Thursday, December 15, 2016

IBM OneExchange Medicare Supplement K plan working well

This is the second year I used a "K" Medicare Supplement plan with original Medicare.  I am pleasantly surprised with the "K" plan. I have written extensively about the benefit of original Medicare and a Medicare Supplement plan (aka medigap) in other posts if you want to know more about the kind of insurance I recommend.

When I first bought a Medicare Supplement plan (in 2013 when IBM threw us out of their group health insurance), I was sure the best option was an "F High Deductible" plan.  I had a low premium for a policy that would only provide benefit when my out of pocket coinsurance costs went beyond about $2100. Some people call this "disaster insurance".  It turns out it was "disaster insurance" because the insurance company made many mistakes and it took an act of congress to get them to "activate" the policy.  I won't relive that story but if you are interested here's a link to that post:

After that experience I decided to try the K plan in 2015 because I wanted a reliable insurance company and AARP UHC has a good reputation.  Unfortunately they didn't sell a F-HD plan in my zip code. Turns out maybe that's not a bad thing. The K plan provides some insurance benefit (10% of coinsurance) until my out of pocket expenses are $4960 - then it covers all my coinsurance for the rest of the year.  That's a high deductible and it resets every year.  It takes a whole lot of being sick to reach that amount.  However, it took a whole lot of sick to reach the "F-HD" deductible of $2100 too. By the time it was met in 2014, the medigap year was almost up so there wasn't a huge amount of insurance benefit from the F-HD plan before it reset.

The premium for the "K" plan in New York is about the same as the "F HD" plan premium I purchased in 2014 and is about $80/mo.  However, this year the K plan paid about $500 of my coinsurance cost.  That's about $40/month I didn't have to pay out of pocket making the effective rate of my disaster policy about $40/mo. If I had used an "F-HD" plan I would have received NO benefit because my coinsurance and part B deductible costs for the year were about $1200 which is well below the F-HD deductible amount.
If you buy an F-HD deductible medigap it is likely your policy deductible will reset before you get much benefit unless you start accruing medical bills in the beginning of the plan year or you are chronically ill.  If you are considering something like hip or knee replacement, do it in the beginning of the F-HD medigap year to maximize your chances of receiving benefit for that year.  There is sometimes confusion over WHEN a medigap deductible year resets. It is on the anniversary of when you buy the policy.  (this was wrong - the deductible resets in January no matter when you buy the policy).

If you are reasonably healthy, the K plan is a nice option. However, if I could buy an F-HD medigap at the same premium price from a reliable insurance company I would switch back to it. I still think it is the best medigap policy to get unless you are chronically ill.  The bottom line is do the math to make sure you have the right policy and are not overpaying for medigap insurance.

Wednesday, November 23, 2016

IBM Medicare 2016 Prescription Discount Cards

During Medicare open enrollment advertisements abound about Medicare Advantage Plans, Medicare Supplement plans, part D drug insurance plans and ... prescription discount cards.  What do prescription discount cards have to do with Medicare?  Absolutely nothing. Prescription discount cards ARE NOT Medicare part D insurance plans.  They are not insurance plans at all.  They are not regulated except for laws about false advertising and fraud. They are merely a way to maybe get prescription drugs at a discount.  You have to buy a part D insurance plan if you want Medicare drug insurance.  Reminder, if you don't buy a part D insurance plan you will pay a 1% per month penalty for every month you don't have the insurance and only can buy it during the fall to be effective January of the next year.
However, prescription discount cards might be useful for Medicare recipients.  What are they?  The best explanation I have come across was written by an organization called NeedyMeds.   This is an organization I often recommend as they are dedicated to helping people reduce their prescription drug costs.  The organization website is  On that site you can get their prescription discount card.
When might you use a prescription discount card instead of your part D insurance?  The best reason is when you get a new prescription and it is not on your part D plan's formulary.  Another possible reason is the prescription discount card actually gives you a better price for the drug than the copay you'd have to pay using your part D plan.  However, if you do use the discount card instead of your part D insurance then the cost of that drug will not be included in your out of pocket cost calculation for your part D insurance and will affect when you enter or exit the doughnut hole.  I believe IBM's catastrophic drug benefit will similarly not include it.
Obviously, when a drug is not covered by your plan then the only choice you have is to try to get a discount to reduce your cost.  Manufacturer discount coupons are usually better than prescription discount cards.  However, they frequently have expiration dates.  You can usually find those coupons by googling the drug. There are also low income assistance programs offered by a lot of drug companies.  You can find them through the needymeds website.  Although your prescription discount card might not expire (I believe most don't), the discount you receive can vary from use to use and/or from pharmacy to pharmacy.  Not all pharmacies accept a given discount card.  I suggest trying several different discount cards with a pharmacy to see if one is better than another each time you refill a prescription not covered by your part D plan.  There is a wrinkle to that suggestion.  Some pharmacies won't do it. Try to go to the pharmacy when they are not busy and they might be willing to check several cards.

There is one more caveat about using a prescription discount card.  The pharmacy might make a mistake and use the discount card instead of your part D plan.  In one case, I helped someone whose pharmacy even told the part D insurance that the client was canceling his part D insurance because they thought the prescription discount card was his new insurance (the pharmacist was new). The client then faced a part D penalty as well as dramatic drug cost increases.  It took a lot of unwinding to fix the problem and get the pharmacy to reimburse the client.  After knowing that, I never use a discount card in the same pharmacy where I use my part D insurance.  The problem is you won't get any advice about drug interactions.
Who provides prescription discount cards?  As I said, has one.  So do AARP and AAA. There are LOTS of other discount card providers but I won't list them because I don't know anything about the organization nor the legitimacy of the card.  I do know that some have been sued for false advertising. NEVER pay for a prescription discount card.  They are always "free" for the user.

Here are some other sources of  information about prescription discount cards:

Saturday, October 8, 2016

IBM OneExchange Medicare 2017 prescription drug (Part D) plan idiosyncracies

I am learning a few things about part D plans idiosyncrasies.  In a post last year I wrote quite a bit about the planfinder ( but there is ever more to learn.  It's important to use the government planfinder to look at the plan you think you want to buy because the description of it is more detailed than what's in OneExchange plan details. Here's a few things to consider:

Part D penalty (added 10/23/16):

Many times I've heard people say they don't need part D insurance because they don't take any drugs.  It's your choice to not buy a part D policy but you will pay a penalty if you change your mind AND you can only enroll in a part D plan during fall open enrollment to have the insurance in January of the following year. The penalty is 1% per month of the average plan premium for every month you don't have a part D plan.  It adds up and the average plan premium is reset (higher) every year.  My recommendation, buy the cheapest plan available in your zip code and maybe pick one that doesn't have a deductible.  This way, if you do need to fill a one off prescription you won't have to meet the deductible.  It might be worth paying a higher premium.

Tier 1 Generic Drugs:
Medicare rules to drug insurance companies require there be NO copay for a drug classified as Tier 1 Generic.  A drug insurance plan can classify a drug into any tier they want.  Many now have Tier 1 Preferred.  Thereby, they put the drug in a category such that they can charge a copay.  Pay attention to how your drug plan classifies your drugs.  I found a plan for someone that had a deductible but the person's drugs were all Tier 1 Generic so there were no copays and therefore no deductibles come into play unless it applies to a new prescription not in that tier.
Deductibles (updated 10/23/16):

If you need regular prescriptions, and not a lot of one off prescriptions, the only reason to worry about deductibles is if you have a cash flow problem.  Otherwise, pick the plan that has the lowest annual cost.  It's rather sad that people who can least afford it because of cash flow issues end up paying more for their drug plans.  Government subsidies are available if your income dips below about $24,000/year for a married couple and you have few assets (ala cash in the bank).  If you tend to have a lot of one off prescriptions in addition to your regular medications then you might want to consider picking a plan with no deductible.

Search options:

In planfinder you can filter out plans that do not cover all your drugs by clicking on the "Drug options" on the left side of the screen and selecting that option.  That feature is available to you just before you continue to plan results.

Drug entry:

Make sure all the drugs you take are for FDA approved conditions.  In an earlier post I explained what this means.  If you are taking a drug (like Adderall) it won't be covered unless you are under 18 years old because that is the demographic the FDA approved.  There is no sense entering that drug and it may be misleading because the cost of that drug is included in the results but Medicare won't allow it to be covered by the drug insurance company unless it meets the on-label criteria. Also, don't enter drugs into plan finder that no plan will cover.  For example, Medicare does not allow coverage of hair growth drugs.  Plan finder will include the cost of those drugs in the results but I think it is misleading.  Any drug you buy which is excluded will not count toward the doughnut hole calculation.

Zip Code Drug Tiers (added 10/13/16):

If you are selecting a drug plan for a relative, make sure you enter the right zip code.  This is important for a couple of reasons.  Drug insurance plans are sold by zip code.  That means a plan might be available for purchase in New York City, but not in Syracuse.  Even if a plan looks like it is available in two different cities, it may not be structurally the same.  The drug costs of what I thought was the same plan turn out to be different for San Francisco than for New York City.  The insurance company put exactly the same prescriptions in different tiers.  In San Francisco the prescriptions were in tier 1 generic which has no copay.  In NYC they were in tier 1 preferred which has a copay.  It is bad enough that the tier a drug is assigned to varies widely from plan to plan.  Drug insurance companies also vary it from zip code to zip code.

One Exchange website plans (added 10/23/16):
The list of plans you see on the One Exchange website might not include all the plans they sell.  I know this is true for their Medicare Supplement plans particularly regarding AARP UHC plans.  If there is a part D plan on that is a better plan for you but doesn't show up on the One Exchange website, call and ask if they sell the plan.  This is also true for Medicare supplemental plans and for Medicare Advantage plans.  My guess is they show the plans on their website that provide the most commission to them.

Deductibles and Doughnut hole 2017 coverage changes (added 10/23/16)

The deductible plans are allowed to increase deductibles from $360 to $400 in 2017.  Not all plans have deductibles but that just means they make up the difference with higher copays. An Affordable Care Act (aka Obamacare) provision is gradually lowering until 2020 the copay cost in the coverage gap.  The 2017 percentage you will pay for brand name drugs in the gap drops to 40% (down from 45% in 2016) and the percentage you will pay for generic drugs drops to 51% (down from 58% in 2016).  Plan finder will reflect those changes in the plan cost calculations. Reminder, the ACA target copay for 2020 for both drug categories is 25% unless congress modifies the ACA.

I'll keep updating this list as I learn more.

Sunday, September 18, 2016

IBM Medicare spouse access to HRA funding

People have asked me recently whether there is any advantage to using One Exchange services to buy insurance for their Medicare eligible spouse. The reason to do it is to more quickly spend your HRA money and/or make sure your spouse has easy access to the funds if you predecease your spouse.

The health insurance products you buy through One Exchange are EXACTLY the same products you buy when you search on  The only difference is shows you ALL the products you can buy in your zip code.  One Exchange shows you a SUBSET of the health insurance products because they only show products for which they get a commission.  One Exchange is an insurance agent. IBM requires you to buy at least one product from One Exchange to access your HRA. IBM is forcing you to use an insurance agent to get the money.

If you get an allotment of money every year from IBM it is highly likely you will use up that allotment for a given year just on yourself for part B, part D premiums, medigap premiums, dental, glasses and coinsurance payments.  If your allotment is a one time amount you received at retirement (via an FHA), you spend that money until the account is depleted which may take a number of years. In the first case, once the annual allotment is spent out, you're done with One Exchange until the next year.  In the second case, you're done with One Exchange when your HRA is depleted.

Case 1:  The retiree gets an annual allotment.  He spent the entire allotment on himself for the past 2 years.  His wife is now turning 65.  He did not opt to have his benefit reduced to pass some money to his wife if he does not survive her.  The only reason for his wife to buy any of her Medicare insurance through One Exchange is because the retiree might expire before the annual allotment is spent. The spouse will be able to spend the rest of the funds until the end of that year. After that year, there is no more allotment and therefore no reason for the spouse to use OneExchange and have reduced insurance choices (and I am not sure the spouse is even allowed to use the services).

Case 2: The retiree gets an annual allotment.  He/she did opt to have a reduced amount to pass on the benefit to the spouse.  The retiree might want the spouse to buy one health insurance product (MA, medigap or part D) within the One Exchange system in case the retiree expires during the year so that it is setup and the remaining money is easily available to the spouse plus have an easier transition for the next year allotment.

Case 3: The retiree gets a fixed amount HRA at retirement through FHA funding to spend until it is depleted and it may take a number of years to do it.  The retiree might want the spouse to buy health insurance products within the One Exchange system to more quickly spend down that FHA/HRA account (as there is no guarantee it will be available until it is depleted) and also for the same reason as Case 2  - that is to make the transition easier for a surviving spouse by already having established access to the HRA funding.

Wednesday, August 24, 2016

IBM evaluating 2017 Medicare health insurance choices

The time of year to reevaluate your Medicare health insurance options is rapidly approaching.  Between October 15 and December 7 you have the opportunity to switch to another plan.  In September, insurance companies that offer Medicare Advantage plans will mail out 2017 plan information to current recipients as well as do intense marketing to try to get people to switch to their plans. The TV ad campaign is almost as intense as it is for the presidential election!  Be sure to READ and KEEP the information you receive from your current insurance providers.

Don't wait until the end of November to consider your choices.

First and foremost - remember that you only need to buy ONE medical plan from OneExchange to get your IBM health insurance benefit.  It has to be a medical plan - dental and vision don't qualify as health insurance.  Medicare Advantage plans, Medicare Supplemental plans (aka medigaps) for original Medicare users, and Medicare prescription drug insurance plans (part D plans) are what they mean by medical plans.

Secondly, Medicare Advantage plans and part D plans CHANGE their plans from year to year.  They cannot change the medical procedures they will cover (that is dictated by the government) but they can change who provides services. Medicare Advantage plans add or delete doctors, specialty clinics and change copay amounts.  Part D plans add or remove drugs they will cover and/or change the tier pricing for the drugs they cover. MAKE SURE you know what your coverage will be and switch if you don't like their 2017 changes.

I continue to believe original Medicare, a Medicare supplemental (medigap) plan and a separate part D plan offer maximum flexibility.  You can go to any doctor or specialty clinic anywhere in the USA.  You can pick a drug plan that best matches your prescription needs.  If you want to switch away from a Medicare Advantage plan to original Medicare and a medigap plan it is important to know whether you can get medigap coverage in your state without underwriting for preexisting conditions or premium adjustment for preexisting condtions.  States like New York and Connecticut don't allow such stuff.  Contact your state agency for more information:

Insurance companies are going through a lot of reorganization and consolidation to maximize their profit to stakeholders. For example, Aetna is a FOR PROFIT company.  You may have heard the news coverage about them. They are loudly wailing about how much money they've lost providing Obamacare insurance plans in rural areas.  That doesn't mean they aren't making profit.  They are still very profitable.  However, it appears (from the volunteer work I do) they are now squeezing all their plan holders (Medicare or otherwise) by routinely denying claims for obscure reasons to try to make up for what they've "lost" in rural coverage costs.  Make sure you not only understand your insurance provider coverage, but also look at the Medicare star ratings and the online chatter about the service of your insurance provider.  The nice thing about original Medicare is it is the government insurance pool.  There still is pressure to reduce cost (by congress) but there are no stakeholders looking for maximium profits.

Wednesday, June 29, 2016

IBM Medicare prescription drug insurance off label drug coverage

Every year - EVERY YEAR - it is really important to reevaluate your prescription drug insurance plan coverage to ensure you are getting the best coverage at the least annual cost during Medicare Fall Enrollment which occurs October 15 to December 7.
I recently listened to a Medicare recipient bitterly complain about how much work it is to manage her IBM Medicare insurance options, claims and enrollment.  She said she was retired and she wanted IBM to take care of this stuff for her!  I must admit it was irksome.  Even when IBM provided us with Medicare group health insurance, it was always important to evaluate the options they presented and determine the "best fit" choice.  So, as the slogan dictates, JUST DO IT!  If you ignore it, it can and will come back and bite you.  If you need help doing it, involve your relatives or find support organizations through Department of the Aging in your state to get advice.
The 2016 Medicare Fall enrollment session is right around the corner and will give you the opportunity to consider your plan choices for 2017.  This year has been a rough prescription drug coverage year for a lot of Medicare users whether the drug insurance coverage was provided through a Medicare part D stand alone insurance policy or a Medicare Advantage plan.  Beginning January 2016, prescription drug insurance companies were instructed by Medicare to clamp down on prescriptions prescribed for "off label" use and were told to deny such coverage.
What is "off label"?  All prescription drugs go onto the market because the pharmaceutical company proved the drug worked to treat a given condition.  Sometimes, the drug is only useful for that condition.  As an example, as far as I know, insulin's purpose is to treat diabetes.  That's the use which has been approved by the FDA.  If your doctor decided to prescribe insulin to treat some other condition, no matter how effective it might be, it would be an "off label"  use.

There are a lot of drugs that are only approved for a specific use or for a specific population.  For example, drugs used to treat Attention Deficit Disorder such as Adderall are FDA approved for CHILDREN meaning they are not approved for people older than 18.  Drug companies did not prove the usefulness for adults.  But adults can have the condition.  If the drug is prescribed it will be DENIED because of the instructions Medicare gave to the insurance companies. The only exception is if the disease being treated is cancer.
Why does Medicare have this power?  Medicare subsidizes private insurance companies.  Simply said, the government gives private insurance companies money every time you use a drug.  If you never use drugs then the insurance company does not get the subsidy (they just get your premium).
Why is all this blah, blah, blah relevant to you?  Just because a prescription drug plan has a drug on its formulary, it doesn't mean they will cover the drug.  The drug is only covered by insurance if it is used for the FDA approved condition.  There is no sense entering that drug when you do your plan selection in October unless you get a written guarantee from the drug insurance company that it will be covered.  Fat chance with that but maybe you want to try to get it for non-cancer related conditions.  You will highly likely have to pay full cost for the drug or try to find other discount options by asking the pharmaceutical company.

The bottom line is to pick a plan to cover your "on label" drugs unless the drug is used to treat cancer.
This post is long enough so I'll end it here.  Just a quick reminder - OneExchange sells a SUBSET of the prescription insurance plans available to you in your zip code.  If you are using original Medicare, AND you buy a Medicare Supplement through OneExchange, look at all the part D insurance options on to make the best choice.

Monday, May 2, 2016

IBM Medicare Retiree Ombudsman for help

Until recently, Roger Meggy, an IBM retiree, has been helping people with a variety of OneExchange problems. He has had a good success rate in helping people resolve issues as well as inspiring OneExchange to improve their websites and documentation. Towers Watson and IBM management agreed to have Roger serve as an ombudsman when this transition first occurred in 2013 so he developed a unique and unfettered access to support people within those organizations for problem resolution. 
Roger can no longer do it but is passing the baton to Ron Linton who will now be a liaison.  Ron can be reached at  If you are at wits end on how to navigate OneExchange or how to remedy a problem, contact Ron. He is also seeking volunteers to help produce a hints and tips guide for IBM retirees.  
Although Roger is no longer able to do it , he can be reached at for those who want to wish him well.

Sunday, April 3, 2016

IBM Medicare & Obamacare (Affordable Care Act aka ACA)

There is still a lot of confusion about insurance options for people turning 65.  I believe this because of the questions I hear during Medicare counseling as a volunteer and for friends.

  1. Over 65 employed:
    People who are over 65 and employed are able to continue to use their employer health insurance plans (if the company offers it and is larger than 20 employees). You CANNOT use ACA insurance - you can only use employer insurance.  Generally, it is recommended those people should enroll in Medicare part A (hospitalization coverage) because there is no premium for that part of Medicare.  Then, part A would act as secondary insurance.  In most cases it doesn't provide more than employer insurance but there may be instances where it is useful such as when Medicare will cover a procedure as inpatient whereas the employer insurance will require it to be outpatient. For IBM insurance it is fine to enroll in part A. Sometimes employer insurance won't allow part A enrollment so be sure to check on it.  If the employer offers prescription drug insurance that is creditable then it is fine to also use the employer drug insurance plan. IBM drug insurance is creditable.  If your drug insurance is not creditable (which is determined by Medicare) then you will face a drug insurance penalty of 1% per month of the national average drug insurance premium for every month you use an inadequate drug plan when you try to enroll in a part D plan.  That penalty almost never goes away.
  2.  Over 65 retired with working spouse:
    People over 65 who are retired are able to obtain insurance coverage through a working spouse (working for a company larger than 20 employees). Once again, you CANNOT use ACA insurance.  It has to be employer insurance.  If the spouse's company is less than 20 employees then you must register for Medicare part A and part B to have adequate health insurance.  If you do not  - no matter the reason - and continue, for example, to use spousal insurance coverage, that insurance coverage automatically changes to being SECONDARY insurance to Medicare when you turn 65.  That means the insurance will only cover co-pays and deductibles. If the spousal prescription drug insurance is creditable you can continue to use it but make sure you keep proof of having that coverage for when your spouse stops working.
  3. Turning 65 retired & using ACA marketplace insurance:
    Sometimes retired IBMers decide to use ACA marketplace insurance rather than IBM retiree insurance prior to turning 65.  If you are not collecting Social Security you will not automatically be notified that you must sign up for Medicare.  Worse still, sometimes the private insurance company that is providing the ACA insurance policy doesn't pay attention to your birthday. They cannot cover you when you turn 65 (by law). The moment you turn 65, that insurance policy (once again) becomes secondary insurance. There is legislation in process to notify people not collecting Social Security about this but it is not yet implemented.  
  4. ACA impact to Medicare:

    There is a great deal of mis-information about ACA legislation as regards Medicare.  The implication typically is that ACA insurance is financed off the back of Medicare and therefore Medicare coverage is being severely cut back.  In fact, not one medical procedure covered by Medicare insurance has been affected.  No doctor fees have been reduced because of ACA. Sequestration lowered doctor fees. That was done by the legislative body because of the budget fights.  
  5. Here's what has changed in Medicare because of ACA:
    The prescription drug insurance doughnut hole is being closed (Hooray!).

    Medicare Advantage plans were paid 15% more than the part B premium collected from people using those plans (which meant taxpayers were financing the 15%).  It is being phased out.  It is rather outrageous private plans were being subsidized by the government.
    There is a big effort to eliminate Medicare fraud cost and eliminate prescription drug insurance coverage for off label use of drugs when the condition is not cancer related. The off label problem occurs because pharmaceutical companies don't prove to the FDA the efficacy of a drug for conditions where it might be useful. Many drugs are only modestly useful for off label conditions and wouldn't be approved.  People don't realize Medicare is subsidizing the cost of prescription drugs by providing payments to part D plans.  As such, Medicare wants to be sure the drug is effective. Such efforts are substantially reducing the cost of Medicare - far more for fraud than off label use.