When you are denied coverage for a medical procedure or a prescription drug it is important to do an appeal with your insurance company. If you have a Medicare sanctioned plan the appeals process is governed by Medicare law. Sometimes it takes a couple of iterations to get to an independent group (that is - not the private insurance provider) to get a fair assessment.
I just wanted to remind you that IBM secondary insurance and Aetna Integration insurance is not governed by the Medicare appeal process laws because it is not government sanctioned medigap or secondary insurance. For those insurance policies if you are not satisfied with the decision they render you have to complain to the department of insurance in your state. It is unlikely doing that will change the decision but it is important to complain because those departments track complaints and put pressure on insurance companies that are generating a lot of complaints.
I don't know what the appeals process is for IBM's prescription drug insurance plan. Although it is a "creditable" plan, I am not sure if the company (CVS Caremark) is required to have the same appeals process as a government sanctioned prescription drug plan (PDP). If you are choosing the IBM prescription insurance plan you should ask the question. If it does not conform then your appeals are totally handled by CVS - which means there is no independent review and your chances of reversing a decision are slim. If someone has an answer please post a comment.
Monday, November 12, 2012
Aetna Integration A detailed description
There is a brochure on the Aetna website that provides details about the Integration plan. It is a good summary of the plan. Unfortunately, I can't link to it because you need a user id to get to the site and you can only get one if you are enrolled. If you are considering getting the insurance I suggest you call and ask Aetna to email you a copy of the brochure. Here is the table of contents:
Continuation Coverage
Table of Contents
Preface ........................................................................1
Important Information Regarding Availability of
Coverage
Coverage for You .....................................................1
Health Expense Coverage.......................................1
Treatment Outcomes of Covered Services
When Your Coverage Begins............................2
Who Can Be Covered ..............................................2
Retirees
Determining if You Are in an Eligible Class
Obtaining Coverage for Dependents
How Your Medical Plan Works........................5
Common Terms........................................................5
About Your Comprehensive Medical Plan...........5
Using the Plan
Cost Sharing
Emergency and Urgent Care...................................6
Coverage for Emergency Medical Conditions
In Case of an Urgent Condition
Coverage for an Urgent Condition
Non-Urgent Care
Follow-Up Care After Treatment of an
Emergency or Urgent Medical Condition
Requirements For Coverage.............................8
Clinical Review Criteria Requests
What The Plan Covers ......................................10
Comprehensive Medical Plan .................................10
Wellness......................................................................10
Routine Physical Exams
Preventative Health Care Services Expenses
Routine Cancer Screenings
Early Intervention Services
Bone Mineral Density Measurement or Test,
Drug and Devices
Vision Care Services
Limitations
Hearing Exam
Primary and Preventive Obstetric and
Gynecological Care
Physician Services .....................................................13
Physician Visits
Surgery
Anesthetics
Hospital Expenses ....................................................14
Room and Board
Other Hospital Services and Supplies
Outpatient Hospital Expenses
Coverage for Emergency Medical Conditions
Coverage for Urgent Conditions
Alternatives to Hospital Stays.................................16
Outpatient Surgery and Physician Surgical
Services
Birthing Center
Ambulatory Care
Home Health Care
Hospice Care
Other Covered Health Care Expenses .................19
Acupuncture
Ambulance Service
Diagnostic and Preoperative Testing ....................19
Outpatient Diagnostic Lab Work and
Radiological Services
Outpatient Preoperative Testing
Durable Medical and Surgical Equipment (DME)
.....................................................................................20
Experimental or Investigational Treatment .........21
Pregnancy Related Expenses..................................21
Prosthetic Devices....................................................22
Hearing Aids
Benefits After Termination of Coverage
Short-Term Rehabilitation Therapy Services.......23
Cardiac and Pulmonary Rehabilitation Benefits
Outpatient Cognitive Therapy, Physical Therapy,
Occupational Therapy and Speech Therapy
Rehabilitation Benefits
Reconstructive or Cosmetic Surgery and Supplies
.....................................................................................24
Reconstructive Breast Surgery
Specialized Care........................................................24
Chemotherapy
Radiation Therapy Benefits
Outpatient Infusion Therapy Benefits
Diabetic Equipment, Supplies and Education.....26
Treatment of Infertility............................................26
Advanced Reproductive Technology (ART)
Benefits
Enteral Formulas......................................................28
Treatment of Mental Disorders and Substance Use
.....................................................................................29
Treatment of Substance Abuse
Oral and Maxillofacial Treatment (Mouth, Jaws and
Teeth) .........................................................................30
Medical Plan Exclusions .........................................31
When Coverage Ends..............................................31
When Coverage Ends For Retirees
Your Proof of Prior Medical Coverage
Continuation of Coverage.......................................32
Continuing Health Care Benefits
Extension of Benefits ..............................................33
COBRA Continuation of Coverage......................33
Continuing Coverage through COBRA
Who Qualifies for COBRA
Disability May Increase Maximum Continuation
to 29 Months
Determining Your Premium Payments for
Continuation Coverage
Sunday, November 11, 2012
Prescription Drug Coverage 2013
I am sorry I have not been able to write much this year and the deadline for making your decisions is only a few days away. Hurricane Sandy visited Westchester, New York and turned a forest into a meadow. Happily, not so much changed from last year so most of what I wrote applies.
I just took a quick look at the rules that are being "upgraded" for the IBM's prescription drug plans. The sentence saying that more than 250 drugs will require prior authorization in 2013 was not great to see. What the provider will likely do is ask you to try alternate comparable drugs before they approve your prescription. It is called step therapy. That can range from annoying to life threatening as sometimes those alternate drugs don't work at all and can impact your health.
Once again, I decided to go with Aetna Integration A which meant I cannot use IBM's drug plan and had to select a separate private prescription drug plan (PDP) from a non-IBM provider. I used the plan finder on the medicare.gov website to be sure I picked a PDP that has been sanctioned by medicare. I also enrolled directly through the medicare.gov site as it is the quickest way to enroll and I have a record of the enrollment in case the private insurer makes a mistake and denies I was enrolled.
The list of PDP providers available in your zip code can be daunting. There are a lot of factors to consider when selecting a drug insurance plan such as - where you will be able to fill prescriptions, whether or not step therapy will be required for your particular drug, deductibles (which cannot be higher than $350) and copays. Some plans also provide insurance in the "donut hole" but of course the premium for those policies will be higher. All of these factors are important to consider when you pick a plan - not just premium price.
My personal experience: this past year is the PDP plan I picked was cheap but it was not the best decision. I could not use mail order and had to go to Target to pay the least for my prescription. However, they let me do 90 day refills so it wasn't too bad. The plan then decided not to cover my drug in 2013 so in September they stopped allowing 90 day supply refills. I now have to go back to the pharmacy every month to get a refill. It is annoying. They also did not directly tell me the drug would not be covered in 2013. They just said there were changes in their formulary and I should check their formulary.
I just took a quick look at the rules that are being "upgraded" for the IBM's prescription drug plans. The sentence saying that more than 250 drugs will require prior authorization in 2013 was not great to see. What the provider will likely do is ask you to try alternate comparable drugs before they approve your prescription. It is called step therapy. That can range from annoying to life threatening as sometimes those alternate drugs don't work at all and can impact your health.
Once again, I decided to go with Aetna Integration A which meant I cannot use IBM's drug plan and had to select a separate private prescription drug plan (PDP) from a non-IBM provider. I used the plan finder on the medicare.gov website to be sure I picked a PDP that has been sanctioned by medicare. I also enrolled directly through the medicare.gov site as it is the quickest way to enroll and I have a record of the enrollment in case the private insurer makes a mistake and denies I was enrolled.
The list of PDP providers available in your zip code can be daunting. There are a lot of factors to consider when selecting a drug insurance plan such as - where you will be able to fill prescriptions, whether or not step therapy will be required for your particular drug, deductibles (which cannot be higher than $350) and copays. Some plans also provide insurance in the "donut hole" but of course the premium for those policies will be higher. All of these factors are important to consider when you pick a plan - not just premium price.
My personal experience: this past year is the PDP plan I picked was cheap but it was not the best decision. I could not use mail order and had to go to Target to pay the least for my prescription. However, they let me do 90 day refills so it wasn't too bad. The plan then decided not to cover my drug in 2013 so in September they stopped allowing 90 day supply refills. I now have to go back to the pharmacy every month to get a refill. It is annoying. They also did not directly tell me the drug would not be covered in 2013. They just said there were changes in their formulary and I should check their formulary.
Monday, October 29, 2012
October 2012 - choices for 2013
I quickly looked at the IBM package this morning for the first time. I don't see much change but the prices for some of the options. People who need to cover their medicare eligible spouses are really getting slammed if they pick anything but Aetna Integration plan or the PPO plans and buy a separate Medicare part D prescription drug plan (which can be as cheap as $20/month) for the Integration plan. People who need to cover their non-medicare eligible spouses seem to be hit the hardest if they want to get drug coverage.
I will provide more analysis after doing more reading but wanted to do a quick post because there is not much enrollment time this year. The only thing I wanted to focus on for this post is that the Medicare Advantage plans IBM offers (the PPO and HMO plans). For those plans:
I will provide more analysis after doing more reading but wanted to do a quick post because there is not much enrollment time this year. The only thing I wanted to focus on for this post is that the Medicare Advantage plans IBM offers (the PPO and HMO plans). For those plans:
- Make sure your doctors and local hospitals will accept the plan
- Make sure your drugs are on their formulary and if they require step-therapy
- Consider the fact that you will not be covered at specialized clinics like Cleveland Clinic or Sloan-Kettering if needed (most of those clinics do accept original Medicare)
Sunday, December 18, 2011
Options to change your insurance in 2012
Obviously, the IBM enrollment period is over but I wanted to remind you that you do have a "window" provided by Medicare law (it has nothing to do with IBM) called the Medicare Advantage Disenrollment period and it is January 1- Feburary 14, 2012. During that period you can switch from IBM's Medicare Advantage plan to original Medicare. So, if, for example, you decide you hate Aetna's HMO or PPO you can switch to original Medicare during that period. You won't be able to get IBM supplemental nor IBM prescription drug insurance because the IBM enrollment period is close. However, you will have the ability to buy a Medicare approved prescription drug plan (and you should buy one to avoid a penalty even if you don't need it). You also MIGHT have the ability to buy a medigap plan for secondary insurance. It depends on the state laws whether or not the private insurance companies have to sell it to you.
Another change you can make any time during 2012 is to switch (one time) from your IBM Medicare Advantage plan to a "5 star" rated Medicare Advantage plan. Ditto for the Prescription Drug Plan. Once again, it is a change you can make that has nothing to do with IBM but once you make the change you cannot use IBM's offerings for the rest of 2012. The wrinkle in this option is there has to be a 5 star plan in your zip code. The way you find out if you have one is to go to plan finder on medicare.gov.
None of the above is relevant to people who are buying insurance for their non-medicare eligible spouses unless you no longer need to cover your spouse because once you switch, IBM will stop providing your spouse's insurance too.
Another change you can make any time during 2012 is to switch (one time) from your IBM Medicare Advantage plan to a "5 star" rated Medicare Advantage plan. Ditto for the Prescription Drug Plan. Once again, it is a change you can make that has nothing to do with IBM but once you make the change you cannot use IBM's offerings for the rest of 2012. The wrinkle in this option is there has to be a 5 star plan in your zip code. The way you find out if you have one is to go to plan finder on medicare.gov.
None of the above is relevant to people who are buying insurance for their non-medicare eligible spouses unless you no longer need to cover your spouse because once you switch, IBM will stop providing your spouse's insurance too.
Monday, November 28, 2011
No Aetna Offering Details!!!
I just spent about 40 minutes trying to get a detailed plan description for the Aetna A Integration plan. It is not available to me until I am enrolled! I called Aetna and asked for the details and they said everything that is available was already sent to me. I called IBM and the representative said the details would be available in January if I am enrolled in the plan.
I registered a complaint with IBM. It is outrageous that detailed information is not available for people who want to do detailed comparisons. I urge you all to similarly complain. How are we to make informed decisions unless we know exactly what is and is not covered?
I registered a complaint with IBM. It is outrageous that detailed information is not available for people who want to do detailed comparisons. I urge you all to similarly complain. How are we to make informed decisions unless we know exactly what is and is not covered?
Sunday, November 27, 2011
Full program descriptions
I had a little time tonight to try to find a full program description for the Aetna Integration A plan. I thought I would be able to easily find it on the website providing by Aetna which is ibmrhabenefits.aetnamedicare.com (password=IBM65). I just wanted you to know that I was wrong because I thought full plan details were on this site. The website says (in small print) that it is a marketing website. If I want a full plan description I need to call Aetna. That's really annoying. Even IBM's medical plan is fully documented in the resource library at netbenefits.com. I am probably going to give them a call tomorrow to get the complete plan description just because I want to see what they say.
It doesn't change my decision because I know enough to know I want to try this plan in 2012 but it really does make me feel like they are trying to hide the details of this plan. If you are considering their HMO or PPO offerings don't just go by their "marketing" brochures. The detailed documents are really important. I know this because I volunteer on a medicare helpline and a large number of the "issues" callers have are because of denials of coverage or billing problems they have with medicare advantage plans.
Someone commented that if your spouse is not medicare eligible you only have 4 choices and have to use the IBM medical and prescription coverage plans. It's true but at least you do have choices. A friend tried to get coverage for his spouse separately and the best he could find was a private plan for $17,000/year for his spouse and that didn't include drug coverage. What IBM offers may not be as good as you want but it sure is better than anything else you can buy - assuming you can even buy a plan. If Obamacare sticks the problem might go away in 2014. It's up to the Supreme Court now.
I also wanted to mention that this year I decided to try the vision plan coverage because it is so inexpensive. It seems to me it sort of pays for itself since they pay $35 for a doctor when the doctor is out of network and the prescription glasses discount coverage is better that the free vision card offering. I needed new glasses next year and the provider I like to use is included in the plan so I am giving it a try.
It doesn't change my decision because I know enough to know I want to try this plan in 2012 but it really does make me feel like they are trying to hide the details of this plan. If you are considering their HMO or PPO offerings don't just go by their "marketing" brochures. The detailed documents are really important. I know this because I volunteer on a medicare helpline and a large number of the "issues" callers have are because of denials of coverage or billing problems they have with medicare advantage plans.
Someone commented that if your spouse is not medicare eligible you only have 4 choices and have to use the IBM medical and prescription coverage plans. It's true but at least you do have choices. A friend tried to get coverage for his spouse separately and the best he could find was a private plan for $17,000/year for his spouse and that didn't include drug coverage. What IBM offers may not be as good as you want but it sure is better than anything else you can buy - assuming you can even buy a plan. If Obamacare sticks the problem might go away in 2014. It's up to the Supreme Court now.
I also wanted to mention that this year I decided to try the vision plan coverage because it is so inexpensive. It seems to me it sort of pays for itself since they pay $35 for a doctor when the doctor is out of network and the prescription glasses discount coverage is better that the free vision card offering. I needed new glasses next year and the provider I like to use is included in the plan so I am giving it a try.
Monday, November 14, 2011
Choices, choices, choices
Either I am getting confused more easily or this year it was harder to sort through the choices. Probably it is a bit of both. I took another look at the Aetna Integration offering and there is a summary sheet on one of the brochures that had several items regarding what is not covered that were a bit disconcerting:
I spent a great deal of time verifying that we had selected the right prescription drug plans. Although Medicare.gov had good planfinder tools it, I kept jumping from plan finder to formulary finder to compare plans to make sure I got a complete picture of the plans I was selecting. It took a lot of time.
It looks like Aetna is pushing the PPO plan pretty hard. I cannot emphasize enough that if you go that route you will have to use their doctor and hospital network to get the full benefit of the plan. If your doctors and hospital are already in the network then it is worth considering. Just remember, the participating health providers can decide to drop out any time during the year but you cannot change health plans until January 2013.
Oh, one more thing. If you are selecting a PDP do it soon as it is best to enroll via Medicare to be sure that your records are updated (versus enrolling via the private insurance company and having them notify Medicare). Medicare is advising on Medicare.gov that it takes up to 10 days to get the verification that you are enrolled. That means you will be close to the enrollment deadline when you get your verification if you enroll this week. Do it now!
- No coverage for Durable Medical Equipment. That means if you need something like a wheel chair there is no copay. A lot of DME items are big ticket items so this will mean you have to do a lot of comparison shopping before buying equipment. Make sure you buy from a supplier that sticks to Medicare's fee limits so you really are only stuck paying 20% of the cost.
- No coverage for experimental procedures.
- A blanket statement that they only cover what is in the plan documents for medical and hospital services. How do you get the document? You have to go to the Aetna website.
- No coverage for preventative benefits beyond Medicare at no additional cost. I honestly don't know what that means. A big part of my annual checkup is the blood work. Medicare doesn't cover those tests. IBM supplemental medical did. I don't know if Aetna Integration does.
I spent a great deal of time verifying that we had selected the right prescription drug plans. Although Medicare.gov had good planfinder tools it, I kept jumping from plan finder to formulary finder to compare plans to make sure I got a complete picture of the plans I was selecting. It took a lot of time.
It looks like Aetna is pushing the PPO plan pretty hard. I cannot emphasize enough that if you go that route you will have to use their doctor and hospital network to get the full benefit of the plan. If your doctors and hospital are already in the network then it is worth considering. Just remember, the participating health providers can decide to drop out any time during the year but you cannot change health plans until January 2013.
Oh, one more thing. If you are selecting a PDP do it soon as it is best to enroll via Medicare to be sure that your records are updated (versus enrolling via the private insurance company and having them notify Medicare). Medicare is advising on Medicare.gov that it takes up to 10 days to get the verification that you are enrolled. That means you will be close to the enrollment deadline when you get your verification if you enroll this week. Do it now!
Saturday, November 12, 2011
More 2012 Analysis
I spent a few hours going through the new plan offering and I still feel like I don't know enough. I did learn a few things. The switch to CVS Caremark is not great for me as they will not cover three of my drugs AFTER next year and they will make my husband go through step therapy for one of his drugs. Ugh. I decided it was time to pick a Medicare part D plan (also called a PDP or Prescription Drug Plan) and not use IBM's prescription offering.
I did look at the Aetna PPO offering because someone told me they heard you can go to any out of network doctor that accepts Medicare and you'll still pay 20%. Well, that's not quite true. I finally found it on the PPO fact sheet. You can go to any out of network doctor that accepts medicare AND agrees to accept the PPO. That makes more sense because that is how PPOs usually work. I've had a few health problems this past year and am really glad I was not confined to specific doctor networks or having to contend with having a doctor agree to take both Medicare and the PPO plan. It's enough of a hassle to find a doctor that will accept Medicare.
The HMO offerings are even more restrictive. However, the positive aspect of an HMO is you will have access to all the doctors who are part of the HMO. They cannot tell you they are no longer accepting patients. And if they quit the HMO you will be assigned to another doctor. If a PPO doctor decides to no longer be with a plan it is up to you to go hunt for another doctor in the PPO network - and even if they are in the network I believe they can stop accepting new patients - it is something to ask of Aetna. If you live in a remote area that might mean your replacement doctors are not nearby. I tried to figure out whether you could get coverage if you wanted multiple opinions in the HMO or PPO plans (something I needed to do this year as I was getting conflicting opinions). I couldn't find it and since it is not what I will choose I gave up looking. In original Medicare you can get as many opinions as you want. I am not sure I see a lot of advantages to the PPO unless the drug coverage suits your needs. I do believe that HMOs are effective at containing your medical costs. Just realize the trade-offs.
So, I decided to switch from IBM's supplemental medical/drug plan to Aetna's Integration plan A. I can do that because both my husband and I are Medicare eligible. I am doing it because I know I will have several doctor visits next year and there is a small chance I may need to go to the hospital. The Medicare deductibles and copays will be covered by Integration A making the plan a real winner for me. If your spouse is not Medicare eligible then you are stuck with IBM's supplement plans and the switch to CVS unless you can buy spousal coverage some other way. The Health Care Reform Act provides insurance exchanges in 2014. Not much help for 2012.
I spent quite a few hours on medicare.gov looking for a PDP for me and a PDP for my husband. It turns out he can get a PDP with Medco for $36.80 a month and they cover all his drugs. Since he has had a good experience with them and there is no step therapy involved he is using them. The annual cost and the consumer ratings are good. His drugs will cost more but I believe that the cost savings from Integration plan A will counterbalance that. I need to go with a different PDP because Medco will not cover one of my drugs (which is interesting as they covered it as an IBM provider) and found one for $30.10/month that has a good rating.
At first I tried to look for drug plans that have robust formularies but decided they were too expensive. It just wasn't worth the monthly fee. If we have to take different drugs next year we will change plans in 2013. If we are prescribed a drug that is not on the formulary of the plans we are selecting in 2012 we will appeal the decision to not cover the drug. Sometimes the plan will cover the drug on an exception basis until you can switch to a different plan the next year. Also, if a drug is not covered on your plan the drug company might work with you to get the drug at a lower cost until you can switch to a different plan in 2013. It's worth the risk to try this approach.
As best I can tell, all the analysis I did in 2010 and 2011 still applies so if you want more information read through the rest of the blog. There are suggestions on websites to use for more information. I also urge you to go to the websites for the 2012 IBM plans, ask what-if questions, make sure your doctors and drugs are covered by the insurance. Do the math. You are buying insurance. The insurance company wants to make money and you want to not have to spend money! Try to find a solution that is a win-win.
I did look at the Aetna PPO offering because someone told me they heard you can go to any out of network doctor that accepts Medicare and you'll still pay 20%. Well, that's not quite true. I finally found it on the PPO fact sheet. You can go to any out of network doctor that accepts medicare AND agrees to accept the PPO. That makes more sense because that is how PPOs usually work. I've had a few health problems this past year and am really glad I was not confined to specific doctor networks or having to contend with having a doctor agree to take both Medicare and the PPO plan. It's enough of a hassle to find a doctor that will accept Medicare.
The HMO offerings are even more restrictive. However, the positive aspect of an HMO is you will have access to all the doctors who are part of the HMO. They cannot tell you they are no longer accepting patients. And if they quit the HMO you will be assigned to another doctor. If a PPO doctor decides to no longer be with a plan it is up to you to go hunt for another doctor in the PPO network - and even if they are in the network I believe they can stop accepting new patients - it is something to ask of Aetna. If you live in a remote area that might mean your replacement doctors are not nearby. I tried to figure out whether you could get coverage if you wanted multiple opinions in the HMO or PPO plans (something I needed to do this year as I was getting conflicting opinions). I couldn't find it and since it is not what I will choose I gave up looking. In original Medicare you can get as many opinions as you want. I am not sure I see a lot of advantages to the PPO unless the drug coverage suits your needs. I do believe that HMOs are effective at containing your medical costs. Just realize the trade-offs.
So, I decided to switch from IBM's supplemental medical/drug plan to Aetna's Integration plan A. I can do that because both my husband and I are Medicare eligible. I am doing it because I know I will have several doctor visits next year and there is a small chance I may need to go to the hospital. The Medicare deductibles and copays will be covered by Integration A making the plan a real winner for me. If your spouse is not Medicare eligible then you are stuck with IBM's supplement plans and the switch to CVS unless you can buy spousal coverage some other way. The Health Care Reform Act provides insurance exchanges in 2014. Not much help for 2012.
I spent quite a few hours on medicare.gov looking for a PDP for me and a PDP for my husband. It turns out he can get a PDP with Medco for $36.80 a month and they cover all his drugs. Since he has had a good experience with them and there is no step therapy involved he is using them. The annual cost and the consumer ratings are good. His drugs will cost more but I believe that the cost savings from Integration plan A will counterbalance that. I need to go with a different PDP because Medco will not cover one of my drugs (which is interesting as they covered it as an IBM provider) and found one for $30.10/month that has a good rating.
At first I tried to look for drug plans that have robust formularies but decided they were too expensive. It just wasn't worth the monthly fee. If we have to take different drugs next year we will change plans in 2013. If we are prescribed a drug that is not on the formulary of the plans we are selecting in 2012 we will appeal the decision to not cover the drug. Sometimes the plan will cover the drug on an exception basis until you can switch to a different plan the next year. Also, if a drug is not covered on your plan the drug company might work with you to get the drug at a lower cost until you can switch to a different plan in 2013. It's worth the risk to try this approach.
As best I can tell, all the analysis I did in 2010 and 2011 still applies so if you want more information read through the rest of the blog. There are suggestions on websites to use for more information. I also urge you to go to the websites for the 2012 IBM plans, ask what-if questions, make sure your doctors and drugs are covered by the insurance. Do the math. You are buying insurance. The insurance company wants to make money and you want to not have to spend money! Try to find a solution that is a win-win.
Monday, November 7, 2011
IBM Prescription drug coverage for 2012
I just took a quick look at the IBM medical coverage selections for 2012 so my observations are going to be brief. I will try to provide better insight later in the week.
I was surprised to see that Medco will no longer be the prescription drug plan provider. It is changing to CVS Caremark. It is really important to determine if CVS will cover your drugs if you decide to use IBM for your drug coverage. It was similarly important to do that if Medco continued to be the provider but at least Medco would have notified you about the change if they would no longer cover your drugs. Also, some of the issues with the donut hole are continuing to ease because of the Health Care Reform act so it is worth the analysis to decide if it is time to get a separate drug plan and not use IBM's offerings. Medicare.gov has a spectacular plan finder.
I also wanted to reiterate that if you decide to use a Medicare Advantage PPO or HMO be sure you really understand ALL the potential costs of that plan. The literature mostly describes coverage for hospital and doctor visits. All these plans are required to cover whatever original Medicare covers but they sometimes pay less than original medicare for a give procedure such as an ambulance. Do the detailed comparison!
Finally, there is an aspect to Medicare for Durable Medical Equipment (DME) that is important to understand. Medicare does not set limits for what a DME provider can charge for, say, a wheel chair. It only sets limits for what the reimbursement level will be. So, make sure to understand how DME works with your HMO or PPO should you decide to go that way. If the PPO makes you go specific suppliers you will be stuck with what they charge and cannot shop around.
More to come as I study the options for 2012
I was surprised to see that Medco will no longer be the prescription drug plan provider. It is changing to CVS Caremark. It is really important to determine if CVS will cover your drugs if you decide to use IBM for your drug coverage. It was similarly important to do that if Medco continued to be the provider but at least Medco would have notified you about the change if they would no longer cover your drugs. Also, some of the issues with the donut hole are continuing to ease because of the Health Care Reform act so it is worth the analysis to decide if it is time to get a separate drug plan and not use IBM's offerings. Medicare.gov has a spectacular plan finder.
I also wanted to reiterate that if you decide to use a Medicare Advantage PPO or HMO be sure you really understand ALL the potential costs of that plan. The literature mostly describes coverage for hospital and doctor visits. All these plans are required to cover whatever original Medicare covers but they sometimes pay less than original medicare for a give procedure such as an ambulance. Do the detailed comparison!
Finally, there is an aspect to Medicare for Durable Medical Equipment (DME) that is important to understand. Medicare does not set limits for what a DME provider can charge for, say, a wheel chair. It only sets limits for what the reimbursement level will be. So, make sure to understand how DME works with your HMO or PPO should you decide to go that way. If the PPO makes you go specific suppliers you will be stuck with what they charge and cannot shop around.
More to come as I study the options for 2012
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