Wednesday, September 11, 2013

IBM Extend Health Questions and Answers

Many people have come to this post so I am adding an update here about the HRA subsidy that is really important.  Make sure you receive and read a letter mailed from IBM about survivor designation.  The "do nothing" default is that your HRA subsidy will be reduced even if you do not have a spouse or eligible dependents.  I can't even guess as to why that is true.  The letter was sent on 10/14/13.  You must take action by 12/16/13 if you want to keep your entire subsidy.

I finally reached an excellent Extend Health agent who seemed to know a lot.  Here are the questions and answers he gave me.  I cannot say for sure that he was correct so you should ask again when you talk to Extend Health. 


September 11,2013 
1.       Are all the Extend Health plans traditional CMS Medicare plans that are currently in the marketplace? Will there be any unique offerings like the IBM secondary medical plan that only kicks in after $4000+ deductable?  That was not a CMS approved plan.

Answer: There will not be any unique offerings at all.  Anything Extend Health offers is only what is available in the market place.  The offerings we had were specialized corporate offerings.  So there will be no Aetna Integration or specialized part D plans.
2.       There are no CMS approved plans for dental or vision insurance as separate plans.  Will these still be offered as separate insurance plans or is the only way to get this coverage  through a Medicare Advantage plan?

Answer: There will likely be dental plans offered but they will be ones that are available in the market place.  Plans like Humana Dental and Delta Dental will be offered.  Met life Dental is only sold as a corporate plan and not and individual plan so Met Life will not be available.  Make sure your dentist takes the specific plan that is offered.  Since there is no price advantage to buying the plan through Extend Health you might just want to buy it in the open market.  If you have bought at least ONE medical or part D insurance policy from Extend Health you will be able to use HRA subsidy money to pay for out of pocket expenses and premiums for dental and medical insurance even if it is not a plan available through Extend Health

3.       If the offerings are all traditional CMS plans are Medigap plans then subject to the same state rules as CMS Medigap plans?  Like not being able to switch Medigap plan types once you make a selection unless that plan type goes away.  Will Medigap plans be subject to state rules such as age rated premiums,  zip code rated premiums or delayed coverage for preexisting conditions? Does Extend Health negotiate private plan premiums so they are lower than what is available to the general market place?
Answer: Extend Health does not negotiate any premiums.  There is no price advantage to buying a policy through Extend Health and state rules apply regarding pricing by zip code or age rating.  Because the IBM group insurance plan is terminating people in any state will have a “guaranteed issue right” to buy whatever plan they want even if they did not have a medigap plan.  
   
4.       Does Medigap ‘guaranteed issue right’  apply even if someone only used the IBM’s prescription drug plan and had no secondary insurance or used a Medicare Advantage plan in 2013? If someone buys a Medicare Advantage plan in 2014 do they lose their ‘guaranteed right’ to buy a medigap plan in 2015?

Answer: Yes, “guaranteed issue right” will apply in 2014.  If you buy a Medicare Advantage plan in 2014 then state rules will apply in 2015 which will mean in some states you have no guaranteed issue 
right to buy a medigap unless your Medicare Advantage plan terminates.

UPDATE - I think this is not accurate - I now believe guaranteed issue right only applies for medigap purchases if you had an IBM medical plan in 2013.  If you only bought a prescription drug plan you might not have a guarantee issue right … it depends on the state you live in.  
5.        Will there be any non-CMS structured offerings like IBM’s prescription drug offering that had no donut hole and capped at $3500 of pay out – e.g, it was a CMS qualified plan because it was creditable coverage but not at all structured like a CMS part D plan. If there are any such plans will they still be subject to the higher premium rule for higher income individuals?

Answer: No, there will be no unique plans offered.  All CMS rules apply for any part D plan you decide to use.
6.       Your brochure (page 6) implies you will only be offering Medicare Advantage plans that include prescription drug insurance.  Is that true?

Answer: The offerings that will be available have not been published yet
7.       Both my spouse and I are IBM retirees.  Do we have to enroll separately versus as husband and wife to get our subsidies?

Answer: Each of you will have your own subsidy but you can enroll together and can pick the plans that suit each of your needs.  You do not need to enroll in the same plans.
   

8.       If I don’t buy insurance through Extend Health in 2014 am I precluded from buying through the exchange in future years?
Answer:  It appears you can – but ask this question again during your enrollment session.
  

9.        My spouse receives a Medicare part B premium subsidy and  gets reimbursed through SHAP reimbursement.  Your brochure implies (page 9) that the process will be the same and it is not part of the HRA process and subsidized coverage.  Is that correct?

Answer: Yes, that is correct
   

10.    You say your current insurance pool covers about 500K users for the companies you serviced before IBM contracted with you.  What is the current typical wait time for them to get answers to their questions? When IBM retirees join the pool how big will the pool become and what is your anticipated typical wait time to accommodate that big an influx of people?

Answer: I didn’t ask this question.
11.   How does the process work if a retiree is covered under a spousal plan but cannot continue spousal coverage after the spouse dies – and the spouse dies in the middle of the year?  Are there life changing events where the retiree then can use the Extend Health exchange or must they wait for the next enrollment period?

Answer:  Extend Health will be setting up a special group to handle those situations.  However, since the policy is terminating for the living spouse, Medicare gives the living spouse a Special Enrollment Period to switch to a new plan.  That can be done through Extend Health or directly by calling Medicare.
    
12.   How are advisors compensated?  Do they get a commission when the retiree decides to use an Extend Health offering and – if so – is it based on the premium of the offering?

Answer:  Advisors are salary based and do not receive commission for the products we buy (he said nothing about bonuses).

13.   Can you put claims in for medical expenses against the HRA that are not covered by the insurance plans you have through Extend Health? Like dental expenses or dental insurance premiums?

Answer:  YES!  As long as you have purchased a medical or part D insurance product through Extend Health you can put in claims for plans you did not get through Extend Health. However, I suggest you ask this question again (and again and again) to be sure.

UPDATE - if you are only buying a part D plan - it must be a different plan that what you bought in 2013 in order to get the subsidy.
14.   Will Extend Health allow us to enroll in any Medigap, Medicare advantage and drug insurance plans available in our zip code? If not, why not?

Answer: NO.  They are only authorized to sell some of the products.  Some insurance companies will not let them sell their products.

15.   Can you change your mind after an enrollment call and call again to switch to a different plan and do it  through 12/31/13?

Answer:  Only if you do your enrollment AFTER October 14, 2013.  If you do it before October 15, 2013 you will be only allowed a onetime change because you will be in a Medicare Special Enrollment Period because your company group plan is ending (I think this answer is not correct).

16.   What happens to unspent HRA subsidy money?  Who gets to keep it?

Answer:  It goes back to IBM.
   
Questions added on October 8, 2013:


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 husband 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)


34 comments:

  1. IBM could have just created an account and funded it per retiree. Instead EH gets the money and we have to apply for it. They say they do not negotiate prices so these plans offered then could be bought individually probably at a lower cost as there would be no comission to EH and no admin costs. Does ACA keep this from happening?

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    1. ACA has nothing to do with this and Extend Health.

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  2. I agree but IBM did not want to administer the account and did not want to give retirees the money because a rebate system gives IBM a high likelihood that they will not have to spend all the money. Retirees will mess up the rebate and/or forget to claim it. So, IBM just pays EH to administer the HRA account. EH pays it out to the retirees who get the paperwork right. If a retiree doesn't spend the entire subsidy whatever remains at the end of the year is returned to IBM. My guess is that'll be somewhere between $45- 90M if retirees are as lousy at rebate claims as is the general public. EH is just an insurance agent for the plans so there is no negotiation. All the plans are already individually offered in the market place. It is up to an insurance company if they want EH to act as their agent. Some insurance companies don't use agents like United Healthcare AARP plans. The price of insurance plans is always the same whether or not you buy through an agent. My bet is EH does get a sales commission just like insurance agents but it is not passed to their call center staff. The ACA has absolutely nothing to do with this IBM change. It is not illegal to sell insurance through an insurance agency. Nor is it illegal to terminate an corporate insurance plan. The fact that EH uses the word "exchange" is also misleading. It isn't an exchange. EH is just an insurance agent that is offering to sell a subset of Medicare related policies to individuals. If the retiree has a problem with an insurance claim they have to work it out with the insurance company. EH plays no role at all in the insurance once you buy it.

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  3. Will the HRA amount be dependent on how many policies one buys through EH? If I buy, for instance a dental policy thru EH but my medical on the outside market mean I get a smaller amount in the HRA?

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    1. no. you can use the HRA if you only have one policy through EH.

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  4. According to what the agents told several retirees so far (but keep asking) all you need to do is buy "something" from EH to gain access to your subsidy. They said the claims processing is totally separate and the bills you submit either for premium reimbursement or out-of-pocket medical expenses do not get matched to the insurance policy you bought through EH. They will tell you the subsidy amount you will receive before you buy your insurance. As I said - keep asking the agents this question. My agent told me the specific rules from IBM have not yet been published. He said subsidy rules are different from company to company.

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  5. I called EH to confirm the process for manual reimbursement which is, as I understand it, fill out the form and attached a paid invoice and send it in. I called the "expert", who didn't know, who transferred me another group who said only another group could answer that question but that they would not be available until IBM put in the money because they would not have my profile until IBM put in the money. Is this a hint of the bureaucracy we can expect? Will this be a snail mail blizzard? Will I have to make copies of all manual submissions to assure that I am reimbursed for each one?

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  6. I think the only thing EH easily enables is the automatic reimbursement of insurance premiums. Notice I said reimbursement because it is after you pay the premium. It is also not clear to me if the automatic premium reimbursement process is only for policies you buy through EH. Otherwise how would they know if you still have the policy as you can cancel a policy at any time - especially a dental policy where there is no "Medicare penalty" do do so. All other reimbursements are as you described it. That's why I keep saying IBM is counting on retirees to forget to reclaim their money and then IBM gets to keep whatever is left of the subsidy.

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  7. What do they consider being "enrolled"? When you fill out your profile (actually, I had a call in early Sept. and she asked for all that information over the phone) or when you actually sign up for a plan? I would assume the latter, but if it took place during the phone call and she filled out a profile (which I saw and added some additional input), then that is before Oct. 15th!

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  8. You are not enrolled UNTIL you buy a medical plan from EH. You must buy either a medigap or a Medicare Advantage plan to enroll which means you can then get your subsidy. All you did was create a profile and make an appointment.

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    1. OK, just read in earlier comments that we can buy ANY (Vision, dental etc) plan and gain access to subsidy. Is it now limited to Medicare Advantage or Medigap plans? Sadly Advantage plans seem to be only MVP in which my Dr. does not participate.

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    2. Until I went to the Poughkeepsie briefing I thought a part D, vision or dental plan was a medical plan as they fall into the category of "medically related insurance". It is not how Extend Health describes a medical plan. If you torture words long enough they will confess to anything.

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  9. The Medicap plans end with a note that AARP plans can be found by calling the EH number. When I do that, no one has a clue what I am talking about. I have been on hold twice for over an hour. Web site has crashed. Clearly these folks are unprepared for today, just like Obamacare

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  10. Now, now ... Extend Health is here to help ... maybe they just want to make the department of motor vehicles look really good.

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  11. The select medical plans do not provide a match up with the providers we entered into EH. The prescription plans do not verify that the prescriptions we entered are available from the plans. How is all that going to be resolved?

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    1. it isn't going to be resolved until we all let IBM know that this is a disaster for all retirees. I was trying to get information about my dental insurance today. I "enrolled" during my call and only 2 plans went through, the third did not. I was on the phone for 4 hours this morning between EH and the carrier. EH did nothing as usual except spout off canned scripts. They said they filled out the enrollment information and it is the carrier's responsibility. So they toss it over the wall and if someone is at the other end to catch well good. If not, you are out of luck. I collected about 15 different phone numbers this morning but no one could end up helping me. This is going to be fun. Hope I do not have any claims. I can only imagine what that will be like. EH is worthless.

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    2. I suggest you write to Dr. Rhee. He just loves to get complaints.

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  12. I don't understand what you mean by select medical plans matching up with the providers. But I do suggest before you enroll in anything whether it is a medical plan or a prescription drug plan that you call the provider directly and verify that you are getting the coverage you think you are signing up for. Take notes on who you talked to and when you called. This way if something turns out to be wrong you can appeal to medicare for a special enrollment period because you were mislead by the provider. I'll also put this in a new post.

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    1. Select plans have a lower cost than the same plan "not select". Select means the insurer has a specific panel of providers you can go to, otherwise you are out of network. The EH site, which has a list of our providers, does not detail which providers are in their "select' panel nor do they attempt to match up the providers we entered with that select panel. Without this data how can one decide if one wants the lower cost "select" option or the more expensive one that covers any provider that takes Medicare.

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    2. OK, I understand. You are talking about a medigap select plan which is only available in some states. I suggest you call the insurance company directly to find out what doctors are in the network. Once again, great question and I will write a post on this because there is a terrific document on the www.medicare.gov website that explains medigaps: http://www.medicare.gov/Pubs/pdf/02110.pdf

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  13. In addition to the "select" plans, EH list drug plans but they do not indicate if the drugs we entered are covered. How can you make a decision on a drug plan if you don't know if your drugs are covered.

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  14. I saw the same problem for part D when I looked on the site. I know some of the plans they listed do not cover my drugs as there are only a couple that do. So, I will be sure by checking with the insurance company. But, honestly, I don't think I will use EH to buy a part D plan. Why bother? I'll have to submit paperwork to get reimbursed for copays so I will do it for part D premiums as well. To find out if your drugs are covered, I suggest you go to www.medicare.gov to look at the coverage provided by the part D insurance but be sure you are looking at 2014 plans. But you can also call the insurance company.

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  16. Calling the insurance companies or looking on their web site for the details of their plans assumes the plans they have on EH are exactly the same ones they offer generally. Is there evidence for that?

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    1. The plans are exactly the same as what a Medicare eligible individual can buy in the open marketplace. There are no IBM corporate structured plans such as Aetna Integration. Nor does Extend Health create their own group plans uniquely for EH members. If you think of Extend Health as an insurance agent it will help. They sell what is available in the marketplace and get commissions for selling the stuff. The one exception is the Aetna PPO offered in 2013 through IBM. That is a corporate structured offering but Aetna asked if they could continue "selling" it to IBM retirees for 2 more years and IBM agreed. That qualifies as an Extend Health medical plan. I don't know if that is bought through EH or not. However, I think it might only be offered to retirees already on the plan and I don't think you will see it on the EH website. If you are interested in that plan ask the EH agent if you can get it.

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  17. I have scanned the blog and am more confused than I ever was. My 81 year old brain cannot absorb what really going on. All I really wanted was to find out what my two dental plans available would cover. But I really had no real good answer. I came here for help, and see that others are as confused as I am. IBM has really given us a mountain to climb - and I'm just not up to it.

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  18. I just finished a call with EH - and was just trying to find out the particulars of dental plans so that I could compare costs et al. After waiting a long time and listening to the awful music the last ad on the wait line was "check your policy carefully." When I got to the agent, he was not helpful in telling me how to get a copy of the policy from Delta and Human other than a phone number for each. To compare, the number that is 50% of has to be known. This is kept secret as far as I can tell or as far as EH is concerned. Now more and more wasted time on the phone. I really do not like this kind of choice. EH should be more helpfu.

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    1. The dental plans EH offers are exactly what is available in the open market. There are number of plans offered by Delta Dental, Humana Dental and AARP/UHC. The ones offered by EH are the worst of the lot. The best seems to be AARP dental insurance but it is not even close to what we had with MetLife Dental. You cannot buy a plan like that unless you are part of a group. The VA is offering a low income Veteran dental insurance plan but you must be LOW income. When I say the AARP plan is the best of the bunch - it is still not great. The premiums are high and the maximum annual coverage is $1500. So you are betting about $600 in premiums that you might get $1500 back for the dental work you have done. It doesn't seem like a good bet to me because to get that $1500 back you'd have to have extensive dental work and your total out of pocket would be significantly higher than just the cost of the premiums. Try this website to see if you can find something you like then call the plan and talk to them: http://www.insurancecompany.com

      IBM was not much interested in helping us have better choices for our health and dental insurance. The executives were interested in reducing the burden on IBM and increasing their bonuses for being genius about squeezing old people for money. It is a pity.

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    2. Correction regarding the VA MetLife dental plan. You do not have to be low income to get the plan. You do have to register with the VA health system and tell them your income. The income levels are only relevant if you use VA health services. Then you'd have to pay the highest copays if you are in "tier 8". For the MetLife dental plan the premiums are the same for all vets who have enrolled in the VA health system irrespective of income. The premiums are zip code based but are something like $25/month for $1300/year worth of insurance or $50 for $3000 and you can cover your spouse. I have a blog post that has the link to the MetLife site to begin the process.

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  19. I am 80+ years old.I have never been so confused in my whole life.
    I am enrolled now with an medicare advantage plan and i want to pay my premiums through extendhealth with the direct deposit authorization.
    I don't know what todo.
    I guess i have to hire a lawyer to help me.
    Anybody know the answer?

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    1. Do you have anyone to help you with this as it is a bit complicated. You cannot stay in your current Medicare Advantage plan because you did not enroll in it using Extend Health agents. You must enroll in a plan Extend Heath sells and it cannot be the same plan you are currently using. That is the only way you will be able to get the IBM subsidy money to pay your premiums. You MUST call Extend Health as soon as possible and they will help you enroll. The only problem is they may not be able to give you a new plan which lets you go to the same doctors you go to today. Go to www.extendhealth.com/ibm and there will be information about how to contact them. You must talk to them. No lawyer can help you with this - what IBM is doing is not illegal. It is just unethical.

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    2. I just reread your comment. I made an assumption that you did not buy the Medicare Advantage plan through Extend Health so here is another answer if you did buy it from Extend Health. Although you bought the plan using Extend Health agents they are not a bank and do not have your subsidy money. IBM has it. The way you get that money is by being reimbursed for premiums and doctor fees you have already paid. You must first pay the insurance company and doctors. It's up to the Medicare Advantage insurance company you picked to tell you how to pay them the premiums. Some allow your premium to be charged to a credit card. Some will setup for the money to be taken out of your bank account. You can also have it taken out of your Social Security money but I advise against that option because it is hard to get out of doing it. You can ask Extend Health to Automatic Reimbursement the premium money back to you and they will submit the claim to IBM to get you the premium money every month but it is always AFTER you pay the insurance company. You can call Extend Health to set that up if you did not already do it. You must submit copies of the doctor bill you paid to Extend Health to get them reimbursed. If you have someone to help you do all of this it would be good as it is complicated.

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