Thursday, October 3, 2013

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.


  1. We are kind of a unique situation as we have been fulltime RVers for the past 13 years and are still listed as Texans. However, we plan to switch to Florida when we buy a place there. But we still plan to be on the road 6 months a year. The wording in this post concerns me re plans covering a geographic area. Never had that problem with the Aetna Traditional Medicare Integration Plan. It was my understanding that medigap plans cover the 20% not paid by Medicare and I never understood that it was localized as with an HMO. It's the reason we have gone with medigap plans and not an advantage plan.

    1. As long as you didn't switch medigap insurance companies the plan goes with you. Aetna acted as a national plan. Sadly, it's gone. I assume your permanent residence is Texas. So, you are kind of stuck. I think you should call the Florida SHIP ( will have the phone number) and ask them what to do. If I come up with more ideas I will post another reply.

    2. “Rich,” first and foremost, as “PLATO” has stated many times, you are an excellent candidate for a Medicare Supplement (Medigap) plan, for example either a Plan F or Plan F High Deductible, as these plans offer consistent NATIONAL coverage with ANY provider that accepts Original Medicare.

      Unfortunately plans can NOT be “sold” or “bought” across state borders, thus you MUST enroll in a plan available in your state / Zip Code / county. For example, as a resident of Texas you can not enroll in a Medicare Supplement plan offered by BC/BS of NC as it NOT available to you, although the COVERAGE you would have, by law, is the same.

      You can keep your current Medigap policy regardless of where you live as long as you still have Original Medicare. If you want to switch to a different Medigap policy, you will have to check with your current or the new insurance company to see if they will offer you a different Medigap policy.

      The EXTRA coverage provided by a Medicare Advantage plan can vary significantly from one area to another. Also companies and plans in one area may not be available in another. Keep in mind, some Medicare Advantage PPO plans have reciprocal in-network coverage outside the plan area, for example in some other states. This is why as “PLATO” and I say, you MUST understand the coverage offered to you.

      There are often six month residency limitations/requirements in plans. When you move permanently, CHANGE YOUR HOME ADDRESS, if you follow the special circumstance guideline, you may be eligible for a Special Enrollment Period (SEP #8) during which you may be able to switch to a “new” Medicare Advantage Plan or Medicare Prescription Drug Plan for example.

    3. I'm not sure how this will play out. I don't have any interest in Advantage plans. I called EH and got the same info you just gave, that the medigap plans are national. It's the cost of the plans that is determined by where one lives.

      We decided after 13 years living on the road in our motorhome to buy a villa in FL which we closed on back in March. However, we hit the road and are still listed as Texans. We've had a legal address as part of the Escapees RV Club in Livingston. The plan was to become Floridians when we returned to Florida which will be in a couple of weeks so we can get the homestead exemption for next year's taxes. I doubt that will be done by the time I have my appt with EH. We have until Dec 31 to become Floridians for tax purposes. I need to figure this out. Rates are less in TX.

    4. I am sorry I tried to answer you too quickly in my last reply. You have a guarantee issue to buy a medigap plan 63 days after the plan you now have terminates (ergo, Aetna Integration). You have until the end of February to buy a medigap plan where you cannot be denied so you do have time to figure this out. Now, you probably don't want to do that because you'll not have secondary coverage for two months. Where should you buy the plan? In the state that has the lowest premium because the medigap goes with you when you move. So, if you can get a cheaper plan in Texas then buy it in Texas. However, I suggest you first call the Florida SHIP ((800) 963-5337) and find out if you can buy an entry age rated policy for age 65 because you have had continuous secondary coverage and your old plan is terminating. Also, ask what the residency requirements are for Florida. Finally, ask them what the policy prices are. It might be that Florida medigaps are cheaper if they let you use entry age rating.

    5. “Rich,” thank you for the good “conversation” on “PLATO'S” excellent blog. Sounds like you have options with important TIMING considerations which may work to your advantage - no pun intended as you are not interested in a Medicare Advantage plan.

      To specifically address another point in your original comment, Medicare Supplement (Medigap) Plans are NOT localized and do NOT work like a HMO plan as the coverage provided is NATIONAL and to reiterate may be used with ANY provider that accepts Original Medicare as “PLATO” has often said. Please see my comment above for comments about switching plans, which may become applicable to you..

      A theme of the blog post which “PLATO” graciously posted is that you may only ENROLL in a plan offered/available to you based upon the state / Zip Code / county of your residence at the time of enrollment. The actual COVERAGE or service area - or provider network with some plans - is defined by the plan in which you enroll.

      As “PLATO” and I encourage you to do, you SHOULD carefully review plan information BEFORE enrolling. This leads me to saying you should look at information specific to plans available to you, and an excellent source source of factual information accurately and comprehensively summarizing the plan is the PLAN BROCHURE (see original blog post).

    6. Seems to me that my best option is to buy policies in TX before we 'move' to Florida. ;-)

      I'm very familiar with such moves. I retired out of Atlanta. We sold the house, bought the motorhome and hit the road. GA has an ad valorem tax and wanted $2100 to put the motorhome on the road. I had done a lot of research my last 2 years of work and knew about RV friendly states. We chose TX to 'move' to. I told people we were faux Texan and lived in a mail folder. :-)

      Thanks for the help.

    7. “Rich,” a couple of additional points. Your strategy makes sense in your situation, and may give you the maximum number of choice options as “PLATO” and you have discussed. While I do not know all of the specifics of your situation, let me mention the following points, some, or all, of which I am sure you may already know:

      1) When talking with an Extend Health adviser, I would recommend making sure the adviser (agent) you talk with is licensed in BOTH Texas and Florida,

      2) While you could reschedule your 11/2/13 appointment - either online or by phone - remember you do NOT need to enroll in any plan during this [initial] or follow-up calls. Of course you must complete the process by the appropriate deadline (see point 4), and waiting until the last minute is not a good idea,

      3) In addition to many first-line advisers, EH has specially trained/experienced people to handle unique transitional and/or out-of-the-ordinary plan scenarios. Depending upon how your initial enrollment call goes, you may want to request an “escalation” to an appropriate adviser familiar with your pending “move” circumstance,

      4) Remember, as “PLATO” has well-covered in various blog posts and comments, YOU, “Rich,” may be eligible for multiple OVERLAPPING enrollment (change) periods with significantly varying rules, including Medicare Open Enrollment, IBM EH enrollment, Special Enrollment Period (SEP) due to loss of IBM plan, SEP due to your permanent change of address, Medigap “switching,” and possibly several other enrollment or change periods - “eligible for enrollment or change” periods may differ for other IBM retirees and may include special Medicare Advantage change periods. The point to remember is that making a change under the rules of one enrollment/change period may preclude you from using another, thus, as you note, it would be best to work out all of the steps and TIMING of your strategy before proceeding to insure you ultimately have the plan(s) of your choice, which goes back to point 3, and

      5) Like YOU (“Rich”) and “PLATO,” I would not exclude evaluating YOUR “Texas option.”