Saturday, October 18, 2014

IBM OneExchange Medicare 2015 Enrollment Directions

The emails and USPS mailings from IBM and OneExchange over the last week that couldn't be more confusing.  It's easy enough for me to confuse myself - I really don't need any more help.
There is an implication that we must "do something" to keep getting the IBM HRA/FHA.  If you already enrolled in a medical or prescription drug plan through OneExchange aka ExtendHealth  in the last 12 months then you don't need to "re-enroll" in the plan if it is still an active plan.
Here's when you need to "do something" regarding OneExchange enrollment: 
  • The Medicare Advantage or prescription drug plan you use will not be offered in 2015.  Then you need to find a new medical or prescription drug plan.
  • Your Medicare Advantage or prescription drug plan (PDP) will change in 2015 and you don't like the changes.  For example, the premium is increasing, the formulary is changing or the Medicare Advantage plan is changing their doctor network and excluding your doctor.
Although you don't need to contact OneExchange and do anything - I suggest you call them to verify you don't need to do anything.  Make notes on when and who you talked with and what they said.  That is just a little preventative medicine in case you need to file a complaint with Medicare because OneExchange screws up.  Remember ... OneExchange is an insurance agent to Medicare.  As such, if you find they have screwed up your enrollment and put you in a wrong plan or dis-enrolled you can appeal to Medicare that you were misled by an insurance agent and get it fixed.  But you need names and dates to make a good case for it.   If OneX screws up and denies access to your HRA you need that information to file an appeal with the IBM Plan Administrator that you were misinformed. 
I also want to keep reminding you that Medigaps aka Medicare Supplemental insurance policies for participants who use Original Medicare are not part of the Medicare Fall Enrollment process.  There are very specific rules for when/if you can enroll/dis-enroll in Medigaps.  You MUST look at your state rules for those policies. DO NOT make any changes until you know the full consequences of those changes.

Sorry to say - you have to have an advocate to be sure this stuff is done correctly.  I keep trying to educate my children on Medicare and my IBM HRA just in case I can't be my own advocate as I get older. They mostly ignore me but I know some of it is sinking in.


  1. I called the IBM service center, and they said the letter indicating you had to "do something" to have coverage, was in error. I will call OneExchange,though, as you have suggested, to tell them I want to keep my plan for 2015.

    1. Hurray for IBM - I received a letter yesterday confirming they made a mistake! How nice! If only they would say the contract with Towers Watson was also a mistake. Wishful thinking.

  2. Medicare Supplement (Medigap) can be changed any time of the year. It is Medicare Advantage (Medicare Part C) and drug plans (Medicare Part D) that adhere to a strict enroll(Oct. 15-Dec.7)/disenroll(Jan.1-Feb.14) schedule.

    1. Hi, Stuart. Sorry, but what you wrote is WRONG. Medigap rules are regulated by state laws. So you must look at the rules for the state where you purchased the policy. What you wrote is true only for a few states (e.g. New York State). For example, in California changes to medigap policies can only be done for 30 days in the month of your birthday. Also, when a change is made it is not effective immediately. It is effective the first day of the next month. To find out the rules for a given state call the State Health Insurance Assistance (SHIP) state agency. The phone numbers are listed at

  3. One other Issue you must consider and that is Underwriting if you choose to change policies. If you recall we were all exempt from underwriting when this first started in the late fall of 2013. The reason being that there was a major change in how Health Care insurance was offered to us. Since we were under the IBM umbrella prior to IBM deciding to dump Medicare eligible retirees over to getting our health care policies from one of the many health care exchanges available. Of course we were steered to One Exchange(Extend Health) with the inducement of the HRA. When I applied to Humana for my 2014 Medigap Policy they waived underwriting because I furnished them the following documents at their request.
    The IBM letter dated August 2013 that detailed IBM's plan to dump us.
    2.My present IBM/UHC Health card.
    3. My current Humana application.
    I go into the detail of this because some of you, if you are like me, don't remember all the details from 2013.
    When it came time to re-enroll for 2015 I ran the numbers from my Medigap Hi-Deductble Plan F and looked at other Medigap Plans and Plan N looked good for what I spent in 2014 for premiums and health care costs. I use eHealth as my exchange for my medical insurance. These reps are good. The eHealth rep asked me what my present health condition was and it is not good at all. Since I worked with eHealth for 2014 policy the rep knew I did not have to do underwriting with Humana. However, he explained that if I wanted to switch within Humana or go to another carrier, that Underwriting would occur. He cautioned me that it was a very good chance that I would not pass underwriting or if I did my premium cost would be astronomical. Now I could still have applied, because you do not cancel your present policy until you have an approved application with the premium clearly stated before you cancel the policy in force. I called Humana and discussed this with them and they did everything to discourage me from even taking the time to apply because of me very serious health condition. I made the decision to keep my Medigap Plan F Hi-Deductible for 2015.