Saturday, October 17, 2015

IBM Medicare plan finder for 2016 Open Enrollment and Aetna transition

On Thursday, 10/15/15, the Fall Open Enrollment began for Medicare.  This is the time of year you can change to a different Medicare Advantage plan, original Medicare or a different part D plan. The changes must be made by midnight December 7, 2015 and are effective January 1, 2016.
A subset of  IBM Medicare eligible retirees were allowed to stay on the IBM Group Heath Insurance Aetna (HMO or PPO) for the last two years and didn't use OneExchange.  This year they join the club. The IBM Aetna plan is terminating at the end of December 2015 and the retirees must now deal with OneExchange to buy at least one health insurance policy (Medicare Advantage, Medigap or part D) before the end of the year to get their HRA.  I just helped someone who is dealing with this situation and it was a little unsettling.
What IBM did for this group of people is more than a little patronizing.  They automatically enrolled eligible retirees into a 2016 individual Aetna Medicare Advantage plan which includes prescription drugs and sent out new health plan cards. These are plans ANYONE in your zip code can buy if it's available.  There is no unique IBM benefit in these plans. She thought she had the same IBM Aetna plan and just was getting it through OneExchange.  I bet that is the norm. The new plan was not a good fit, particularly for her drug coverage, so we worked through some options and decided original Medicare with a Medicare Supplement and a separate part D plan provided better benefit. I highly recommend affected retirees scrutinize the new Aetna plan to be sure it provides the right coverage. Another aspect to consider is that Aetna will be merging with Humana. Customer service is likely to be a nightmare in 2016.
The words used in the IBM letter said the new Aetna plan was a "comparable plan" but did not include dental nor vision coverage. Comparable is such a nice, empty word. It's like saying two houses are comparable because they both have bedrooms and bathrooms.  If these retirees do nothing, from Medicare's perspective, they're enrolled in the Aetna plan effective January 1, 2016. Technically, those retirees would have until the end of February 2016 to select a new plan because they have a "Special Enrollment Period" (SEP) from Medicare if they hadn't been automatically enrolled. Maybe it was just a kind gesture? It would have been a risky choice for anyone to wait until January or February of 2016 to select a new plan and be uncovered until the next month. By being automatically enrolled, those two months of the SEP are now gone because they now have a 2016 plan. Maybe if they call 1-800-MEDICARE and demand to be dis-enrolled they will get the full SEP.  I don't know if that is possible.  I suspect IBM did the automatic enrollment to give OneExchange significant commission from Aetna because they will be the insurance agent of record for those automatic enrollments. They know many elderly people will not understand what happened and take no action. I wonder if it is legal.  The bottom line is make sure you get the plan you need and not the plan IBM decided you want. Your SEP gets a little complicated. I believe you have until the end of December to pick a new plan.  But, after December 7th (the Open Enrollment period end), I think you can only enroll one time in a new plan, meaning you cannot keep changing your mind after December 7th.
This Open Enrollment  I need to switch to a new part D plan for my spouse and myself for 2016.  My spouse's current PDP plan does not cover a new drug.  My plan provides the lowest price only if I go to a Walmart pharmacy, which is the preferred network pharmacy. It is nine miles away, in a busy city and the service leaves a lot to be desired.  I always find a reason to go to a non-preferred pharmacy two miles away and pay a higher copay! Obviously, it isn't a good plan choice for me.  The basic advice is chose a part D plan with the lowest total of annual premium and drug costs that meets your needs. 

My approach to choosing a new part D plan was to first use the plan finder on  I use that tool because it is the "official" Medicare plan finder.  If there is wrong information in the results from the federal government plan finder I can file a complaint with Medicare.  It also provides information on ALL the part D plans available in my zip code. OneExchange will only show part D plans that pay them commission (reminder - OneExchange is an insurance sales agent)! After deciding on a PDP plan, I went to OneExchange to see if they sold it.  It was on their list so that makes our part D switch easier since we can enroll through OneExchange and setup automatic premium reimbursement with one phone call.
If OneExchange did not have the plan, I would enrolled in the new PDP online at as there is an "enroll" link in plan finder.  If you don't like doing that then call 1-800-MEDICARE to enroll.  I do not recommend calling the insurance plan to enroll. They will likely try to up sell you to a Medicare Advantage plan and/or might enroll you in the wrong PDP or, worse still, a Medicare Advantage plan, by mistake.  It is misery to correct those problems because there is no easy way of proving it's wrong. They keep a voice recording of you agreeing to enroll.  If you enroll through Medicare it is far easier to correct any mistakes made by customer service.  As usual, be sure you make notes on the day, time and agent who helped you.  That's also true for OneExchange.  The new plan will send enrollment information within a couple of weeks.  Don't wait until late November to enroll.  Enroll early to make sure you got the plan you wanted and/or the information matches the information you saw online.  If not, you have time to correct it because you can enroll as many times as you want until December 7th.
I decided we will both enroll in the same part D plan because my spouse delegates insurance problem resolution to me!  His current plan wasn't particularly easy to work with and neither was mine. With both of us on the same plan at least I only have to learn one plan!  Oh, the joys of problem resolution.

Speaking of easy to use, the plan finder is not easy.  There is a lot of information but it is mostly designed for an experienced user.  Social workers and Medicare advocates navigate it very well.  The casual 65+ year old user experience is frustrating.  For example, it seems if you enter at least one drug even if you don't take any drugs (like Lisinopril) and select only one pharmacy in your zip code, plan finder will give you more information about plan choices and plan details. There is also some important "lingo" that you need to understand:

  1. Pharmacy networks
    How you fill prescriptions is an important aspect of choosing the best part D plan. Plans might have out of network pharmacies that will not accept your insurance plan, in-network pharmacies that will accept your plan but at a higher copay price, preferred in-network pharmacies that will accept your plan at the lowest copay price, and mail order pharmacies. Not all insurance plans use a network pharmacies structure. The plan status of a pharmacy you select will be displayed in the plan finder results.  Beware, the results you see may not show a plan's "lowest price" pharmacy unless you happen to select it. Before you enroll in a plan, find out which pharmacy offers the lowest price so you can do an accurate comparison of plans. If you cannot easily find it, call the insurance company and then run plan finder again with that pharmacy.  Also, it seems if you select more than one pharmacy, plan finder will show a subset of the plans available in your zip code which are best match to the pharmacies you selected. That's why I recommend only picking one pharmacy because it doesn't do that if you pick only one pharmacy.  I cannot provide logic for why and it is worthy of a complaint to Medicare. 
  2. Drug Tiers

    Drug tiers are categories that relate to prescription copay pricing. There are typically 5 tiers or categories for drugs. The higher the tier number, the higher your copay. Plans change the tier for a drug from year to year.  That's why it is really important to run plan finder every year to be sure you are getting the lowest price for your prescriptions. Each insurance company defines what their tiers mean and decide where to slot a drug. A drug might be tier 2 in one PDP and tier 3 in another PDP.  All the plans might put the drug into tier 2 but tier 2 can mean something different in each plan.  On the first screen for PDP results you will see a box that describes the deductible and the plan tier information in summary.  It isn't very helpful, doesn't say tier and looks like this:
        Drug Copay/ Coinsurance: $1 - $4, 20% - 35%.     
    The interpretation for that line is tier 1 & 2 drugs copays range from $1-$4, tier 3-5 coinsurance ranges from 20% - 35%. Really clear, right?  To see a plan's definition of tiers you must enter a drug (even if you don't use drugs).  Click on the plan name and go to the screen showing the details of the plan and the cost of the drug. Scroll down to find a link that is titled "View Drug Benefit Summary" (it is after the bar chart of drug costs) to get tier details. The detail will also help you better understand the plan's pharmacy network structure. I made a copy of a couple of tier structures for 2016 as examples:
  3. Drug Formulary
    The drug formulary is the list of drugs the plan will cover.  It's really important to find out if a drug is covered.  The plan finder results show with a "yes" or "no" as to whether all your drugs are covered by a plan.  Even if the plan shows a "no", in the details of the plan, the results will include the cost of the uninsured drug in the total yearly cost calculations.  It was designed to be helpful but I think it is confusing. You can apply a filter (on the left side before clicking to see plan details) to only see plans that cover all your drugs.  If you decide to use a plan that does not include your drug on its formulary, the cost of that drug will not count in calculations for doughnut hole computations.  That means you'd exit the doughnut hole only based on cost of drugs that are covered by your insurance plan.
Do not get distracted by which plan has a deductible and which doesn't.  It is sort of irrelevant.  The two most important factors are making sure your drugs are on the plan's formulary and the total annual cost of the plan for each kind of pharmacy. Usually mail order pharmacies are cheapest for 90 day supplies. But not always. The second example above is a plan that has the same pricing structure for retail pharmacies and their mail order preferred service.  If you use another mail order service (a non-preferred mail order service) your cost would actually be higher than getting supply from a retail pharmacy!
Medicare automatically saves the prescription information you enter on plan finder anonymously to enable you to retrieve the list in a subsequent session.  The id and password to retrieve your drug list will show on the upper right side of the drug entry page.  Retrieve the list by entering the id and password on the drug entry page the next time you use the tool. If you make changes note the new id and password for the changed list. They'll save those lists for years.  The trick is for you to remember where you recorded the ids and passwords!

If you have prescription refill scripts with your 2015 PDP pharmacies and the new plan has a new pharmacy network,  at the end of the year (while you still have the old plan) ask the new retail or mail order pharmacy to contact the old retail or mail order pharmacy to have them transferred so you will have them available in January 2016 without having to ask the doctor for new prescriptions.

If you want to learn more about Medicare's plan finder there are helpful videos on the right side of the plan finder screen.  There are also some scenarios available to practice.  I tried those and did not find them particularly helpful but maybe I am missing something. There are 5 case studies with different situations and a link to the training at:
Happy Open Enrollment!




  1. your blog is a real time saver in navigating the joys of One Exchange. It was a nightmare when we had to make the switch in 2013. At that time we purchased both the medigap policies and the plan D policies through One Exchange. The only change we need to make this year is to change my mothers Rx plan to the preferred AARP vs the saver plan. Do you think we have to go through the fun of One Exchange to accomplish this?

    1. If the plan you want is available through OneExchange then do it through them. This way you can get automatic premium reimbursement and it will also be easier to argue with them if they mess up any copayment refunds. It'll be a little less onerous than 2013 because you know exactly what you want. If the plan is not available through OneExchange then all you need to do is either call 1-800-MEDICARE to enroll or do it online on Effective 2016, she will automatically be disenrolled from her current plan and switched to the new plan. You don't need to do anything else with either insurance company. To get auto premium reimbursement, you will have to file a form with OneExchange.

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  2. If I want to switch from one Part D plan to another, can I do this on OneExchange website, or must I schedule a phone call with OneExchange rep?

    Thank you for all your help!

    1. You have to call them. If you know what you want just call them (skip the schedule an appt part) and tell them you want switch and you know what you want. The reason you have to call is they want to record your voice saying you are buying the policy you picked. It is their proof that they did not make the switch without your approval. It guarantees they get their commission from the insurance company.