Tuesday, October 16, 2018

IBM Medicare Via Benefits Medicare Fall Enrollment for 2019

Medicare fall enrollment began yesterday.  You have until midnight December 7th to make decisions about what, if anything, you want to change regarding your Medicare insurance. DO NOT wait that long if you have to call Via Benefits to change a policy you bought through them to another one they offer because it will take forever to get through to them. 

YOU MUST buy at least one policy through Via Benefits to get to use your HRA/FHA.  If you bought a plan such as a part D (PDP) that was not through Via Benefits then you can select a new PDP by going to www.medicare.gov to enroll or by calling 1-800-MEDICARE to enroll.

You'll get bombarded by mail and email from every insurance company selling Medicare Advantage plans and prescription drug plans (PDPs) in your zip code because this is the time of year you can change to those plans.  It is also the time of year you can drop your Medicare Advantage plan and switch to original Medicare. 

HOWEVER, it depends on the state you live in whether and when you can buy a Medicare Supplement plan to use with original Medicare. Call your State Health Insurance Assistance Program to find out the Medicare Supplement aka medigap rules for your state if you do not know them. 

You can find your State Health Insurance Assistance program phone number  at https://www.shiptacenter.org.


Friday, October 12, 2018

IBM Medicare Via Benefits OneExchange ExtendHealth Disadvantage of Medicare Advantage

In the last few months the Department of Health and Human Services became the advertising agency for Medicare Advantage plans.  This is supposed to be an unbiased organization that provides the oversight and administrative processing for Medicare recipients.  It is now the unabashed tool of private insurance companies.

Updated 6/11/19

It's disheartening because Medicare Advantage plans have a lot of downsides that are hidden in the details and the sweet smile of insurance agents. This link to a Reuters news report confirmed it has been happening for a while, but the current government administration is over the top:
https://www.reuters.com/article/us-column-miller-medicare/medicare-advantage-plans-get-unfair-push-from-u-s-government-critics-idUSKBN1O621T

Updated 12/5/18

A few days ago this report appeared in the New York Times about how the Department of Health is "advertising" Medicare Advantage plans and the lack of pros and cons:

 https://drive.google.com/file/d/1nOu51PEZhmaG9OUzDyblYQJSXIUVLUDM/view?usp=sharing

The best synopsis I have seen about that downside of Medicare Advantage plans is this description in Investopedia.  I encourage anyone considering a Medicare Advantage plan to first read this article:

https://www.investopedia.com/articles/personal-finance/010816/pitfalls-medicare-advantage-plans.asp

Updated 10/15/18

The New York Times and a number of other publications recently did an article about Medicare Advantage Plans inappropriately denying claims such that 75 percent of appeals are successful at the first level of review.  That means insurance companies are exploiting customers who are too overwhelmed to appeal either because they do not realize they can appeal or they don't have the wherewithal to do it.  How ruthless!

Here is a link to a copy of the NYT article:

https://drive.google.com/file/d/1FUFTc8RhIvYkyhiS35jB_mSPPe1R8oJs/view?usp=sharing

If you want to read the full inspector general report here is a link to a copy of the report:

https://drive.google.com/file/d/1P0CUSXXlimKU3DlT4bVSCQ6EvNKYG-UX/view?usp=sharing

Updated 10/20/18

A couple of days ago I received and email from "Medicare" that was legitimately from the US government urging me to consider a Medicare Advantage Plan.  I was so irate that the federal government is pushing private insurance over the traditional Medicare insurance pool that I sent a copy of the email to my local congressional representative to complain.  This is beyond egregious.  The federal government has no business hyping private insurance plans and looks like a violation of federal government ethics rules (Employees shall act impartially and not give preferential treatment to any private organization or individual). 

Updated 10/30/18

I recently saw a program on PBS about how companies that offer Medicare Advantage plans have been pushing doctors in their networks to use more serious diagnosis codes so the insurance companies can increase the amount reimbursement they get from the federal government.  Companies like United Healthcare are now being sued by the government for BILLIONS of dollars in over-payment of claims.  Here is a link to the program:  https://www.pbs.org/video/medicare-advantage-taking-advantage-aldeae/

Updated 11/13/2018

I just found the following recent quotes from the heads of HHS and CMS:

"Medicare Part D and Medicare Advantage demonstrate the successes possible when we harness consumer choice and private-sector innovation to improve care and lower cost," said Alex Azar, secretary of the Department of Health and Human Services.   
CMS Administrator Seema Verma added: "The steps that the Trump Administration has taken to improve and drive competition in Medicare Advantage means more savings, more benefits, and lower costs for seniors."




Saturday, October 6, 2018

IBM Medicare Via Benefits OneExchange Extend Health Fall Open Enrollment 2019 choices

I have said several times in this blog that Via Benefits (aka Extend Health or OneExchange) does not sell all the Medicare plans available in your zip code.  I decided to take a look at how many plans were available in my zip code on www.medicare.gov as compared to the plans offered by Via Benefits for 2019:

Plan Type            zip code offerings         Via Benefit offerings

Prescription              23                                   15
(PDP)

Medicare                   28                                   21
Advantage
 with Rx

Medicare                    6                                     0
Advantage
without Rx


I made this chart to emphasize how important it is to look at all the plans available to buy as you might find a better plan in your zip code than in the subset of the plans offered by Via Benefits.  If it turns out that is true for a Medicare Advantage plan, I suggest you call Via Benefits and ask them how you can get an exception to buying a plan from them because their offerings are inadequate for your medical needs.

As I wrote in my last post, I did change to a Medicare Supplement (aka medigap) F high deductible (aka F-HD or F+) plan.  The K plan was okay but the maximum out of pocket protection in the case of a catastrophic illness was too high, particularly if I was incapacitated unable to switch to something better.  I am learning as I age that I have to make insurance choices as simple as possible even if it means paying a higher premium.
 
I also wanted to harp on the fact that there is more and more propaganda as regards pushing seniors to Medicare Advantage plans.  Now www.medicare.gov is doing it.  This past week I was counseling a client who complained that some of the doctors she uses would not take her Medicare Advantage plan but would accept Medicare.  When I asked her why she kept the plan, she said because the premium was cheaper than buying a part D and a medigap to use with original Medicare. For some reason, the out of pocket costs  she paid to the doctors who wouldn't take her plan were not part of her cost calculations!

I have written this a bunch of times, but feel it is worth writing again.  This is INSURANCE.  You are buying insurance coverage but you hope like hell you never need to use it.  You buy auto insurance in case you have an accident.  If you never have an accident, it doesn't mean the auto insurance wasn't worth buying.  It means you are lucky.  Ditto house insurance and fires.  Ditto health insurance!