrollments because you cannot enroll in two part D plans.
You will know you have successfully enrolled in an insurance plan and are setup to get your subsidy from Extend Health if several things happen:
  1. The insurance plan tells you that you have been enrolled.
  2. Your profile is updated on Medicare's database . You can call 1-800-Medicare if you want to check your 2014 enrollment because the Medicare website will only show the plan you are using for 2013 - and it only applies to Medicare Advantage and part D insurance. Medigap insurance updates probably won't be accepted until January 2014.
  3. Your EH website profile shows that your application is completed.
  4. EH sends you a letter saying you have been successfully enrolled.
I have successfully enrolled.  However, my spouse's application is still "open" on the Extend Health website which means EH has not been notified by the insurance company that the policy is accepted.  However, my spouse's insurance company sent us a letter on November 8th saying the policy application is accepted.  On November 20th I check the EH application status and when I saw it was "open", I emailed Extend Health and they told me it takes a couple of weeks for the insurance company to notify them. I was surprised because the insurance company for my plan was quick to notify Extend Health that my plan was accepted.  Well, here it is December 20th and the EH website application status is still "open".  I just sent a second email to Extend Health telling them we are concerned about the status.  I am doing this to build a case so if they try to deny my spouse's subsidy we have proof we did everything "right" and can complain to IBM so that we can get the subsidy.
I am also doing this so that if something really messes up I can file a grievance with Medicare that Extend Health is not acting as a proper insurance agent on my behalf.
Now that we are in the individual Medicare insurance marketplace, it is extremely important to keep a record of every conversation you have with Extend Health (who is your insurance agent), your insurance provider, Medicare agents, Social Security agents and any other government agency agent you contact.  You must get names of the people you talk to and what you heard - down to time of day you heard it.  That is the evidence you will need if you have to do an appeal with Medicare for either inappropriate marketing (EH), claims denials (insurance companies), misleading information that caused you to make poor insurance choices (government agencies and/or EH) or grievances such as for poor customer service (EH and/or your insurance provider).
12/26/13 Update:  EH responded to my email by calling to tell me they had received notification from my spouse's part D plan so the application process is complete. How coincidental that they got notification shortly after receiving my email.  Amazing ... isn't it?   I looked on the EH website to be sure it had been updated and it was.  Finally, we are both set up to get our HRA subsidies.  It only took 2 months of work to do it! I should send a bill to IBM for project management services.

Friday, December 6, 2013

IBM's latest HRA Beneficiary letter is laugh out loud funny and pathetic

When I got the mail today I saw both my spouse and I had received yet another "Important Information About Your IBM Benefits" letter.  When I saw the letter I immediately wondered what new way they thought of to squeeze more money out of old people.  And, they are indeed squeezing away.  They are now at the bottom of the barrel scrounging for nickels and pennies.
Both my spouse and I worked for IBM so we each get our own subsidy. IBM just informed us that we are not eligible to leave survivor benefits to each other.  HOWEVER, if we do not return the form selecting NO survivor benefits our HRA will still be reduced!  Also, if we had a dependent and wanted to leave survivor benefits to that dependent - only one of us is allowed to do so. 
We had no intention of leaving benefits to each other as it made no sense for us since we are both in good health (knock on wood).  But, we do know a couple where the very ill spouse was going to do it so that the remaining spouse would get the extra benefit.  My guess is other couples had decided to do the same thing.  It must have messed up the "steal money from them" spreadsheet numbers and the bonus increases that would come from stealing old people money - ergo, this iteration of letters was sent out to make sure we understood the money is theirs and to not mess with it. 
This latest action by IBM has moved the whole "transition" into the realm of being a ten act play in the Theatre of the Absurd.

Thursday, December 5, 2013

IBM Medicare Extend Health --- Where to get HELP beyond going to IBM or Extend Health

I posted this entry in 2009 but I think people are not looking at old entries so I am reposting because the IBM Service Center and Extend Health are not doing a good enough job helping people through this complex transition.  IBM retirees did not typically need to know all the ins and outs about Medicare because IBM provided some great plans.  Sadly, that is ending and the burden is on us to become educated.  I hope the following information helps you begin to understand and navigate the world of Medicare:
Unlike private health insurance, Medicare is a government owned and managed health insurance system. Even when you used IBM group health plans IBM offerings for primary coverage (that is, original Medicare or Medicare Advantage plans) were still regulated by Medicare law.  What that means is congress passes laws that dictate what coverage a doctor or supplier is able to provide. Medicare Advantage (aka private plans) are bound by that coverage law - they can only fiddle with who provides services or whether they think the medical procedure is necessary for your treatment. This sounds onerous and sometimes it is. If healthcare professionals break the law the government can prosecute them. Some examples will demonstrate how laws impact your medicare coverage.
Suppose you need to be on an oxygen support system. Choose wisely because once you pick an equipment supplier you have to keep that same supplier for 5 years. That's because there is a law that was passed in 2006 to lower Medicare costs. It is structured to have Medicare provide the supplier with monthly payments for 3 years for the equipment. After 3 years the supplier is only paid for maintaining the equipment. At the end of 5 years you can get a new oxygen support system from a different supplier. If you want more modern equipment or to switch suppliers any time during the 5 years you have to pay for it totally out of pocket.
There are a myriad of rules and regulations regarding fees and billing. Doctors are not allowed to bill you for services over and above 5-15% (percentage depends on the state) of what Medicare says is the approved amount for that service. If the provider tries to charge you more that is Medicare fraud. Medicare Advantage plans are also required to cap fee for services at the same rate as original Medicare - but are allowed to vary your copay so they can have higher copays for specialty services and lower copays for routine services.
Another important rule pertains to using a skilled nursing facility to recuperate from an illness. You MUST go to the facility from the hospital and need to have been in the hospital for at least 3 days. Otherwise Medicare will not cover it. It is the law. Nor will your private primary (e.g., Medicare Advantage) or secondary (e.g., medigap) medical insurance cover it - because it will have been denied by Medicare. Just as with any law - ignorance of the law does not absolve you from suffering the consequences. These laws are constantly changing or being amended. Each time you face a given situation you have to ask questions before you agree to anything -  do research to determine what rules currently apply.
How can you possibly know all the rules surrounding Medicare healthcare? You can't. Even healthcare professionals regularly give out wrong information. Unless you see it in writing don't believe it. Sadly, even the government infromation hotline 1-800-MEDICARE is not foolproof - they give a lot of wrong answers. The burden is on the patient and the family to do research for a given situation. It can take a great deal of time but the payback for knowing the rules can save you a great deal of money.

There are a number of agencies - both government and non-profit - that will help you find answers. Make sure the agency is legitimate as there are also a lot of scams around. What follows is a list of some resources:
  1. 1-800-Medicare and/or
    This is the government official hotline and website for Medicare. The hotline people are good - but overwhelmed (and with the boomers coming along will likely be more overwhelmed) so their answers are as brief as possible. It is a 24 hour service (to cover Hawaii and Alaska) and the best time to call is late at night to get better service. The website is really excellent but complex. There are many reference documents on the site that are excellent but you have to search to find them. Take the time to learn the site.
  2. CMS centers for Medicare and Medicaid -
    This is the government agency that ADMINISTERS Medicare and Medicaid. The actual services are provided by regional private agencies that the government hires to do the paper work. You get your quarterly Medicare medical statements from CMS. There is a huge amount of information on the website as well as data bases that detail Medicare coverage and fees. Many "white papers" detail specific situations such as "Who Pays First" which is about when Medicare is secondary insurance (e.g., if you work past 65 and have employer coverage). There is also something call "local coverage determinations" that details what procedures have been approved by regional administrators.  That information is hugely helpful if you are appealing an insurance plan denial.  But it is hard to navigate and typically you need experts to help you find the right information - such as the Medicare hotline agents.
  3. State Health Insurance Assistance Program -
    This is a national program to help seniors navigate the Medicare world. It is a federal mandate that each state must have the agency and typically the states setup the agencies within the Department of Aging. This is an important resource because the rules about how Medicare medigap insurance is administered differs from state to state.  There are also some special setups such as Medigap Select programs that states have setup. They will also know about state unique assistance programs, clinics and charities designed to help seniors.  Generally the agencies are referred to as state SHIPs. However, states have a habit of giving agencies unique names - for example in Florida the agency is call "SHINE", in New York City it is called "HICAP". Some states have great agencies and others ... well ... they staff with mostly volunteers that are not well trained. If you are getting mediocre assistance press the agency to give you someone better to work with.  They will do it if you make noise. The site above will provide the phone number of the agency in your state.
  4. State Pharmaceutical Assistance Program - part D insurance help
    About 40 states have programs to help low income seniors cover their drug costs. You can find the program in your state by going to . It is unlikely IBM retirees will meet the income eligibility requirements but there is some useful Medicare D information on the site. You also should look into getting a prescription discount card in case your Rx is denied by your current insurance and you lose an appeal.  Sometimes the state offers one.  There is a non-profit that offers one at - you might also want to price your drugs using the prescription discount card versus your insurance as sometimes you'll get a better discount.  The negative side of doing that is the cost of the drug will not be included in the "doughnut hole" computation.  If you use a lot of drugs it is likely unwise to use a prescription drug discount card.
  5. State health insurance information for consumers -
    Most states have complaint data about health insurance companies and particularly about HMOs. Before selecting a Medicare Advantage or medigap program look at how they rate on your state insurance website ( in NY it is  There are also star ratings for Medicare Advantage plans in the Medicare publication "Medicare & You" that  is specific to your state and you receive the boook every year.
  6. Medicare Rights Center 1-800-333-4114 and
    This is a national non-profit organization that provides advocacy and helpline support for Medicare questions, help finding part D plans, help understanding medigap and medicare advantage plans.  The agency is not affiliated with the government but often testifies in congressional hearings as well as provides evidence of consequences of poorly structured laws. Occasionally case advocates will help clients navigate the appeals process if they feel you have been unjustly denied coverage. The helpline is mostly staffed by volunteers so the answer quality ranges however, the full time staff reviews all the call notes will call you back to try to remedy any bad answers. The regular staff does the case work and there are staff as well as volunteer lawyers that help. They will also help low income clients enroll in low income subsidy programs. The information search website ( aggregates medicare information and provides links to other support sites. It is excellent

Wednesday, December 4, 2013

IBM Medicare Extend Health - More about Dental Plans

It is turning out to be way more difficult to find solutions for dental insurance than it was for health and prescription drug insurance.  Several people have been looking at various plans.  Here's what they have found out -----
The dental plans offered by Extend Health are just about the worst plans in the marketplace. Even some of the EH agents have told retirees what EH offers stinks! That's not to say other plans in the marketplace are much better. It seems the one AARP offers is the best of the lot but even then - the premiums are high and they will only cover cleanings and simple fillings for the first 6 months you own the policy. So, if a tooth fails you are SOL to have it fixed before June. And it caps at $1500 payout for the year. 12/6/13 - I just saw that EH added two plans offered by MetLife but I don't think these offerings are "offering" much.  It is also very frustrating that we find out what EH is selling by word of mouth or going onto their site.  Once enrolled, who'd  want to go back and keep checking the EH site to see what else is being sold!
Someone just told me about a group plan that is interesting ---- IF your dentist accepts it (mine accepts no plan). You pay Cigna a flat fee for the year (something like $130) to become a member of Cigna's dental insurance group. That entitles you to get the Cigna negotiated dentist rates from a dentist in their network. You pay the dentist whatever the negotiated rate is for a given procedure. For example, if a typical cleaning is $120 but the Cigna rate is $90 that's what you will pay the dentist - again, only if the dentist accepts the plan.
If you want to know more about the Cigna plan go to
There is another website that describes the myriad of dental insurance plans available to individuals but, as I said, none are particularly great ---
I already posted a blog entry about the VA dental plans available if you or your spouse are veterans.  They are the best plans I have seen so far because they are group dental insurance plans. It turns out they are available no matter what your income level as long as you served in the military and enrolled in the VA health system before 2004.  After that time, if you try to enroll the VA will not even let you register  in the VA health system if your income is too high (over approximately $50,000 annually - it depends on your zip code). There is also a dental plan for veterans of foreign wars who were in combat that does not appear to be income based.  However, you must prove you were in combat.
It's a pity that IBM wouldn't even give us the option to buy into the MetLife group plan since they had to know the individual dental plans stink.  I am not surprised - just continue to be disappointed in IBM.
I, personally, will skip buying dental insurance and basically self insure for as long as I can afford to use my existing dentist.

Sunday, November 17, 2013

IBM Extend Health Transition how to reach Dr. Rhee & the new VP of HR

I have posted in other places Dr. Rhee's email address but I thought I would make the information easier to find should you want to voice your concerns over this transistion:
Dr. Rhee  is at
The current VP of Human Resources is Diane Gherson.  Her email address is

Saturday, November 16, 2013

IBM Extend Health Transition - IBM Service Center Reps Also Giving Wrong Answers

A friend called the IBM Service Center about the enrollment requirements to gain access to the HRA.  The first representative got it wrong and said retirees had to buy all their insurance policies through Extend Health.  She wisely called back and the second representative told her that was  wrong.  I suggest the "call 3 times" process when you are asking an important question.  If you get the same answer from 3 different agents there is a good chance it is correct.
It's easy to understand why the Service Center staff would give wrong answers.  There have been rule changes upon rule changes.  In addition, none of the changes have been officially communicated so it is no wonder no one knows anymore what the requirements are for HRA subsidy access. 
The more people write emails to Dr. Rhee and/or Extend Health to complain about this whole process the less Dr. Rhee will be able to claim the program is a success.  It won't stop the transistion but it might rattle some cages.

Thursday, November 7, 2013

IBM Extend Health Transition Complaints --- All Roads Lead to Extend Health

I wrote to Dr. Rhee to, once again, complain about what is happening.
What follows is my email to and answer from Dr. Rhee about the incorrect enrollment information I got from Extend Health.  IBM is now pushing most complaints to Extend Health to answer.  I spent about 30 minutes on the phone yesterday with an EH "specialist" after we played phone tag a few times.  In one of his voice messages he told me the agent involved in screwing up my enrollment would be counseled as this was a teachable moment.  I left a testy voice message back and saying "don't you dare blame this on any individual … there are many agents who are giving us wrong answers so it is EH management who is at fault for not properly training their agents".  When we did talk he dropped the BS bingo language and we had a honest conversation. I told him the way EH is communicating with us really stinks whether it is related to program rule changes, website design, agents saying things wrong, having to spend hours on the phone just to enroll and not being able to read the legal rantings in addition to hearing a recording that sounds like it is being played at the wrong audio speed.  
Extend Health can't take the rap for IBM doing this crappy transition. They can only take the rap for crappy service.  It is IBM executives that decided to create this mess and threw a bunch of old people under the bus.  The only positive thought I can conger about what is happening is that one day the people who thought it was so clever to do this will also be old.  Even though they might have a lot more money than me, most of them won't be Warren Buffet rich so they will still have to deal with the same health insurance crap we are dealing with now and NO subsidy because that benefit is long gone.  By then Medicare will be means tested to the max so their Medicare insurance will cost them a whole lot more and hopefully suck all their money away!  

From: Retiree Comms <>
Sent: Wed, Nov 6, 2013 12:12 pm
Subject: Extend Health Transition Major Enrollment Problem


I have asked an Extend Health executive to contact you to review your experience.  We take customer service very seriously and your experience is not acceptable.  We are working very closely with Extend Health on the quality of support their benefit advisors deliver. 

We are not able to meet your request to continue in your Aetna Medicare Integration plan.  That plan is very similar to Medigap plans, which are available to every retiree on the exchange.  I know this is not the answer you were looking for, but we believe the Medicare Exchange delivers increased choice and flexibility in plan options for the vast majority of our retirees.  

Thank you for writing to express your concerns.

Kyu Rhee, MD, MPP
Vice President Integrated Health Services

To:        Kyu Rhee/Somers/IBM@IBMUS
Cc:        Diane J Gherson/Armonk/IBM@IBMUS
Date:        11/01/2013 07:21 AM
Subject:        Extend Health Transistion Major Enrollment Problem

Dear Dr, Rhee,

I did all my homework and checked THREE times with Extend Health agents to be sure my enrollment selections would be acceptable to EH such that I could get my HRA subsidy. I checked both before and after my enrollment call. Everyone I spoke with at EH confirmed my selection would meet the criteria for enrollment such that I could get my HRA subsidy. And, my profile indicates I am enrolled and my application is being processed. My EH plan choice was to enroll in the same part D insurance plan I am already using in 2013.
When does an EH enrollment mean "maybe not"? I am learning that I am not really enrolled in an insurance plan until the insurance company processes and accepts my application. Better still - EH says it is not their problem if the insurance company rejects my enrollment EVEN WHEN THEY KNOW IT WILL BE REJECTED.
I know my application will be rejected because a colleague tried, this week, to do a similar enrollment to mine and the EH agent he worked with knew enough to stop him from doing it. My colleague specifically referenced my enrollment and gave the EH agent my name to say ... that person did it ... why can't I? According to the EH agents he worked with - my enrollment through EH will be rejected by my part D insurance plan because I already am enrolled in that plan. Ergo, I will not have enrolled in a plan via Extend Health and since EH will not show as the insurance agent of record I will not have access to my HRA subsidy. 
Now, I would have thought the EH agent would immediately flag my profile and tell someone to call me asap because the agent knew my name and that I will have this problem. Instead - he told my colleague this wasn't an EH problem - they are only the insurance agent. He said the insurance company will send me a letter and tell me about the duplicate enrollment rejection. My guess is the letter will say since I am already enrolled in the plan I don't need to enroll again. My further guess is they will say nothing about the fact that EH is therefore not the agent of record for my plan. And, therefore, had my colleague not tried to do the same thing, I would likely think I still had full access to my HRA subsidy. 
Wait - it gets better. If the insurance company sends me a letter after December 7th, I will still be in a stew even if I realize the impact on my HRA subsidy access. I will not be able to switch to another part D plan because Medicare Fall Enrollment will be close and I have no SEP for my part D plan. Ergo - no subsidy for me! Wow, this really demonstrates how EH is totally invested in helping me make the right insurance choices. 
THE ONLY REASON I KNOW ABOUT THIS PROBLEM IS PURE LUCK that a friend tried to do the same thing. 
I decided I will call EH and just tell them I changed my mind and want to enroll in another part D plan rather than try to fight this battle with them. I'm the one that has the most to lose re my HRA subsidy. Ugh, another hour  plus on the phone with EH enrollment listening to boilerplate and repeating my name and SS# a thousand times. It's a good thing I am retired. 
Is this really a better choice for IBM retirees?  Certainly it is not for me.  I am begging you - please give me back the choice of Aetna Retiree Health Access health exchange so I can get my Aetna Integration plan. RHA was a true insurance health exchange that offered excellent choices at stellar premium prices.  You did it for Aetna PPO and HMO enrollees.  Why can't you do it for Aetna Integration enrollees too? 

Monday, November 4, 2013

IBM Medicare Extend Health Enrollment Deja Vu to change part D plans - Lucky Us!!!

We just went through the enrollment process a second time to switch to new part D plans since we were not supposed to reenroll in the same plans we are using in 2013 as it would NOT allow us to access our HRA accounts. 
I continue to be astonished and furious that NO ONE from Extend Health called back to tell us about this problem after we enrolled on October 22nd.  The agents this morning verified that we would have had a problem if we did not change to new part D plans.  I actually feel sorry for the agents because they are taking the heat for the incompetence of their organization. 
It took about one hour to make this change.  I just shake my head over that too.  I should have been able to do it online in 5 minutes.  Once again, we had to talk with 3 different agents - each time verifying our information.  The best part is being able to hear the boilerplate recording yet again. 
This is onerous.  Just onerous.

Friday, November 1, 2013

IBM Medicare Extend Health DO NOT try to enroll in the same Part D plan you use in 2013

I wish IBM would hold a public hearing with their stockholders on the transition to Extend Health.  Whomever vetted Extend Health aka Towers Watson should be fired. 
As I have written earlier, I did all my homework and checked THREE times with EH to be sure what I was doing would be acceptable to EH such that I could get my subsidy both before and after my enrollment call.  Everyone I spoke to at EH confirmed my selection would meet the criteria for enrollment such that I could get my subsidy.  And, my profile says I have enrolled and my application is being processed.  My choice, which was confirmed, was to enroll in a part D insurance plan I already am using in 2013.
When does an EH enrollment mean "maybe not"?  You aren't really enrolled in an insurance plan until the insurance company processes and accepts your application.  Better still - EH will say it is not their problem if the insurance company rejects your enrollment EVEN WHEN THEY KNOW IT WILL BE REJECTED.
When a colleague tried, this week, to do a similar enrollment to mine the EH agent he worked with knew enough to stop him from doing it.  My colleague referenced my enrollment and gave the EH agent my name to say ... that person did it ... why can't I?  According to the EH agents he worked with -  my enrollment through EH will be rejected by my part D insurance plan because I already am enrolled in that plan.  Ergo, I will not have enrolled via Extend Health so EH will not show as the agent of record.  Ergo, I will not have access to my subsidy because I did not pick a plan where EH would be the insurance agent of record on my part D plan.
Now, one would think the EH agent would immediately flag my profile and tell someone to call me because he knew my name and that I will have this problem.  Instead - he told my colleague this wasn't an EH problem - they are only the insurance agent. The insurance company will send me a letter and tell me about the duplicate enrollment rejection.  My guess is the letter will say since you are already enrolled you don't need to enroll again.  My further guess is they will say nothing about the fact that EH is therefore not the agent of record for you plan.  And, therefore, had my colleague not tried to do the same thing, I would go on believing I had full access to my subsidy.
Nice - right?  Wait - it gets better.  If the insurance company tells me this after December 7th, I will still be in a stew even if I then realize it impacts my subsidy access. I will not be able to switch to another part D plan because Medicare Fall Enrollment will be close and I have no SEP for my part D plan. Ergo - no subsidy for me!  Wow, this really demonstrates how EH is totally invested in helping us make the right insurance choices.
I decided I will just call EH and just tell them I changed my mind and want to enroll in another part D plan rather than try to fight this battle with them.  I'm the one that has the most to lose. Ugh, another hour on the phone with EH enrollment listening to boilerplate and repeating my name and SS# a thousand times.  It's a good thing I am retired.
Time to write another letter to Dr. Rhee.

Wednesday, October 30, 2013

IBM Extend Health Transition MetLife Dental Plan for Veterans is a WOW!

Update 1/7/14:  We thought we could enroll in the VADIP plan because my spouse is a veteran but had never registered in the VA health system.  Unfortunately, now, you cannot even register if your income is above a threshold of about $55,000.  My spouse never bothered to register years ago -- because WE HAD IBM MEDICAL.  The government income limit rules went into effect after 2003. If you registered before 2003 you are grandfathered. You must be registered in the VA health system to be eligible to buy the VADIP plans even though the VADIP is not means tested. Too bad.

The Veterans Administration is working with Delta Dental and MetLife to provide dental plans to eligible veterans next year.  It is an experimental program that begins enrollment 11/15/13 for dental insurance effective 1/1/14. 
You must enroll in the VA health system to be able to use this dental program. You can enroll in the VA health system online - it is quite easy and they respond really quickly.  They will want to know your financial status but they do not ask for verification of your income statement if your annual income is more than about $50K/year.  They only want verification for low income statements to determine subsidy benefits.  The dental plans are not low income premium adjusted --- everyone pays the same premium.  My guess is low income veterans will continue to go to VA locations for dental services.  Here is two links to help you get started:
For VFWs there is already a program in place but to use this program you must prove you were in active combat in a foreign war.  It looks to me like the benefits are not as good as the VADIP program described above.  To find out more about the VFW program go to:

IBM Extend Health Transition IBM PR - Retirees "Like" This Change. Really?

The IBM public relations team keeps saying there are many retirees that like the change IBM is making for Medicare eligible retiree insurance plans.  I wonder how many is "many".  After all 1% of 110,000 people is a lot of people.  But it certainly isn't a majority.
I do believe there are some people who like this deal better.  Who are they and why?
  • Retirees with spouses under 65: 

    They were required to pick from the IBM medical/prescription drug plan choices to be able to cover both themselves and their spouses. IT WAS IBM THAT FORCED THIS RESTRICTION.  IBM's supplemental insurance plan didn't really start paying until out of pocket expenses were $4000.  There were a few things immediately covered like preventive and diagnostic health checkups but the medical coverage didn't start until you had about $15-20,000 in medical bills. That's a lot of doctor bills (most of a hospital short stay bill is covered by Medicare A).   The prescription drug plan also might not have been a good plan for covering drugs used by the couple. An easy fix would have been to allow the couple to each enroll in different plans.
  • People living in rural areas:
    Sometimes people have difficulty finding local doctors - particularly for specialties.  Joining a localized HMOs may be the best way to remedy the problem.  Perhaps IBM HMO offerings might not  provide the best doctor networks available in the area.  There is no easy remedy for this kind of problem.
  • Better Medicare Advantage plans:
    There are a lot of MA plans in the open market that provide different doctor networks or different benefits than the Medicare Advantage plans offered by IBM.  Maybe the doctors a retiree wanted to see were in a network plan not offered by IBM.
HOWEVER - the Aetna PPO and HMO offerings from Retiree Health Access were some of the BEST Medicare Advantage plans I have seen and I have seen a lot because of the volunteer work I do. It's hard to believe there are better ones available.  The Aetna Integration offerings are also spectacular offerings. Integration A is almost equal to a medigap F no deductible plan.  It doesn't get better than that. The Met Life Dental group plan is one of the best plans available.  All these plans were excellent price performers.  I believe IBM had an easy fix for the retirees with spouses under 65.  If they subtract out those retirees - I wonder how many people are happy with this change versus how many people are unhappy about it.  When I think back on the sea of confused and distressed faces of the retirees in the Poughkeepsie meeting in September - I think I know the answer.

Tuesday, October 29, 2013

IBM Extend Health Transition - Yet Another Rule Change for HRA access?

I was looking at the website yesterday and there were postings saying that the requirement to get the HRA subsidy has changed (again).  They say now only the retiree needs to buy either a medical plan or a prescription drug plan from Extend Health to gain access to the HRA subsidy for both the retiree and the spouse's reimbursement of insurance premiums and out of pocket medical expenses.  The retiree's spouse does not have to purchase an EH plan. The posting included an email from Dr. Rhee with that information.
I have not verified this with an Extend Health agent but, if it is true, it is important to know.  I also don't understand why we are not being officially notified of these substantive rule changes and have to find out by word of mouth.  This change means you can buy most of the plans that are a best fit for your medical needs irrespective of whether or not EH sells the insurance.
I also should mention that it may be risky to buy a medigap plan through Extend Health as the way to gain access to your HRA.  The rules on this are not clear and maybe IBM will fix the following delimma.
Right now, if you are able to buy a medigap plan with guarantee issue because the IBM group insurance you have is ending in 2013 then you cannot be denied by the medigap insurance company.  However, once you've bought the EH medigap plan your guarantee issue right ends unless you live in a state that requires continuous enrollment.  Very few states require it.  New York and Connecticut do. 
So, what's the big deal about that?  Well, suppose in 2015 Extend Health is no longer selling that medigap insurance plan you bought through them in 2014.  That can happen because the insurance company decides they no longer want EH as an insurance agent.  Does that mean you've lost your access to your HRA subsidy unless you buy another plan through EH?  You might be able to keep your subsidy access by buying, during Medicare Fall Enrollment, a part D insurance plan EH sells - if a plan they offer cover your drugs. If not, then you might have a problem.  You can only switch to a new medigap plan EH does sell if your state has continuous enrollment.    You have no guarantee issue right to do so in other states and therefore can be denied or charged a higher premium.  The medigap plan you bought in 2014 is not ending - EH just isn't selling it anymore.  That's the delimma.
I don't have a solution for the situation beyond making IBM aware of the problem.  They set the rules.  They can eliminate the requirement to buy any insurance from EH the same way they are changing the other rules.


Saturday, October 26, 2013

IBM Extend Health Buying a Medigap Policy - Easier Said Than Done

Update - 11/21/13 - the insurance agent said she must come back to the house to have us sign our policies for them to take effect.  I asked if she could just mail the policies  but she insisted she needed to bring them to the house.  Here goes another round of let me sell you .....this is just onerous.

I know, I know ... I keep saying that but I shake my head over what IBM has done to all of us.  It's not right.  We made IBM a great company by providing our expertise and labor. Although I am not a Marxist, I do believe our labor had great value and we made IBM prosper by  providing it. In return IBM made a  promise to value our labor via retiree health insurance.  We earned these benefits and now IBM is stealing from us.

Original entry on 10/26/13

My spouse and I bought our medigap policies a few days ago but it wasn't easy to do.  I started the selection process by looking at Extend Health offerings.  As I have said in previous posts, they offered very few choices and the ones they did offer were not from the lowest price products available in my zip code for medigap F high deductible.  So, Extend Health was not a good place for me to buy a medigap.
Medigap insurance is what is called indemnity insurance.  To quote Wikipedia -  "an indemnity is a generalized promise of protection against a specific type of event by way of making the injured party whole again."  In the case of a medigap the indemnity is defined very precisely by the particular letter associated with your insurance policy.  Each type of policy (A,B, F, K, L, N ...) specifies when the insurance policy will pay and when it will not pay.  The payment is always secondary to original Medicare and since it only pays as a secondary there is no specification for what medical procedures will be covered - only the degree to which it will cover your original Medicare deductibles and coinsurance (e.g., copays).
I wrote that paragraph because people are still anguishing over which medigap insurance company is better or worse or whether the doctor will accept the plan.  There isn't a better or worse and there is no doctor network involved in the payment process .  Every insurance company is issuing EXACTLY the same policy that works in EXACTLY the same way as second payer to original Medicare. CMS automatically sends the claim to the medigap for processing.  The doctor is not involved at all. Therefore, the only way to pick an insurance company is based on PRICE.
OK - so I wanted to buy the lowest price medigap F high deductible plan in my zip code.  I looked on to find out who offers policies and called the company that sells the lowest premium F high deductible policy several times plus I sent emails. They never returned my calls or responded to my emails. I wasn't surprised as I had heard this same result from several people over the past four years that I have been helping people with Medicare questions.  I don't know why they list as selling the policy and have actually filed a complaint with the department of insurance a year ago but never heard from them either!
I was able to reach an agent for the next lowest premium insurance company on my list. The policy was $10/month more expensive.  However, this monthly premium is still $28/month cheaper than the policy Extend Health offered. I had to buy through an insurance agent as it is the only way they sell the insurance.  The agent came to our house to sell us the medigap policy which also did not please me.  I deliberately told her when I made the appointment that I was only interested in buying a medigap F high deductible policy but I suspected she would try to sell us every product offered by the company.  And that is exactly what happened.  We said no to burial insurance, long term care insurance, annuity insurance ..... Try as we might to short circuit the sales pitch she pressed on.  After about an hour of sales pitch we were getting really cranky so she finally filled out the paperwork for us to buy the medigap F high deductible plans.  This insurance company also requires automatic payment out of our checking account which I do not like but kept reminding myself the premium difference for us was $56/month for these 2 policies versus the EH offered polices. Wow, that was so much easier then just going online and enrolling in IBM group insurance!  I wish Dr. Rhee would get a boil for every lie he is telling.  His body would be covered.
I also wanted to revisit the math surrounding medigap plans. People are still confused about which plan to pick.  Here is another way of looking at which medigap plan to buy.  I'll use myself as an example.  I am pretty healthy but I have a couple of medical conditions that require monitoring and it seems I end up in ER about once a year for something stupid like a sprained ankle, an infected cat bite or a gall bladder attack.  Even so, my medical bills are typically around $4000/year total. Medicare covers 80% of that so if I did not have secondary insurance I'd pay about $1000/year between copays and deductibles. If I pay a medigap annual  premium of $3000/year to immediately get 100% secondary coverage and only get $1000 worth of payments from the policy it seems to me to be a waste of money.    I'd rather pay $1048/year premium and the $1000 out of pocket.  Especially since the $2048 will be totally covered by my HRA subsidy and I will still have almost $1000 left to use for my part D coverage. 
If I really get sick then I know my insurance and out of pocket cost will cap at $3158.  At that point the F high deductible plan will take over.  So, I am betting $158/year that I will stay well.  Not a bad bet.


Wednesday, October 23, 2013

IBM Extend Health transition HRA Beneficiary Letter - MAKE SURE YOU GET & READ IT

Update 11/24/13:

Just so you know - you should receive a letter back from IBM confirming your selection. I sent in my notorized form several weeks ago and just received a letter back from IBM confirming my choice of "no survivor coverage". 

On October 14, 2013 IBM sent out a two page flier/letter about the HRA survivor benefit. This letter is a legal document. Make sure you get this very important letter as it affects how much money your will get in your HRA account.
Read the letter, then read it again and make sure you understand it.  You need to take overt action on how you want your survivor benefit to be processed.  Here is the crazy part. It doesn't matter if  you are single or married or have eligible dependents --- you MUST take action or, by default, your subsidy will automatically be reduced. I'll say it again because it is rather unbelieveable -----
In order to keep your entire subsidy - you must elect "NO IBM SURVIVOR COVERAGE",  notarize the form (it is on the back of the two page flier) and mail the form to the Budco processing company by December 16, 2013.   There is a second deadline of January 16, 2014 during which you can submit a form to change your first selection so that gives you the chance to change the default. 


Tuesday, October 22, 2013

IBM Extend Health Enrollment Experience ---- Update and Confusion

Written on 10/30/13 -- Correction and Update
I just got off the phone with a friend who tried to "enroll" in the same drug plan he already has. He was told that he cannot do that because then Extend Health will not be the insurance agent on record and he will not be entitled to his HRA subsidy. He talked to three different EH people and they all said the same thing. He now has to pick a new drug plan because it is still better to do that then to buy an EH medigap plan which is substantially more expensive than what he can get on the open market.

Even though I asked an agent before I enrolled if we could use the same part D plans as we already had and then I asked the enrollment agent again when we enrolled if we could just reenroll in the same plan - they both are wrong. I am told that our enrollment will be rejected. Now, when will they tell us this? Beats me. I was going to just let it go until they caught it but am not sure that is a good idea. I just spent a couple of hours trying to sort through our alternative choices. None of which are great.
So, I called Extend Health once I decided on the changes and explained the situation.  The Benefits Agent said there was no need to change a thing as my spouse and I are properly enrolled.  This is insane ---- just insane.  I will just wait it out and see what happens.
Written on 10/22/13
Today my spouse and I enrolled in Extend Health plans so we can get our subsidies.  The call took approximately one hour and most of that time was spent listening to boiler plate scripts and/or repeating our names and addresses so that we could be recorded for each plan we enrolled into.  We each enrolled in a part D prescription drug plan that we already are using so that we can get our subsidies and we each enrolled in the VSP vision plan. We did not enroll in a dental plan as the one that was offered was worthless.  I told them we did not want to setup any automatic premium payments to be paid out of our checking account for any of the insurance plans but at step 2 of the enrollment process the step 2 agent insisted that it was required by VSP to do so.  I relented and let a one time payment be taken from our checking account for the VSP plan.  Yes, there are two different agents for the enrollment process.  The first agent "helps" select a plan and then you are transferred to a second agent that actually does the enrollment.
I asked the first EH agent if they could sell me a medigap F high deductible plan from Banker Conseco as that is one of the least expensive F-HD plans available in my zip code.  They said they could not.  I didn't think they could  but it was worth asking.  I have an appointment with a Banker Conseco agent later this week to buy the medigap plans directly from the insurance company. 
I also told the first EH agent that I knew exactly what I wanted and to please skip any discussion of the plans available in my zip code.  They quickly did so and did not try to pursue it at all. I believe that is why our enrollment process only took a hour.  Although the enrollment process went smoothly, it is still a ridiculous process.  There is so much script reading and prerecorded listening to make sure EH cannot be accused of misleading an enrollee that it is truly obnoxious.  At one point as we listened to one of the prerecordings we could hear the agent yawning.  That was a highlight of the whole process!
I have been writing much about being sure you know exactly what you want before your enrollment appointment.  My experience confirmed how really important it is to do so. 

IBM Medicare No Grandfathering of HRA reduction for current surviving spouses

I helped someone this morning who is a surviving spouse.  IBM is not grandfathering her subsidy allotment.  They are reducing her subsidy in 2014.  Isn't there something about stealing from widows and orphans that is villian material?  Wow - how low can IBM truly go?  I guess really low.

IBM Medicare Aetna PPO & HMO participants don't use Extend Health

I just helped someone this morning who used an IBM Aetna PPO plan in 2013.  She will be able to use that Aetna PPO plan for 2 more years.  The same deal applies for people who used the Aetna HMO plan.  She doesn't use Extend Health to enroll and there is no dealing with Extend Health for any reimbursements.  She uses the IBM Service Center to enroll.  Because she is still on a corporate group plan she also will be able to keep her Met Life Dental plan and her Anthem Vision plan.  
These Aetna plans were corporate group plans created for a consortium of companies know as Retiree Health Access.  I will guess that there were a lot of IBM retirees enrolled in these plans and it would have dramatically affected the price structure of the plans for them to abruptly drop out.  What a pity that people who were on Aetna Integration plans which were also offered out of RHA weren't given the same option. 
What a shame that IBM is phasing out of Aetna RHA.  That is a real corporate health exchange that put us in a big insurance pool because it was funded and used by many companies.  It gave us excellent choices and my bet is the cost of our insurance would not have dramatically risen because of the size of the insurance pool.  Of course, it meant that IBM would have to spend all the subsidy money instead of betting we will be bumbling idiots and forget to do the paperwork to suck all the money out of our HRA accounts.  Shame on IBM for being so ruthless.  Shame, shame, shame.

Saturday, October 19, 2013

IBM Extend Health Choosing the Best part D Plan

OK, my title for this post is misleading as there is no such thing as the "best" part D plan.  There are a just a number of variables to consider when selecting a part D plan.  Choose the plan that best fits the variables that are the most important to you. Everything I am about to write applied when you were using IBM's prescription drug plan.  However, most people just used the IBM plan without considering these variables.

  • The Formulary - is the criteria that relates to the plan's drug list.  It is a complex term meaning what drugs will this insurance plan cover.  Part D insurance plans are allowed to decide which drugs they cover.  The only regulation applied by Medicare is for drugs that the plan cannot cover - by Medicare law.  (They are drugs that treat conditions like anorexia, hair loss, infertility and erectile dysfunction.)
    The best way to pick the right formulary is to  base it on the drugs you CURRENTLY take.  On plan finder will show whether or not a particular plan covers your drugs. There is no way to predict what drugs you will need to take and it doesn't make sense to pay a big premium for a part D plan because it has a big formulary. And, even if it does cover lots drugs  - the new drug you need might not be on the list!
     IF you are prescribed a drug during 2014 that is not on your plan's formulary, your plan will decline coverage.  You must appeal the denial!  Get a letter from you doctor stating why you need the drug and appeal the plan decision using Medicare's appeal process.  It may take a couple of iterations of appeal to get a third party review, but the plan will usually cover your drug - just for the rest of the year.  During fall open enrollment in 2014 you will need to select a new part D plan for 2015 that includes your drug in its formulary.
  •  Drug restrictions - is the criteria the part D plan imposes for the particular drug you use.  There are several ways restrictions come into play.  The plan may require you to go through "step therapy" to try another, less expensive drugs to treat your condition before they will allow you to fill a prescription for your drug (even though you currently use the drug).  The plan might limit the amount of your drug that can be purchased during a given period of time.  All drug restrictions are described on for each plan. You have to look at the details of the plan to find them. It may also be worthwhile to call the plan and make an agent tell you the restrictions or find the restrictions on the plan's website.  Make sure you take notes and names when you gather information about restrictions or lack thereof.  It is important evidence if you need to file an appeal because you feel you were misled about drug restrictions.
  • Pharmacy Network - is the criteria for where you get prescriptions filled.  When you first enter plan finder on you pick pharmacies you'd like to use.  The results for each plan will tell you whether those pharmacies are in that plan's network.  Pay attention to the results because they will use words like "in network" and "preferred network".  The pharmacies that are "preferred" provide the lowest cost coverage and is the basis for the annual cost computation.  There is also information about mail order services.  Not all plans provide mail order services or it may cost more to use such services.
  • Total Annual Cost - is the criteria for how much your out of pocket cost will be in 2014.  The estimate shown by plan finder includes the monthly premiums for the plan, any deductible, and the copays based on the drug tier assigned to your drugs.  The higher the drug tier the more your copay.  My recommendation - pick the plan that fulfills your criteria for the first 3 variables that provides the lowest total annual cost.

Tuesday, October 15, 2013

IBM Medicare Some Retirees just got the EH letter

Yesterday someone told me they just received the information about the transition to Extend Health and what they received was different information.  They had only been using IBM dental and vision insurance in 2013.  Medical was covered by their spouse's insurance plan.
Of course, neither Extend Health nor IBM Service Center explained to a subset of retirees why it took so long for them to receive transition information when the rest of us have been blabbing about this since the end of August. I believe it has to do with Medicare law and the fact that private plans are not allowed to begin their marketing for "open enrollment" until the beginning of October. That is why you are now seeing the flood of mail and ads on TV about Medicare Advantage plans. So, maybe Extend Health didn't send out information to a subset of retirees until the beginning of October because Extend Health did not want to be accused of breaking the law.  I keep saying this - Extend Health is basically an insurance agent.
The IBM retirees who did not use an IBM medical plan (whether it was the IBM supplemental plans, the Aetna Integration plans or most of the Medicare Advantage plans) are not eligible for a "Special Enrollment Period" which occurs when a corporate group plan is ending. The medical plan these people use is NOT ending.   The retirees using the Aetna PPO plan are also NOT eligible for an SEP because the IBM Aetna PPO plan is not ending. 
This SEP (there are many types of SEPs) allows Medicare eligible people to enroll in a new medical plan and begin coverage up to 63 days after the end of their current plan. This SEP started with IBM's announcement to retirees and continues into 2014 for 63 days. There are no marketing limitations for someone in an SEP. (That is why people about to turn 65 are flooded with mail and phone calls from private insurance companies.)  IBM retirees with this SEP are allowed to pick a new medical plan  63 days into 2014 but coverage wouldn't begin until the first of the next month.  To ensure continuous insurance coverage, EH uses the date 12/31/13 as the deadline for enrollment in one of their plans but buried in their literature is the fact that you actually can enroll in the beginning of 2014.
If you are NOT currently using an IBM medical plan that ends on 12/31/13, you do NOT have an SEP.  You are eligible for the normal Medicare Open Enrollment (aka fall enrollment) which begins today, Oct 15, 2013, and ends midnight on Dec 7, 2013. There are other implications that are important.  There is no "guarantee issue" right to get a medigap supplemental plan.  For example, if you were using IBM's Aetna PPO and want to switch to Original Medicare with a medigap - depending on where you live -  your state law may allow insurance companies to DENY to sell you a medigap plan, add riders to exclude pre-existing medical conditions and/or charge higher premiums based on your medical condition or age.
Extend Health is sending out brochures to the retirees without this SEP that describe Medicare Advantage plans.  EH assumes you will not want to switch to Original Medicare if you are using a Medicare Advantage plan. That is misleading because in several states that have continuous enrollment for medigap,  this is the time to switch to Original Medicare and get a medigap.  Also, if 2013 is the first year you tried a Medicare Advantage plan you are allowed to switch back to Original Medicare with a medigap.
Reminder, if you are already using Original Medicare with a medigap the rules for when you can switch to a different medigap plan with "guarantee issue" are state determined and are not tied to Medicare open enrollment.  For example, in California you can only do it on your birthday.
Reminder, these convoluted Medicare rules/laws are brought to you by your federal and state legislators who often times are influenced by insurance company lobbyists.  And retired federal legislators are not required to use Medicare when they turn 65.  They have their own federal plan. 

Sunday, October 13, 2013

IBM Medicare More thoughts on Medigap Plans

Yesterday I spent about hour helping a friend understand more about how to pick replacement insurance plans to replace his IBM Medical and drug Supplemental plan that he had for himself and his wife.  After talking through the differences between a Medicare Advantage plan and Original Medicare - he decided he wants the flexibility of Original Medicare + a medigap + part D for both him and his wife.
First, we went to and looked at part D drug plans in his zip code.  He takes no drugs so it was easy to pick a plan for him.  He will buy the cheapest drug plan available.  Then we looked at a plan for his wife who has expensive prescriptions and picked a plan for her that covers her drugs.  We next looked at to see if both plans were offered by EH and they are which was great news!  That means he can buy at least two plans through Extend Health, qualify for his subsidy and is free to buy medigap plans from insurance companies with the cheapest premiums in his zip code.
We looked for insurance companies selling medigap plans in his zip code by going to  for the medigap policy finder at the top of the home page.Unfortunately, does not provided policy prices for each insurance company but they do give a price range for all the companies that sell a type of medigap policy in your zip code.  I asked him to get his "Medicare and You" book and we kept it open to the page that has the chart showing the different kinds of medigap plans and what is covered.  He decided to get the F high deductible plan as he rarely goes to the doctor but should something go wrong he will cap his medical cost.  Mostly, he likes that F-HD has the lowest premium.  Extend Health offers the cheapest medigap F high deductible plan available in his zip code, which is, again, great news, so he will also buy his medigap "F high deductible" plan through EH.
However, his wife needs different medigap supplemental coverage because she does have health issues.  He'd love to buy an F no deductible plan for her but the premium cost is too high -  the cheapest plan offered is $206/month premium. It wasn't any better getting an F high deductible plan because the "adjusted premium" of an F high deductible plan was even higher (adding $176/month to the F HD plan premium provided a premium comparison of about $209/month).
 He needed to find a cheaper medigap plan for her that provided "good" coverage.  We looked at other medigap plans with lower premium cost.  He decided the premium price for an "N" medigap plan was a better fit given the lowest premium price offering is $140/month and there is no deductible.  The things N doesn't cover are not important to her.  I told him to call the state SHIP (find your state SHIP by going to to find out exactly who sells the cheapest N policy.  Unfortunately, it's not the the N medigap plan offered by Extend Health.  
When he enrolls through Extend Health he will tell them exactly what part D plans and medigap plans he wants to buy. He knows he will buy 3 policies through EH. For the "N" plan he will ask EH if they sell the plan he wants and tell them the name of the insurance company.  If they can't sell it he will buy the "N" medigap directly from the insurance company.
This was a useful exercise for both of us.  I realized I should have offered more advice about picking the "right" medigap plan when premium affordability is an issue.  My friend is now ready for his call with Extend Health and no longer feels overwhelmed by the whole process.

Wednesday, October 9, 2013

IBM Medicare Part D insurance - What if you already have a part D plan ? UPDATE & CONFUSION

Written on 10/30/13 ----Correction to what was written on 10/9/13
I just got off the phone with a friend who tried to "enroll" in the same drug plan he already has.  He was told that he cannot do that because then Extend Health will not be the insurance agent on record and he will not be entitled to his HRA subsidy.  He talked to three different EH people and they all said the same thing.  He now has to pick a new drug plan because it is still better to do that then to buy an EH medigap plan which is substantially more expensive than what he can get on the open market.
Even though I asked an agent before I enrolled if we could use the same part D plans as we already had and then I asked the enrollment agent again when we enrolled if we could just reenroll in the same plan - they both are wrong.  I am told that our enrollment will be rejected.  Now, when will they tell us this?  Beats me.  I was going to just let it go until they caught it but am not sure that is a good idea.  I just spent a couple of hours trying to sort through our alternative choices.  None of which are great. 
So, I called Extend Health and asked them if we had a problem with our enrollment.  The Benefits Agent checked our status and insisted we are enrolled and there is no problem.  I haven't a clue what else to do but wait and see what happens.  This is insanity --- just insanity.

Written on 10/9/13
My spouse and I already have part D prescription drug insurance and want to keep the plans we have.  I looked on Extend Health's website and those plans are on the list.  So, my question to them was how does that work since we already have the plans. 
The agent told me the enrollment call will just consist of us telling them the part D insurance plans we have and they will modify our profiles showing we have those plans.  She said that will then give us access to our subsidies (we are both IBM retirees).  I sure hope she is right!  We only will buy medigap plans through EH if they offer the cheapest F high deductible plan available in our zip code.  I will be surprised if they do as it is not listed on their website.
A reminder - not all Medicare Advantage plans include drug insurance coverage (part D).  If there is a Medicare Advantage plan in your zip code that does not include part D but it is a plan you want for your coverage - the rule change allows you to just buy the part D plan through Extend Health to get your subsidy.
The only people who will be locked in to buying a medical plan from Extend Health are people who want a Medicare Advantage plan that includes prescription drug coverage.  Then you must buy the plan through Extend Health.

Monday, October 7, 2013

IBM Medicare IBM CHANGED THE RULES!!!! Part D insurance qualifies for HRA subsidy


I just got off the phone with an Extend Health agent.  I was asking questions (of course) and one was pertaining to changing a plan in the middle of the year (Medicare allows a one time change to a 5 star plan if you have one in your zip code) at which point he said  - oh, we just got an email this morning from IBM.  They changed the requirements for HRA subsidy access.  You can access your HRA as long as you have either a medical plan OR a drug plan that was purchased through Extend Health.
That will make life a little easier for some people.

Here are the questions I was asking:

1.       Can I submit bills to my HRA for reimbursement of medical procedures that are not covered by Medicare such as an annual physical by a doctor and associated blood tests (assuming I have money left to do so)?
Answer:  Yes, the IRS ruling for HRA accounts only require that it be a medically related procedure or drug cost.  Paying out reimbursement money from HRA accounts has nothing to do with Medicare.

2.       Can I submit bills to my HRA for reimbursement of doctor bills if the doctor does not accept Medicare insurance?
Answer: Yes – same rules apply as for answer #1.  HRA reimbursement has nothing to do with Medicare.
3.       Can I submit bills to my HRA for reimbursement of dental bills if I do not have dental insurance?
Answer: Yes – same rules as #1 - dental qualifies as a medically related procedure.

4.       Both my spouse and I retired from IBM.  Can we submit bills for reimbursement to each other’s HRA accounts if there is money left in one account and not the other?

Answer: Yes!!!!

5.       If my medigap plan is no longer offered by EH in 2015 do I have to switch to a new EH plan at the end of 2014 to keep my subsidy? 
Answer:  You have to have at least one plan purchased through EH.  You would have to then buy a part D plan through EH if you didn’t want to switch medigap plans.  (I did not like this answer because not all part D plans are offered by EH and your drugs might not be covered by plans they offer. My bet is you could lobby for an exception in that case)
6.       If I want to switch to a 5 star Medicare advantage or part D plan during 2014 – which Medicare allows – will I lost my subsidy if it is not a plan sold through EH?
Answer: You will not lose the subsidy for a part D switch if you still have an EH medigap plan.  You would lose the subsidy for a Medicare Advantage switch.  (Again, I do not like this answer and will bet you could lobby for an exception)

Sunday, October 6, 2013

IBM Medicare Confusion Abounds - Beware What you Hear and Read

I've been looking at some of the chatter about Medicare medigap and Medicare Advantage plans that has been posted other places.  Too often what people write is wrong.  Sadly, the Extend Health agents are also saying things that are wrong.  Double check everything to be sure you are getting an accurate description of Medicare rules and offerings and Extend Health rules.

For example, people are saying some doctors won't accept medigap plans.  Doctors don't chose to participate or not participate in medigap plans unless they are are "Medigap Select" plans.  There are only a couple of states that have those kinds of plans and even then "Select" plans are only available in a subset of state counties.  Everywhere else a doctor cannot say they don't accept a medigap as Medicare automatically sends the claim to the medigap for processing.  The doctor can say they don't want to wait for a medigap plan to pay them because the plan may be slow to pay.  The doctor might therefore ask for coinsurance payment up front.  You will then be reimbursed by the medigap for the coinsurance.  If you decide to get a medigap with a deductible you obviously have to pay the doctor coinsurance anyway until you reach the deductible amount for the policy.  Reminder - any coinsurance you pay will be reimbursed by Extend Health if you still have money left in your subsidy (I keep seeing postings where people are really confused about that). People also write about a lifetime cap for medigap reimbursements.  Maybe it applys to Select plans but regular medigaps are required to payout and can only cancel a client if the client stops paying medigap premiums.

I have seen people mix up medigaps and Medicare Advantage plans. Someone wrote about the vision and dental coverage provided by a medigap. Again, unless it was a "Select" plan - medigaps never offer vision and dental coverage but Medicare Advantage plans often do.  I have seen people write about how medigaps are age rated so the older you get the more expensive it will be.  IT DEPENDS ON YOUR STATE. I have seen people focus totally on the cost of Original Medicare + medigap+ part D versus a Medicare Advantage plan.  There is so much more to the decision of what insurance to have than the price tag of the plans you choose.  Reminder - if you need an expert doctor (say, for a second opinion) and they don't accept your MA plan (but do accept Medicare) you will have to pay the total cost of the doctor visit out of your pocket if there is no money left in your HRA.  There is no way to factor that into a "cost" analysis.

There are still a lot of unanswered questions about Extend Health.  EH stated that you must buy a "medical insurance policy" from them to qualify for your subsidy.  So, what if you just buy one policy from them will you then be able to submit bills for premiums and copays for both you and your spouse?  That would mean you can buy a cheaper medigap for your spouse if EH doesn't offer it. EH has said you must buy a medical or part D plan for your spouse to be able to file bills for your spouse's against your HRA.

The medigap insurance policy that Extend Health offers for medigap F high deductible in my zip code is one of the more expensive offerings in my area and it is also Humana - which is famous for poor customer service (try to call Humana once you have a policy with them - it is easier to reach the Pope). It is the only one they offer for my zip code.  I keep reading that Extend Health will sell you the policy you do want if you ask for it!  So, I know that Empire Blue Cross's price for exactly the same policy is $30/month less --- I am specifically going to ask them if they can sell me that plan!

There are other questions you have to ask your state health insurance assistance agency that are important questions to get answered before you sign up.  The top of the list is whether the state that has rules for issue age rated medigap pricing (also known as entry age rated pricing) require insurance companies to sell you a medigap plan at the issue age you bought IBM's insurance because you had continuous secondary coverage and have a guarantee issue right.  It might dramatically lower your premium price if it applies.  I doubt Extend Health will know and I doubt the insurance company will tell you unless you ask the question.
I just looked at the drug plans offered by Extend Health.  First off, there are 25 drug plans available in my zip code in 2014.  I just looked on to see it.  EH offers me 12 plans!!!  It is also difficult to determine if my drugs are covered by those plans when I look at the EH information.  Don't rely on EH information alone to pick a drug insurance plan. 
Finally, EH had ONE dental plan and ONE vision plan to offer in my zip code.  The dental plan was "stupid".  I would have to pay about $626 in premiums and deductible to get $1000 in coverage for the year. The vision plan wasn't much better but I only had to pay about $168/year to get nothing.  Maybe there are more plans they will offer if you ask? Make sure you ask your dentist and you eye doctor/eye glass store what plans they take and what they think are the best plans to get before buying a plan from Extend Health.  Reminder - no matter how you buy a dental or vision plan or self insure you can get reimbursed for the premiums, copays and total bills from EH as long as you bought an EH medical or part D plan and still have $$$ left in your HRA.

Saturday, October 5, 2013

IBM Medicare The Value of Keeping Promises

I keep thinking about Rhee's response to my email and how what Human Resources is doing is nothing more than a maneuver to steal from the elderly earned IBM services. I need to rant.
There is an implied message in the literature we received that we are lucky to get anyting from IBM.  It had nothing to do with luck. The employment contract we had with IBM was a promise to defer payment of services earned so that we could receive a long term payout over our lifetimes in the form of health benefits.  Somewhere along the way we even started to believe that we are "lucky" to have the benefits.  Never forget - you earned them. We worked hard to earn them and we were given a promise that we would be paid those earnings over our lifetimes. It is simple what is happening. IBM is breaking the promise.
Although there was no legal contract there was a social contract between the employee and the company.  It was a moral commitment between both parties.  We provided high quality work and IBM put part of our earned services in a “benefits bank”.  It was a handshake deal and IBM agreed to be morally obligated to fulfill the promise.  The IBM Human Resources community has now decided to break the promise and Ginni is letting them do it.  The board of directors is no less complicit. Shame on all of them. We kept our end of the deal.
The value of keeping a promise is measured in moral terms.  The cost of breaking a promise is measured by lost ethics.  IBM worked harder to keep their ethical bank account higher than any other corporation in the global marketplace.  Business conduct was the cornerstone of IBM’s success.  It is what made IBM a superpower in the corporate world.  Whether an eroding of ethics occurs in customer interactions or in human resource support it erodes IBM superpower standing and eventually erodes the very fabric of the organization.    Stealing earned services away from retirees is undeniably a major erosion no matter how much lipstick is applied.  It is likely a symptom of a broader IBM collapse.
The most important aspect of this rant is to remind you that we worked for most of our careers during an era of trust and that makes me feel "lucky". 

Thursday, October 3, 2013

IBM Medicare IBM's Answer - Why We are Forced to Buy from Extend Health

I posted an entry earlier this week of a email I sent to Dr. Rhee complaining about being forced to buy a medical policy through Extend Health to get my subsidy.  How could I have not realized that IBM was doing this for my own good because I would not have been able to figure out what insurance to buy all by myself.  How wonderful that IBM still cares about me and that makes it so worthwhile for me to have to pay about $50/month more for my medigap insurance than if I could buy a plan in the open market.  I feel so loved. 

Here is Dr. Rhee's answer:

I want to respond to your letter regarding IBM’s announcement that Extend Health will provide you with new health plan options for 2014.

IBM decided to require retirees to enroll through the Medicare Exchange because we consider the benefit advisor important to helping retirees through this transition. For most retirees, a plan is available on the Medicare Exchange that delivers equal or better value than under the current IBM group plan options, at a lower cost. You may have chosen a plan that costs more, or you may be in one of the few areas of the country where plans are more costly. Previously, IBM used a “national” pricing strategy, meaning regardless of where a retiree lived, he or she paid the same amount for their IBM plan option.

Since you are not satisfied with the cost of the plans you've reviewed on the Extend Health website, I encourage you schedule an appointment with an Extend Health benefits advisor at 1-855-359-7380 to explore these options and to ensure there are no other plans or other suggestions that they may have for you that may meet your needs.

Thank you for your past contributions to IBM, and for writing.

IBM Medicare More Information on Doing Plan Research

George posted excellent information in a comment on how to do plan research and how important it is to do that research.  I am reposting it here to make it easier for you to read. 
Thank you, George!

There is an additional readily available and very easy to review source of factual information accurately and comprehensively summarizing the plan you may be contemplating: the PLAN BROCHURE. Thus, some related thoughts after years of working directly with CMS [Medicare] and insurance companies, and assisting many people.

After selecting (or comparing) Medicare Supplement (Medigap) or Medicare Advantage (Part C) plans on the Extend Health (EH) Web site, as part of the plan information near the bottom of the respective listing(s) you will see a link - “View” - to the insurance company's “PLAN BROCHURE” [in PDF format] - at least I did for plans available in Zip Codes / counties I checked for multiple states. Plan documents (brochures) are also available on most insurance company's Web site – again, at least for the several companies for the states I checked.

After reviewing the somewhat legalistic information on EH, I strongly suggest you review the PLAN BROCHURE as it will present and compare plans usually in an easier to review format with a comparison of like-type plans. While NOT usually the legal plan-coverage document, the brochure may be referenced. For the complete legal plan document, you will need to review a very thick document(s).

For most states / Zip Codes / counties, ONE brochure will summarize coverage for ALL of the choices for a company's specific plan type, for example, all of the company's Medicare Supplement plans from A to N in one brochure, and all Medicare Advantage HMO or PPO plans (and variations) in another brochure, often with specific rate information which you may cross-reference to rates EH states for you.

Remember ALL plan brochures cover a specific geographic area and time period, therefore do NOT refer to an old document or one that is NOT for YOUR state / Zip Code / county.

Once you have reviewed the information available from EH AND the plan information from the insurance company from either EH or the company's Web site, if you have questions, then you will be able to specifically address them by calling the insurance company directly or, in some cases by talking with EH. Either can, and will, help clarify your questions or concerns.  I encourage everyone to get all of your questions answered before proceeding with enrollment. If you are unhappy with the conversation, call again as it is not uncommon for questions to be answered incompletely or even incorrectly, even with EH; and make sure you document the call.

Keep in mind, for a variety of legal reasons, while it may in some limited circumstances enhance a subsequent claim (or complaint), talking with an insurance company (or EH) representative does not make your conversation - questions or answers - a part of, or not a part of, the plan document or coverage thereunder.

Nevertheless, it is imperative that your review all available plan information and follow-up with all available sources, including calling the respective insurance company, CMS, and applicable state insurance agencies, to have all of your questions or concerns answered before proceeding with enrollment; and, that you fully understand the plan, including coverage, payments, and limitations, in which you are enrolling, BEFORE you enroll.