Friday, December 20, 2013

IBM Extend Health Check Your Enrollment Status

After you enroll using Extend Health services, they send your application to the insurance company that sells the policy.  If the insurance company accepts your application they will notify Medicare of your enrollment.  Medicare then either accepts or rejects the enrollment.  If it is accepted, the insurance company will notify you that the plan has been accepted and they are also supposed to notify Extend Health that you have successfully enrolled because they then have to pay Extend Health a commission for the policy you purchased.
A reason an enrollment might not be accepted by an insurance plan is mostly for medigap insurance.  If you try to enroll without any special enrollment period and have preexisting conditions in most states they can deny you. A reason Medicare might do it is if they think you already have coverage a different way.  So, for example, if you tried to enroll in a Medicare Advantage plan that included prescription drug coverage and also a part D insurance plan - Medicare would reject one of those enrollments because you cannot enroll in two part D plans.
You will know you have successfully enrolled in an insurance plan and are setup to get your subsidy from Extend Health if several things happen:
  1. The insurance plan tells you that you have been enrolled.
  2. Your profile is updated on Medicare's database . You can call 1-800-Medicare if you want to check your 2014 enrollment because the Medicare website will only show the plan you are using for 2013 - and it only applies to Medicare Advantage and part D insurance. Medigap insurance updates probably won't be accepted until January 2014.
  3. Your EH website profile shows that your application is completed.
  4. EH sends you a letter saying you have been successfully enrolled.
I have successfully enrolled.  However, my spouse's application is still "open" on the Extend Health website which means EH has not been notified by the insurance company that the policy is accepted.  However, my spouse's insurance company sent us a letter on November 8th saying the policy application is accepted.  On November 20th I check the EH application status and when I saw it was "open", I emailed Extend Health and they told me it takes a couple of weeks for the insurance company to notify them. I was surprised because the insurance company for my plan was quick to notify Extend Health that my plan was accepted.  Well, here it is December 20th and the EH website application status is still "open".  I just sent a second email to Extend Health telling them we are concerned about the status.  I am doing this to build a case so if they try to deny my spouse's subsidy we have proof we did everything "right" and can complain to IBM so that we can get the subsidy.
I am also doing this so that if something really messes up I can file a grievance with Medicare that Extend Health is not acting as a proper insurance agent on my behalf.
Now that we are in the individual Medicare insurance marketplace, it is extremely important to keep a record of every conversation you have with Extend Health (who is your insurance agent), your insurance provider, Medicare agents, Social Security agents and any other government agency agent you contact.  You must get names of the people you talk to and what you heard - down to time of day you heard it.  That is the evidence you will need if you have to do an appeal with Medicare for either inappropriate marketing (EH), claims denials (insurance companies), misleading information that caused you to make poor insurance choices (government agencies and/or EH) or grievances such as for poor customer service (EH and/or your insurance provider).
12/26/13 Update:  EH responded to my email by calling to tell me they had received notification from my spouse's part D plan so the application process is complete. How coincidental that they got notification shortly after receiving my email.  Amazing ... isn't it?   I looked on the EH website to be sure it had been updated and it was.  Finally, we are both set up to get our HRA subsidies.  It only took 2 months of work to do it! I should send a bill to IBM for project management services.

Friday, December 6, 2013

IBM's latest HRA Beneficiary letter is laugh out loud funny and pathetic

When I got the mail today I saw both my spouse and I had received yet another "Important Information About Your IBM Benefits" letter.  When I saw the letter I immediately wondered what new way they thought of to squeeze more money out of old people.  And, they are indeed squeezing away.  They are now at the bottom of the barrel scrounging for nickels and pennies.
Both my spouse and I worked for IBM so we each get our own subsidy. IBM just informed us that we are not eligible to leave survivor benefits to each other.  HOWEVER, if we do not return the form selecting NO survivor benefits our HRA will still be reduced!  Also, if we had a dependent and wanted to leave survivor benefits to that dependent - only one of us is allowed to do so. 
We had no intention of leaving benefits to each other as it made no sense for us since we are both in good health (knock on wood).  But, we do know a couple where the very ill spouse was going to do it so that the remaining spouse would get the extra benefit.  My guess is other couples had decided to do the same thing.  It must have messed up the "steal money from them" spreadsheet numbers and the bonus increases that would come from stealing old people money - ergo, this iteration of letters was sent out to make sure we understood the money is theirs and to not mess with it. 
This latest action by IBM has moved the whole "transition" into the realm of being a ten act play in the Theatre of the Absurd.

Thursday, December 5, 2013

IBM Medicare Extend Health --- Where to get HELP beyond going to IBM or Extend Health

I posted this entry in 2009 but I think people are not looking at old entries so I am reposting because the IBM Service Center and Extend Health are not doing a good enough job helping people through this complex transition.  IBM retirees did not typically need to know all the ins and outs about Medicare because IBM provided some great plans.  Sadly, that is ending and the burden is on us to become educated.  I hope the following information helps you begin to understand and navigate the world of Medicare:
Unlike private health insurance, Medicare is a government owned and managed health insurance system. Even when you used IBM group health plans IBM offerings for primary coverage (that is, original Medicare or Medicare Advantage plans) were still regulated by Medicare law.  What that means is congress passes laws that dictate what coverage a doctor or supplier is able to provide. Medicare Advantage (aka private plans) are bound by that coverage law - they can only fiddle with who provides services or whether they think the medical procedure is necessary for your treatment. This sounds onerous and sometimes it is. If healthcare professionals break the law the government can prosecute them. Some examples will demonstrate how laws impact your medicare coverage.
Suppose you need to be on an oxygen support system. Choose wisely because once you pick an equipment supplier you have to keep that same supplier for 5 years. That's because there is a law that was passed in 2006 to lower Medicare costs. It is structured to have Medicare provide the supplier with monthly payments for 3 years for the equipment. After 3 years the supplier is only paid for maintaining the equipment. At the end of 5 years you can get a new oxygen support system from a different supplier. If you want more modern equipment or to switch suppliers any time during the 5 years you have to pay for it totally out of pocket.
There are a myriad of rules and regulations regarding fees and billing. Doctors are not allowed to bill you for services over and above 5-15% (percentage depends on the state) of what Medicare says is the approved amount for that service. If the provider tries to charge you more that is Medicare fraud. Medicare Advantage plans are also required to cap fee for services at the same rate as original Medicare - but are allowed to vary your copay so they can have higher copays for specialty services and lower copays for routine services.
Another important rule pertains to using a skilled nursing facility to recuperate from an illness. You MUST go to the facility from the hospital and need to have been in the hospital for at least 3 days. Otherwise Medicare will not cover it. It is the law. Nor will your private primary (e.g., Medicare Advantage) or secondary (e.g., medigap) medical insurance cover it - because it will have been denied by Medicare. Just as with any law - ignorance of the law does not absolve you from suffering the consequences. These laws are constantly changing or being amended. Each time you face a given situation you have to ask questions before you agree to anything -  do research to determine what rules currently apply.
How can you possibly know all the rules surrounding Medicare healthcare? You can't. Even healthcare professionals regularly give out wrong information. Unless you see it in writing don't believe it. Sadly, even the government infromation hotline 1-800-MEDICARE is not foolproof - they give a lot of wrong answers. The burden is on the patient and the family to do research for a given situation. It can take a great deal of time but the payback for knowing the rules can save you a great deal of money.

There are a number of agencies - both government and non-profit - that will help you find answers. Make sure the agency is legitimate as there are also a lot of scams around. What follows is a list of some resources:
  1. 1-800-Medicare and/or
    This is the government official hotline and website for Medicare. The hotline people are good - but overwhelmed (and with the boomers coming along will likely be more overwhelmed) so their answers are as brief as possible. It is a 24 hour service (to cover Hawaii and Alaska) and the best time to call is late at night to get better service. The website is really excellent but complex. There are many reference documents on the site that are excellent but you have to search to find them. Take the time to learn the site.
  2. CMS centers for Medicare and Medicaid -
    This is the government agency that ADMINISTERS Medicare and Medicaid. The actual services are provided by regional private agencies that the government hires to do the paper work. You get your quarterly Medicare medical statements from CMS. There is a huge amount of information on the website as well as data bases that detail Medicare coverage and fees. Many "white papers" detail specific situations such as "Who Pays First" which is about when Medicare is secondary insurance (e.g., if you work past 65 and have employer coverage). There is also something call "local coverage determinations" that details what procedures have been approved by regional administrators.  That information is hugely helpful if you are appealing an insurance plan denial.  But it is hard to navigate and typically you need experts to help you find the right information - such as the Medicare hotline agents.
  3. State Health Insurance Assistance Program -
    This is a national program to help seniors navigate the Medicare world. It is a federal mandate that each state must have the agency and typically the states setup the agencies within the Department of Aging. This is an important resource because the rules about how Medicare medigap insurance is administered differs from state to state.  There are also some special setups such as Medigap Select programs that states have setup. They will also know about state unique assistance programs, clinics and charities designed to help seniors.  Generally the agencies are referred to as state SHIPs. However, states have a habit of giving agencies unique names - for example in Florida the agency is call "SHINE", in New York City it is called "HICAP". Some states have great agencies and others ... well ... they staff with mostly volunteers that are not well trained. If you are getting mediocre assistance press the agency to give you someone better to work with.  They will do it if you make noise. The site above will provide the phone number of the agency in your state.
  4. State Pharmaceutical Assistance Program - part D insurance help
    About 40 states have programs to help low income seniors cover their drug costs. You can find the program in your state by going to . It is unlikely IBM retirees will meet the income eligibility requirements but there is some useful Medicare D information on the site. You also should look into getting a prescription discount card in case your Rx is denied by your current insurance and you lose an appeal.  Sometimes the state offers one.  There is a non-profit that offers one at - you might also want to price your drugs using the prescription discount card versus your insurance as sometimes you'll get a better discount.  The negative side of doing that is the cost of the drug will not be included in the "doughnut hole" computation.  If you use a lot of drugs it is likely unwise to use a prescription drug discount card.
  5. State health insurance information for consumers -
    Most states have complaint data about health insurance companies and particularly about HMOs. Before selecting a Medicare Advantage or medigap program look at how they rate on your state insurance website ( in NY it is  There are also star ratings for Medicare Advantage plans in the Medicare publication "Medicare & You" that  is specific to your state and you receive the boook every year.
  6. Medicare Rights Center 1-800-333-4114 and
    This is a national non-profit organization that provides advocacy and helpline support for Medicare questions, help finding part D plans, help understanding medigap and medicare advantage plans.  The agency is not affiliated with the government but often testifies in congressional hearings as well as provides evidence of consequences of poorly structured laws. Occasionally case advocates will help clients navigate the appeals process if they feel you have been unjustly denied coverage. The helpline is mostly staffed by volunteers so the answer quality ranges however, the full time staff reviews all the call notes will call you back to try to remedy any bad answers. The regular staff does the case work and there are staff as well as volunteer lawyers that help. They will also help low income clients enroll in low income subsidy programs. The information search website ( aggregates medicare information and provides links to other support sites. It is excellent

Wednesday, December 4, 2013

IBM Medicare Extend Health - More about Dental Plans

It is turning out to be way more difficult to find solutions for dental insurance than it was for health and prescription drug insurance.  Several people have been looking at various plans.  Here's what they have found out -----
The dental plans offered by Extend Health are just about the worst plans in the marketplace. Even some of the EH agents have told retirees what EH offers stinks! That's not to say other plans in the marketplace are much better. It seems the one AARP offers is the best of the lot but even then - the premiums are high and they will only cover cleanings and simple fillings for the first 6 months you own the policy. So, if a tooth fails you are SOL to have it fixed before June. And it caps at $1500 payout for the year. 12/6/13 - I just saw that EH added two plans offered by MetLife but I don't think these offerings are "offering" much.  It is also very frustrating that we find out what EH is selling by word of mouth or going onto their site.  Once enrolled, who'd  want to go back and keep checking the EH site to see what else is being sold!
Someone just told me about a group plan that is interesting ---- IF your dentist accepts it (mine accepts no plan). You pay Cigna a flat fee for the year (something like $130) to become a member of Cigna's dental insurance group. That entitles you to get the Cigna negotiated dentist rates from a dentist in their network. You pay the dentist whatever the negotiated rate is for a given procedure. For example, if a typical cleaning is $120 but the Cigna rate is $90 that's what you will pay the dentist - again, only if the dentist accepts the plan.
If you want to know more about the Cigna plan go to
There is another website that describes the myriad of dental insurance plans available to individuals but, as I said, none are particularly great ---
I already posted a blog entry about the VA dental plans available if you or your spouse are veterans.  They are the best plans I have seen so far because they are group dental insurance plans. It turns out they are available no matter what your income level as long as you served in the military and enrolled in the VA health system before 2004.  After that time, if you try to enroll the VA will not even let you register  in the VA health system if your income is too high (over approximately $50,000 annually - it depends on your zip code). There is also a dental plan for veterans of foreign wars who were in combat that does not appear to be income based.  However, you must prove you were in combat.
It's a pity that IBM wouldn't even give us the option to buy into the MetLife group plan since they had to know the individual dental plans stink.  I am not surprised - just continue to be disappointed in IBM.
I, personally, will skip buying dental insurance and basically self insure for as long as I can afford to use my existing dentist.