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:
    
http://www.va.gov/healthbenefits/vadip/

https://www.metlife.com/VADIP/index.html
    
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:

http://www.vfwinsurance.com/veterans-dental-insurance.html

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.

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

I was looking at the www.ibmemployee.com 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.
  

  

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 www.medicare.gov 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.
    

   

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 -----
  

IF YOU TAKE NO ACTION YOUR HRA SUBSIDY WILL BE PERMANENTLY REDUCED EVEN IF YOU DO NOT HAVE AN ELIGIBLE SPOUSE OR DEPENDENTS 

  
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. 
  
 

    

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.

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 www.medicare.gov 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 www.medicare.gov 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 www.medicare.gov 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.

IBM Medicare extendhealth.com/ibm 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. 

IBM Medicare www.extendhealth.com/ibm 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 www.medicare.gov 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 www.extendhealth.com/ibm 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  www.medicare.gov  for the medigap policy finder at the top of the home page.Unfortunately, www.medicare.gov 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 www.shiptalk.org) 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.

IBM Medicare www.extendhealth.com/ibm 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.

IBM Medicare www.extendhealth.com/ibm IBM CHANGED THE RULES!!!! Part D insurance qualifies for HRA subsidy

THE PLAN PURCHASE REQUIREMENT HAS BEEN CHANGED. 

 IF YOU BUY A MEDICAL PLAN OR A PART D  DRUG PLAN YOU WILL BE ABLE TO ACCESS YOUR 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)

IBM Medicare www.extendhealth.com/ibm 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 medicare.gov 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.

IBM Medicare www.extendhealth.com/ibm 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". 

IBM Medicare www.extendhealth.com/ibm 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 www.extendhealth.com/ibm 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.

IBM Medicare extendhealth.com/ibm Helping You Choose a Medigap Plan

There is an OUTSTANDING brochure on medicare.gov that describes medigap insurance plans, enrollment rules and variations in pricing. 

    Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare    

         

After reading it I realized how big an impact this change will be for some people.  In some states if you bought a medigap plan when you first turned 65 you would not have to keep paying more for the plan as you age.  The price of the plan would always be whatever the entry price is for "65 year olds".  If you used IBM's insurance, I think you may have lost that right.  Call your state insurance agency (www.shiptalk.org has the phone numbers) to find out --- don't rely on Extend Health to tell you.

I know this is a lot of work but you have to be your own advocate to be sure you are getting the maximum benefit.  READ the medigap brochure on www.medicare.gov - your tax dollars paid for it:

http://www.medicare.gov/Pubs/pdf/02110.pdf

IBM Medicare extendheath.com/ibm Plan Verification Process

Someone just asked a great question that prompted me to give this advice.  Before you actually enroll in a plan offered through Extend Health make sure you are getting the coverage you think you are getting. DON'T rely on Extend Health's information. There already has been too much written about how EH agent quality is highly variable.
    
If Extend Health gives you bad advice you can complain to Medicare that you were misled. Extend Health is acting as the insurance agent for the plan and is subject to Medicare law. That's why they  record conversations.  HOWEVER, it is much more effective to file a Medicare complaint if the actual provider gives you bad information. REMINDER - IBM plays no role in this complaint process.  There is no point calling the IBM service center if something goes wrong.
         
If it happens - and you can prove it - you can ask Medicare for a special enrollment period to switch plans.  No matter who you talk to --- TAKE NAMES, DATES and NOTES about the conversation so that you have EVIDENCE of being misled. If you need to file a complaint you just call 1-800-MEDICARE and tell them you want a special enrollment to switch plans because the information you got about the plan was wrong.  They will then take you through the process.  But, that is onerous.  It is much easier just to double check before you enroll.
     
 There are a couple of ways to verify that Extend Health is providing accurate information.

1. Go to www.medicare.gov and look at the plan description for a Medicare Advantage medical plan and/or drug insurance plan you are interested in using.  Do both by using plan finder. When you do, you enter the drugs you take and Medicare will provide information about whether the plan does or doesn't covers your drugs. Take print outs of the plan information.
       
2. No matter what the answers are for step one - CALL THE INSURANCE PLAN.  The plans offered by Extend Health are STANDARD insurance plans offered in the open market.  For example, if you are choosing an AARP United Healthcare Medicare Advantage PPO plan through Extend Health - then that SAME plan will show up on www.medicare.gov in your zip code.  There will be phone numbers associated with the plans. Verify the information by calling the medical plan or the drug plan to confirm you are getting the coverage you think you are getting. There is one exception - for Aetna PPO a special deal was arranged to allow the insurance company to continue to offer the plan for two more years to retirees already enrolled in the plan in 2013.  That plan will not show up in medicare.gov. I believe Aetna is directly mailing plan information to enrollees.

      
The ONLY time you can be sure you are getting exactly what is being described by a plan is if you are buying a medigap supplemental plan for Original Medicare.  By law, those plans must provide the coverage that is associated with the letter of the plan.  Ergo, all N plans are the same, all F plans are the same, all C plans are the same and so on. 

IBM Medicare Extend Health Medigap Offerings Complaint to Dr. Rhee

I just sent an email to Dr. Rhee and copied Ginni.  I doubt it will do much good but thought I at least had to try -----

Dear Dr. Rhee,

I signed on to the Extend Health website this morning to look at the medigap plan choices Extend Health offers in my zip code and I am extremely disappointed by the selection they are offering. It is very limited and the associated prices for the plans are significantly higher than those offered by other insurance companies in the Medicare open marketplace. For many reasons, not the least of which is the ability to go to any specialty clinic in the United States such as the City of Hope or Sloan Kettering, I must stay on Original Medicare.

I specifically looked at the Extend Health medigap F high deductible offering in my zip code and there is only one plan available. It is also the lowest priced medigap plan that Extend Health is offering in my zip code so it is the cheapest medigap plan I am able to buy. It is priced at $115.86/ month and is offered by Humana.

I can get EXACTLY THE SAME insurance policy (as you know by law they must be the same) from THREE other insurance companies who sell medigap insurance in my zip code for as much as HALF that premium price if I were able to buy it in the open market. This is really onerous as you have made it a requirement that I MUST BUY A MEDICAL plan through Extend Health to be able to access my subsidy. I will now be forced to spend substantially more of my subsidy on premiums to get medigap coverage. WHY IS THAT A REQUIREMENT?

I thought you said we would be offered BETTER choices through Extend Health and you were doing this transition to help us contain our insurance costs. Given what I have seen so far what you are saying is not true as Extend Health is restricting our options because of your requirement to use their offerings.

Please reconsider how you have structured this transition and REMOVE the requirement that we MUST purchase a medical plan from Extend Health to be able to use our subsidy money. It is an unnecessary restriction that will cause many retirees to pay MORE to get the EXACT same coverage as can be purchased in the Medicare open market and thereby puts an unnecessary additional burden on retirees already reeling from this dramatic shift to Extend Health.