Saturday, October 18, 2014

IBM OneExchange HRA/FHA 2015 Disbursements

A recent mailing from OneExchange about Medicare part B premium recurring reimbursements couldn't have been more confusing in both the content and the timing.  There is no explaining why they chose to send out that mailing now.  It seems to me they could have done it months ago. People are confused enough right now about whether or not they need to do anything for enrollment.
  
Here's the deal on HRA reimbursements.  You can get reimbursements two ways.  It can be recurring or you can file for them yourself.  You can get reimbursed for bills such as your insurance premiums, your copays (aka coinsurance), doctor bills for doctors that do not take Medicare.  Medicare part B premiums are just "insurance premiums".
 
In an earlier post I mentioned that people who could afford to "pre-pay" insurance policy premiums for an entire year and then submit the claim to OneExchange to be reimbursed were able to very quickly "drain" their HRA accounts and were done with any reimbursement paperwork by February. However, you cannot do that with Medicare part B premiums.  The federal government is not setup for "prepay"!
  
Reminder for those people who retired before 1997 and get SHAP reimbursement for part B premiums up to a maximum of $900 - you can only apply for reimbursement from OneExchange for the remaining amount of part B payments you make ($358.80 if your part B is $104.90 in 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.