IBM Medicare Advantage 2023 - NYC retirees story: they are trying to stop it!

Updated 12/03/2022 

NYC tried and failed to push city their retirees into Medicare Advantages plans.  It took a lot of organizing and a law suit, but they did it!  Here's a history of the situation.  The third link is the latest update.  NYC lost an appeal November 2022. The fourth link is a new law suit to stop NYC from requiring copayments:

https://www.thecity.nyc/2022/3/3/22960355/retired-nyc-workers-medicare-switch-court-win 

https://www.thecity.nyc/2022/7/19/23270753/health-insurers-kill-medicare-plan-change-city-job-retirees

https://www.nydailynews.com/news/politics/new-york-elections-government/ny-nyc-medicare-advantage-appeal-retired-municipal-workers-20221122-6qfqcwtfezbyvads4jvhbvfc44-story.html

https://nypost.com/2022/11/29/nyc-retirees-sue-adams-administration-for-55m-over-15-health-care-copays/

I don't know if this will make a bit of difference, but there is a campaign on change.org organized by an IBM retiree who is trying to fight the change:

https://www.change.org/p/stop-ibm-from-selling-our-pensions-forcing-retirees-to-select-only-ibm-benefit-plans

Updated 3/23/2023

NYC unions and government continue to battle with retirees over the switch to Medicare Advantage.  The retirees keep fighting back.  This Brian Lehrer program on WNYC was broadcast today about the fight.  It's really sad.  Even with an ironclad contract, retirees have to fight like hell to try to stop the transition to Medicare Advantage.  This is the broadcast:

https://www.wnyc.org/story/the-brian-lehrer-show-2023-03-23

IBM Pension Transfer 2023 GET YOUR RECORDS NOW!

 For all of us, but particularly for people who are being moved to Prudential/MetLife annuities, be sure to get the information about your pension that is stored in www.netbenefits.com just in case something goes wrong or the information gets lost.  I just downloaded the following documents:

Pension Summary

Pension beneficiary

Post Employment Plan Book for 2021

Group Life Insurance (Death Benefit) document

IBM Medicare Advantage 2023 How Insurance Companies Suck Billions Out of Medicare

This morning on the front page of the New York Times there is an in depth article by Reed Abelson about how insurances companies manipulate Medicare insurance claims to get BILLIONS of dollars from Medicare.  This is not new news.  It is a topic that has been ranted about by various media publications for YEARS. Nothing will likely change as a result of this report, but it will help you understand why I rant about these plans.  If you have a subscription to NYT here is a link to the article:

https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html?smid=nytcore-ios-share&referringSource=articleShare

For people who don't have a NYT subscription, it describes how companies like United HealthCare and Anthem do everything they can to upgrade Medicare claim codes so that they can improve the payout they get from Medicare for a policy holder by presenting the policy holder as being sicker than they really are. Medicare will then provide additional funding over and above the initial allotment to the insurance company because the claims indicate the policy holder is really sick. 

It might or might not affect the money the doctor charges the policy holders unless the procedure (such as a chemo treatment) requires a policy holder to pay "coinsurance". Then, the doctor also gets more money from the policy holder. Coinsurance is when the policy holder pays a percentage of the fee for service instead of a "fixed amount" for the treatment.  

Example, people will say they have a copay of $30 when they go to see a specialist.  It doesn't matter how long it takes to see the specialist.  It can be a 5 minute office visit or a 15 minute visit, the copay is still $30. However, if the policy holder has a coinsurance procedure that is "upgraded" in terms of the complexity of the treatment, it will increase the coinsurance payment for the policy holder.  Example again, the doctor visit includes a biopsy which the doctor upgrades from being a simple lab test to a more complex, but unnecessary lab test. The policy holder coinsurance will then also be higher. It's why providers are sometimes complicit in the claim code scheme.

While this exploitation is disgusting and, per the article, sucking billions of dollars out of Medicare funds, it does not address the  impact on the policy holder per the coinsurance problem. Nor does it go into the other favorite way Medicare Advantage plans make money.  That's by sucking money out of the policy holders via denials of claims. The way they suck money out of the policy holder is more subtle.  If the policy holder pays the doctor bill when the claim is denied, then the Medicare Advantage plan doesn't have to pay the doctor. They will keep more of the allotment of money provided by the government at the beginning of the year to cover claims for the policy holder. As I have said in the past, 50% of denials are overturned if the policy holder appeals. Sadly, appealing is complicated and often people don't have the mental capacity to appeal.  Insurance companies know this and exploit it.

Again, all of this has been an issue for years.  Complain, complain, complain to your congressional representatives about how their inaction is hurting all of us.  This issue is political party agnostic.  They all get huge donations from these insurance companies and don't do anything because they don't want to lose that money.

Added on 10/10/2022:  

In 2018 PBS did a wonderful documentary on how Medicare Advantage plans suck money out of Medicare.  I wrote about it at the time, but am including it in this post in case it was missed:

PBS documentary 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/

Added on 2/27/23:

Kaiser Foundation published a article detailing changes the current administration is trying to make to reign in money given to Medicare Advantage plans to pay policy holder claims.  It is very technical, and also worded carefully so as to not alienate the insurance industry, perhaps because the Kaiser Foundation is funded by a Kaiser endowment fund.  They also get grants from state governments, the very same governments that have been systematically pushing their state retirees onto Medicare Advantage plans. In any case, we all need to try to understand how our tax dollars are spend on Medicare Advantage plans. The way I see it,  Medicare Advantage plans should have never been allowed to exist because all they do is suck money out of Medicare trust funds any way they can.. 

https://www.kff.org/policy-watch/is-the-biden-administration-proposing-cuts-to-medicare-advantage/

This analysis from Action Now, a non-partisan foundation, also did a nice job explaining how CMS is trying to rein in the excesses of Medicare Advantage sucking money out of Medicare trust funds:

https://actionnowinitiative.org/medicare-advantage/

Updated 3/28/2023

This is a detailed description of how Medicare Advantage companies suck money out of the federal Medicare program.  It is sooooooo complicated.  I did not understand much of it but maybe you will.  Why does the federal government allow it?  MA is killing Medicare:

https://www.healthaffairs.org/content/forefront/born-third-base-medicare-advantage-thrives-subsidies-not-better-care

IBM Medicare Advantage Brochure Assessment & another sad story

 The brochure arrived yesterday.  I have two comments on it.  

They say you can "go back" to Original Medicare with a Medicare Supplement plan if you decide you don't like the United HealthCare plan. There is a footnote to that statement that refers you to www.medicare.gov to look at "guarantee issue".  First off, going back to Original Medicare isn't at your whim. That is usually possible to do once a year, during Medicare Fall Open Enrollment (Oct 15- Dec 7th), or if you move to a new state.  The bigger issue is rebuying the Medicare Supplement plan. Depending on what state you live in, you might not be able to rebuy the Medicare Supplement plan. That's what "guarantee issue" means.  Some states allow you to reenroll in a Medicare Supplement plan without underwriting or age rated adjustments.  Most states leave it up to the insurance company to decide if they even want to sell you a policy and, if they do, at whatever price they want. There is no cap on out of pocket cost if you use Original Medicare without a Medicare Supplement plan so, unless you also have Medicaid, you need a Medicare Supplement plan.  

My second comment is there is nothing in the brochure about how often United HealthCare denies claims if you have already received treatment, or requires pre-approval before you can be treated.  That information is available from Kaiser foundation and it is not good.  I have written over and over again about the nightmare of pre-procedure and post-treatment denials.  They say wonderful things in the brochure like they will provide unlimited "Skilled Nursing Facility" days for rehabilitation. What they don't say is the probability of receiving unlimited SNF days is slim to none.  They typically deny more SNF coverage after about 10 days (that's the pattern I have seen) and say it's because more treatment is not medically necessary. Then you are in the cycle of needing to appeal.

Another sad story from this past week about a Medicare Advantage plan. A man, in his nineties, went to the ER because he was having significant heart problems.  The ER doctor immediately admitted him to the hospital.  The staff cardiologist monitored him for several days and stabilized him.  When he got the first denial of payment for treatment from his Medicare Advantage plan, they not only denied the hospital treatment as not being medically necessary, they said the provider was out of network. The man was looking at a bill of about $11,000. He didn't focus on the denial of treatment, he focused on the out of network statement.  He called the Medicare Advantage plan and they said they had made a mistake and the hospital treatment was in-network.  They adjusted the claim amount to $6,000 and then denied the claim, again, saying it was not medically necessary. When treatment is denied, the policy holder is responsible for the full amount of the treatment and it does not count toward the MA plan deductible.  The man now has 60 days to appeal.  It must be a written appeal. He needs to get a letter from his provider to attest to the fact that the treatment was medically necessary.  Needless to say, he was totally overwhelmed with what he has to do to fight to get the MA plan to pay the claim while struggling with his medical problems.  Having to battle with a behemoth  insurance organization is the last thing in the world he needs to worry about. This reporting by Axios is about Medicare Advantage denials.

  https://www.axios.com/2022/04/29/medicare-advantage-debate-rekindled-by-report-on-coverage-denials

IBM Pension Risk Transfer Explained (by investopedia)

 For those affected by IBM's transfer of approximately 30% of its pension pool to Prudential/MetLife, this is a description of the process known as "Pension Risk Transfer". It is some measure of comfort that this process is regulated by the federal government:  

https://www.investopedia.com/terms/p/pension-risk-transfer.asp

IBM Medicare DisAdvantage Story

Today I helped someone who's 90 year old mother is on a UHC Medicare retiree plan from a major corporation. How ironic. The mother is a patient in a rehab facility and receiving PT. UHC just denied providing more days in rehab because it's  "not medically necessary" even though the primary care doctor said she should stay in the facility for another 90 days. Her offspring is jumping through hoops trying to appeal the UHC denial. 

Why would a Medicare Advantage plan deny and make it difficult to get medical care?  It's all about making money. The primary way Medicare Advantage plans make money is by "managing care".  That's a clever way of saying they make sure the amount of care their policy holders receive in claim payouts does not exceed the amount of money allotted to provide medical services.  

At the beginning of every year, Medicare gives Medicare Advantage plans a fixed amount of money to use for each policy holder. If the policy holder doesn't need much medical attention, then the Medicare Advantage plan gets to keep the money. If the policy holder gets very sick, the Medicare Advantage plan does everything it can to discourage the policy holder from continuing in the plan and/or carefully "manages" the policy holder's treatment.  The plan could make the case to Medicare for getting more money for a very sick policy holder, but it's a lot easier to "manage" the treatment. Often, the plan become so ornery in that management, the policy holder decides to switch to original Medicare. Perhaps a deliberate strategy?  Sick policy holders are not good for business.

Original, traditional Medicare is a federal government insurance pool.  The federal government is not about making money, it's about providing healthcare.  In fact, when analysis is done, the federal government is more cost effective at providing healthcare coverage than Medicare Advantage plans.

In the following analysis, Kaiser Foundation found people more often switch from Medicare Advantage to original Medicare than the other way around.  It most often happens when people also have Medicaid.  Then they don't have to worry about being able to buy a Medicare Supplement plan (aka medigap) to cover coinsurance and deductible costs. Medicaid does it. The rules for getting medigaps vary from state to state.  Many states don't prevent insurance companies from denying or doing underwriting to significantly raise the premium of a medigap if someone switches from a Medicare Advantage plan to original Medicare. Do you know the rules in your state?

If you have original, traditional Medicare with a medigap, you have the best health insurance insurance money can buy.  Isn't that the most important thing to have at this stage of our lives? Don't throw it away because IBM is telling you some BS about their UHC Medicare Advantage plans.  Next thing you know, Joe Namath is going to appear on their brochures.

https://www.medicarerights.org/medicare-watch/2022/09/22/kaiser-family-foundation-releases-analysis-of-medicare-advantage-original-medicare-comparisons%ef%bf%bc?utm_source=Medicare+Rights+Center&utm_campaign=4a6df8ffb6-medicare-watch-09222&utm_medium=email&utm_term=0_1c591fe07f-4a6df8ffb6-84636113&mc_cid=4a6df8ffb6&mc_eid=4b95281a8e

IBM Medicare DisAdvantage 2023

 I called the UHC IBM phone number to find out more about the IBM UHC Medicare Advantage Plan coverage in 2023 and how the "stipend" works because a lot of information is floating around and I wanted to be somewhat accurate in writing this post.  There isn't a lot of information about the UHC plans. The website retiree.uhc.com/ibm  has a lot of "coming soon" information.  The agents who answer the phone are very kind but all they want to do help enroll people into one of the two plans (which is so premature it's insane).  I am not going to describe the plans because there isn't much information about them beyond that there are two plans and one is more expensive than the other.  They are the Essential Plan and the Enhanced Plan.

As regards the stipend (don't call it an HRA!!!), it is true the stipend is only available to users of the "Essential Plan" and it seems to be about $1,300.  HOWEVER, the Essential Plan has a maximum annual out of pocket cost of $5,000 for the year and an Rx deductible of $395.  The Enhanced Plan maximum annual out of pocket is $750 and an Rx deductible of $50. Even though there is a monthly premium for the Enhanced Plan (about $130/mo),  why one would ever get the "Essential" Plan is unknown (at least by me) because of that max out of pocket (which is often talked about as MOOP).

I specifically asked if UHC policy holders could go to Sloan Kettering or City of Hope.  The answer I got was no.  That's no surprise.  I just wanted to verify it.

Reminder, I will never, ever enroll in a Medicare Advantage plan no matter how good it "looks" on paper because I believe they are Medicare DisAdvantage plans if you get really sick. 

This next part has nothing to do with UHC Medicare Advantage Plans but it is about our benefits.

I asked UHC what happens to people who have "FHA" money left in their account.  How does that work in terms of accessing the money to cover medical costs? Of course, the UHC agent didn't know.  She gave me another number that put me into IBM pension information and when I hit the number for Medicare information I was right back in the UHC call center. I don't know what will happen with that money, but if you have an FHA and can prepay 2023 premiums in 2022 you might want to spend out your FHA before you lose it if you don't intend to use the Medicare Advantage plans.

There are two other IBM benefits I asked about and the UHC agent really had no idea what I was talking about.  These benefits are probably disappearing but IBM has not mentioned anything about it. You might recall that IBM told us they would jump in and help with the cost of drugs for the rest of the year if the retiree had spent about $8,000 out of pocket.  IBM also would help with the cost of  home care (which is not covered by Medicare no matter what the plan) when the retiree spend about $6,500 and also do it for the rest of the year. These were described in IBM's "About Your Benefits" Publication. 

I wrote in a prior post that I believe IBM is stealing compensation money from retirees.  I talked to a friend who is a lawyer and they sort of agree.  The next step for me is to find a class action lawyer who agrees.  

IBM Medicare Advantage 2023

I know too much about the dastardly things Medicare Advantage plans do to people.  At this stage of our lives, the most important thing is having access to the best health care we can get.  The stress of dealing with an MA plan that denies or delays treatment can be really bad. 

I want to know that I can just call up and make an appointment at Sloan Kettering, should I need to do so, and my insurance is not going to be denied. I want to know that I can go see any Medicare doctor without needing a referral. I want to know my insurance won't second guess what my doctor recommends as treatment or that I cannot get the medications I need because I cannot pick a stand alone Rx plan that best fits my medication coverage at least cost. I just looked at Sloan, Mayo Clinic, MD Anderson, Cleveland Clinic and City of Hope.  They all accept original Medicare.  They accept "some" MA plans and then say "check with your insurance".  That's not good enough. 

Like fire insurance, I hope I never, ever need any of those places, but I want fast access when something serious happens. I also don't want to anguish about not being able to use a particular doctor because they "no longer take" the UHC insurance. The thought of needing to change providers or be denied the tests doctors want to do to continue monitoring chronic conditions isn't worth hanging onto $1,300.  It will be a financial impact, but I am lucky to be able to ditch it.

The clincher for me was when a friend told me yesterday that they are in a rehabilitation facility. I instantly thought about how UHC would dictate what rehab facilities I could use instead of me being able to use what my doctor thinks is the "best" facility for my condition.  It's just another example of why I am walking away.

I don't want to influence anyone else's decision, especially those who have financial constraints but I don't want to hide what I will do as my choice. 

IBM Medicare Advantage Enrollment Directive for 2023

 Edited on 9/18/2022:

Yesterday, IBM had two major announcements for retiree benefits.  The US retiree pension fund that supports 100,000 retirees are now annuities administered by Prudential and MetLife.  The payout will be the same, but the federal protections are gone.  There is no ERISA oversight for annuities, meaning there are no federal guarantees we will get our payouts for the rest of our lives. I am sort of surprised because I thought IBM "made money" when the pension was overfunded.  Maybe the rocky stock market helped them decide they didn't need the risk of having to fund the pension if it was under funded and if the annuities go bust, well that's not their problem.  Anyway, if you haven't seen anything about it, this link does a good job describing it:

https://www.pionline.com/pension-risk-transfer/ibm-offloads-16-billion-pension-liabilities-annuity-purchases

This was a big shock but the other big shock is what happens to our HRA funding.  In 2023, you will only get HRA funding  $1,300 only if you enroll into one of the two Medicare Advantage plans structured for IBM by United Health Care. You must pick the "basic" Medicare Advantage plan and funding will only cover you copays.  For those of us in Original Medicare with a Medicare Supplement, we get NO money if we want to continue in that structure.  

This is dreadful for a couple of reasons.  First and foremost, United Health Care is a miserable company.  They are all about making life as difficult as possible both for providers and policy holders.  They require pre-approvals on almost anything that is costly such as surgical procedures, DME or prosthetics. They second guess doctor recommended procedures and won't pre-approve treatment. They control the prosthetics that can be used for things such as knee replacements, they require referrals any time you want to see a specialist. Most importantly, they deny, deny, deny, full well knowing people will give up and not get a procedure if it is a pre-approval or pay a claim if the service has been delivered and then denied because appealing a denial is complicated.  Even if you do the appeal right, they somehow manage to screw up the process and will make you crazy until you appeal 2 or 3 times.

How do I know? I have been advising people about Medicare and how to handle denials and appeals for many years.  UHC screws up everything. Don't even bother to try to call them if you have a problem.  They will spin you in circles. You must do written appeals and file written grievances to get their attention.  I don't know if is on purpose or as a way to get providers and/or policy holders to give up and go away. I bet it is on purpose.

Why force us onto a Medicare Advantage plan, and the one that has less benefit?  A guess. Maybe we are not croaking fast enough and IBM is tired of providing HRA funding.  It will essentially eliminate the medical benefit for retires without having to announce that they are breaking a promise.  UHC probably gets some money for each policy sold and then controls the amount of services people get so retirees won't go through the full stipend.  Many Medicare Advantage plans make money strictly from the federal government and have a zero premium and very low copays but they also control access to medical services so maybe IBM doesn't even have to give UHC money. Want the latest cancer treatment? So sorry. You wanted a pace maker? Your doctor didn't make a good enough case for it. Denied. Getting something like $200 a pop from IBM for each MA plan sold is not chump change to UHC who likely promises to dramatically cut IBM cost because UHC will control access to medical services thereby limiting the reimbursements. 

I am sad.  I never thought IBM would get to this.  I understand why they wanted to get out of managing a pension or managing health insurance policies. It is ancillary to their business.  I initially wasn't happy about losing the insurance IBM provided before 2013 (which was fabulous) and being pushed to Via Benefits but, at least it gave me choices.  It is a low blow to force all Medical eligible retirees into Medicare Advantage plans and a really low blow that the company providing the policies is United Health Care. Even Humana is a better company!!!  Really, a low blow.  It means retirees will get sub-par medical treatment because of a dodgy insurance company that is only interested in making money and could care less about the well being of policy holders.  The IBM company executives don't care either.  They need to squeeze every penny out of piddling programs to pay their fabulous executive bonuses.  Sad. Really sad.

Do you remember when we were told our retiree benefits were "part of our salaries"? IBM told us not to quit and go to other companies that paid better salaries that didn't offer those benefits because, when factored in, IBM's salary was better! I wish I had that documentation. The company is basically stealing our earned income.  Isn't that illegal?  

IBM Medicare Via Benefits Medicare Advantage Plan Problems

 This recent report about Medicare Advantage plans says it all! 

https://www.medicarerights.org/medicare-watch/2022/06/30/government-watchdogs-urge-medicare-advantage-oversight-and-reform?utm_source=Medicare+Rights+Center&utm_campaign=8223a1c3f0-medicare_watch_063022&utm_medium=email&utm_term=0_1c591fe07f-8223a1c3f0-84636113&mc_cid=8223a1c3f0&mc_eid=4b95281a8e