Wednesday, October 2, 2013

IBM Medicare 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 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 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 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. 


  1. Do you know if one can use the HRA for RX, dental, vision if one doesn't choose a medigap plan from EH. I know I wouldn't be able to use the HRA for the Aetna plan if I choose to go that way.

    1. You MUST buy a medical plan to be able to use your HRA $. The only type of plans that are medical plans are Medicare Advantage plans or medigap supplemental plans. Part D, dental and vision plans are NOT medical plans.

  2. I didn't focus on the words about Aetna. I was hoping it was the Aetna Traditional Medicare Integration Plan. I am so angry that they aren't offering that option.

    For me to get the same kind of medigap plan as the Aetna plan with no deductibles it will cost me around $203/month. TIMES TWO. So more than $4800/year for just the supplemental plan. I'm out $1800/year and $150/month right off the bat. And that doesn't include dental that was part of my $120/month deduction from my pension this year for both the Aetna supplement and MetLife dental. Figure another $50/month (guessing here) TIMES TWO for dental and 2014 will cost me around $250/month more than it has the past few years.

    1. You are right - the Aetna Integration plans were fabulous and nothing will match it. However, I suggest you look at medigap F high deductible. You might find (if you and your spouse are "well') that you'll break even as long as you stay well - so it becomes disaster insurance. But there is no denying it is a huge take away for those of us that used that plan. It was too good!!!

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    1. Good advice. To amplify on “PLATO'S” blog post, which I concur with, 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.

  4. Appears there may be a limit to the length a comment may be, thus this comment is a continuation of the one above.

    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.

    Appears there may be a limit to the length a comment may be, thus this comment will be continued below.

  5. Appears there may be a limit to the length a comment may be, thus this comment is a continuation of the one above.

    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. Thus, like “PLATO,” 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, as “PLATO” states, make sure you document the call.

    Keep in mind, for a variety or 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.

  6. Thank you, George. I am going to put all of that into a new post to make it easier for everyone to read because it is great information.