Saturday, September 28, 2013

IBM Extend Health Medicare briefings - some of what is said is wrong

As I said in the last post, the briefing presenter made some mistakes during his presentation.  There were also some fact "omissions" that should have been included. 

Medigap rules ----

  • When he talked about medigap rules he was not state specific and several times said things that were not correct for NY and CT.  He kept saying that medigap plan premiums are determined based on your age (aka age rated).  He also kept talking about medical underwriting which means the insurance company can raise the rate or exclude coverage for specific illnesses if you have pre-existing conditions. NEITHER applies in NY and CT. Then he said several times that you can enroll in a medigap any time as if it were true in any state. That is ONLY true in NY and CT. And the plan does not take effect until the first day of the next month.
  •  In NY and CT plans are never priced based on age or medical condition of the person, no one can be denied a policy and anyone can enroll or switch companies whenever they want (called continuous enrollment) - to be effective the next month but you might be subject to a 6 month coverage wait for preexisting conditions. In some states you are only allowed to change medigap plans once a year e.g., in California it's on your birthday, in Wisconsin it is on the anniversary of the date you first purchased a medigap. What that means is the insurance company cannot deny you.  You can try to do it at other times but the insurance company can deny you.  He never directed the audience to be sure to check with their specific state insurance agency to find out those rules so one might think he assumed everyone was from NY or CT but then he was wrong about what he said for those two states! Confused?  Maybe that was the master plan.

Enrollment periods ---

  • He did not well explain that Oct 15 - Dec 7 is the Medicare open enrollment when a person can SWITCH the kind of insurance they have.  You can switch to original Medicare, switch Medicare Advantage plans and/or enroll or switch part D insurance plans. He only talked about how it was a time to switch Medicare Advantage plans.  He also NEVER mentioned that from Jan 1 - Feb 14 Medicare has a Medicare Advantage disenrollment period where a person is allowed to drop their Medicare Advantage plan and go to original Medicare. He also did not properly explain that from Dec 7 - Dec 31 you can enroll in Extend Health plans but it is a one time deal because that is a special enrollment period to Medicare. 
  • You cannot change your mind about your enrollment choices if you try to do it after December 7th. He never said anything about that. The only option you have left if you want to make a change after that is January - Feb 14 which is, as I said, is when you can "drop" a Medicare Advantage plan. But if you do that you better be able to buy a medigap plan as it is the only way to get your HRA money and in some states that might be a BIG problem as you might be denied by the insurance company.
  •  After Feb 14,  you cannot change your Medicare insurance until the next Medicare open enrollment period (Oct) to be effective January of the following year unless you can prove you were mislead by the insurance company (aka bad marketing aka they lied).  There is one exception - if there is a 5 star rated Medicare Advantage plan or part D in your zip code you are allowed to switch to it any time during the year.  HOWEVER, if you do that for an MA plan you will lose access to your HRA subsidy unless it is a plan offered by EH because IBM requires you to have a medical plan through EH to spend that money. 

Also, he stressed that although EH does get commissions from insurance companies for selling a particular plan -  the agents don't get commissions from "selling" a particular plan.  Wanna bet they get bonuses?  Ah, the value using the right words is amazing.
He also talked about how EH agents will be available throughout the year to answer your questions.  But your questions better not be about claims or how to appeal a denial.  EH is clear in the literature that those issues are handled by your insurance plans.  You cannot complain to EH as they are only the insurance agent.  You cannot complain to IBM as they sold us out.

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