Update 1/7/14: We thought we could enroll in the VADIP plan because my spouse is a veteran but had never registered in the VA health system. Unfortunately, now, you cannot even register if your income is above a threshold of about $55,000. My spouse never bothered to register years ago -- because WE HAD IBM MEDICAL. The government income limit rules went into effect after 2003. If you registered before 2003 you are grandfathered. You must be registered in the VA health system to be eligible to buy the VADIP plans even though the VADIP is not means tested. Too bad.
The Veterans Administration is working with Delta Dental and MetLife to provide dental plans to eligible veterans next year. It is an experimental program that begins enrollment 11/15/13 for dental insurance effective 1/1/14.
You must enroll in the VA health system to be able to use this dental program. You can enroll in the VA health system online - it is quite easy and they respond really quickly. They will want to know your financial status but they do not ask for verification of your income statement if your annual income is more than about $50K/year. They only want verification for low income statements to determine subsidy benefits. The dental plans are not low income premium adjusted --- everyone pays the same premium. My guess is low income veterans will continue to go to VA locations for dental services. Here is two links to help you get started:
http://www.va.gov/healthbenefits/vadip/
https://www.metlife.com/VADIP/index.html
For VFWs there is already a program in place but to use this program you must prove you were in active combat in a foreign war. It looks to me like the benefits are not as good as the VADIP program described above. To find out more about the VFW program go to:
http://www.vfwinsurance.com/veterans-dental-insurance.html
Wednesday, October 30, 2013
IBM Extend Health Transition IBM PR - Retirees "Like" This Change. Really?
The IBM public relations team keeps saying there are many retirees that like the change IBM is making for Medicare eligible retiree insurance plans. I wonder how many is "many". After all 1% of 110,000 people is a lot of people. But it certainly isn't a majority.
I do believe there are some people who like this deal better. Who are they and why?
I do believe there are some people who like this deal better. Who are they and why?
- Retirees with spouses under 65:
They were required to pick from the IBM medical/prescription drug plan choices to be able to cover both themselves and their spouses. IT WAS IBM THAT FORCED THIS RESTRICTION. IBM's supplemental insurance plan didn't really start paying until out of pocket expenses were $4000. There were a few things immediately covered like preventive and diagnostic health checkups but the medical coverage didn't start until you had about $15-20,000 in medical bills. That's a lot of doctor bills (most of a hospital short stay bill is covered by Medicare A). The prescription drug plan also might not have been a good plan for covering drugs used by the couple. An easy fix would have been to allow the couple to each enroll in different plans.
- People living in rural areas:
Sometimes people have difficulty finding local doctors - particularly for specialties. Joining a localized HMOs may be the best way to remedy the problem. Perhaps IBM HMO offerings might not provide the best doctor networks available in the area. There is no easy remedy for this kind of problem.
- Better Medicare Advantage plans:
There are a lot of MA plans in the open market that provide different doctor networks or different benefits than the Medicare Advantage plans offered by IBM. Maybe the doctors a retiree wanted to see were in a network plan not offered by IBM.
Tuesday, October 29, 2013
IBM Extend Health Transition - Yet Another Rule Change for HRA access?
I was looking at the www.ibmemployee.com website yesterday and there were postings saying that the requirement to get the HRA subsidy has changed (again). They say now only the retiree needs to buy either a medical plan or a prescription drug plan from Extend Health to gain access to the HRA subsidy for both the retiree and the spouse's reimbursement of insurance premiums and out of pocket medical expenses. The retiree's spouse does not have to purchase an EH plan. The posting included an email from Dr. Rhee with that information.
I have not verified this with an Extend Health agent but, if it is true, it is important to know. I also don't understand why we are not being officially notified of these substantive rule changes and have to find out by word of mouth. This change means you can buy most of the plans that are a best fit for your medical needs irrespective of whether or not EH sells the insurance.
I also should mention that it may be risky to buy a medigap plan through Extend Health as the way to gain access to your HRA. The rules on this are not clear and maybe IBM will fix the following delimma.
Right now, if you are able to buy a medigap plan with guarantee issue because the IBM group insurance you have is ending in 2013 then you cannot be denied by the medigap insurance company. However, once you've bought the EH medigap plan your guarantee issue right ends unless you live in a state that requires continuous enrollment. Very few states require it. New York and Connecticut do.
So, what's the big deal about that? Well, suppose in 2015 Extend Health is no longer selling that medigap insurance plan you bought through them in 2014. That can happen because the insurance company decides they no longer want EH as an insurance agent. Does that mean you've lost your access to your HRA subsidy unless you buy another plan through EH? You might be able to keep your subsidy access by buying, during Medicare Fall Enrollment, a part D insurance plan EH sells - if a plan they offer cover your drugs. If not, then you might have a problem. You can only switch to a new medigap plan EH does sell if your state has continuous enrollment. You have no guarantee issue right to do so in other states and therefore can be denied or charged a higher premium. The medigap plan you bought in 2014 is not ending - EH just isn't selling it anymore. That's the delimma.
I don't have a solution for the situation beyond making IBM aware of the problem. They set the rules. They can eliminate the requirement to buy any insurance from EH the same way they are changing the other rules.
I have not verified this with an Extend Health agent but, if it is true, it is important to know. I also don't understand why we are not being officially notified of these substantive rule changes and have to find out by word of mouth. This change means you can buy most of the plans that are a best fit for your medical needs irrespective of whether or not EH sells the insurance.
I also should mention that it may be risky to buy a medigap plan through Extend Health as the way to gain access to your HRA. The rules on this are not clear and maybe IBM will fix the following delimma.
Right now, if you are able to buy a medigap plan with guarantee issue because the IBM group insurance you have is ending in 2013 then you cannot be denied by the medigap insurance company. However, once you've bought the EH medigap plan your guarantee issue right ends unless you live in a state that requires continuous enrollment. Very few states require it. New York and Connecticut do.
So, what's the big deal about that? Well, suppose in 2015 Extend Health is no longer selling that medigap insurance plan you bought through them in 2014. That can happen because the insurance company decides they no longer want EH as an insurance agent. Does that mean you've lost your access to your HRA subsidy unless you buy another plan through EH? You might be able to keep your subsidy access by buying, during Medicare Fall Enrollment, a part D insurance plan EH sells - if a plan they offer cover your drugs. If not, then you might have a problem. You can only switch to a new medigap plan EH does sell if your state has continuous enrollment. You have no guarantee issue right to do so in other states and therefore can be denied or charged a higher premium. The medigap plan you bought in 2014 is not ending - EH just isn't selling it anymore. That's the delimma.
I don't have a solution for the situation beyond making IBM aware of the problem. They set the rules. They can eliminate the requirement to buy any insurance from EH the same way they are changing the other rules.
Saturday, October 26, 2013
IBM Extend Health Buying a Medigap Policy - Easier Said Than Done
Update - 11/21/13 - the insurance agent said she must come back to the house to have us sign our policies for them to take effect. I asked if she could just mail the policies but she insisted she needed to bring them to the house. Here goes another round of let me sell you .....this is just onerous.
I know, I know ... I keep saying that but I shake my head over what IBM has done to all of us. It's not right. We made IBM a great company by providing our expertise and labor. Although I am not a Marxist, I do believe our labor had great value and we made IBM prosper by providing it. In return IBM made a promise to value our labor via retiree health insurance. We earned these benefits and now IBM is stealing from us.
Original entry on 10/26/13
My spouse and I bought our medigap policies a few days ago but it wasn't easy to do. I started the selection process by looking at Extend Health offerings. As I have said in previous posts, they offered very few choices and the ones they did offer were not from the lowest price products available in my zip code for medigap F high deductible. So, Extend Health was not a good place for me to buy a medigap.
Medigap insurance is what is called indemnity insurance. To quote Wikipedia - "an indemnity is a generalized promise of protection against a specific type of event by way of making the injured party whole again." In the case of a medigap the indemnity is defined very precisely by the particular letter associated with your insurance policy. Each type of policy (A,B, F, K, L, N ...) specifies when the insurance policy will pay and when it will not pay. The payment is always secondary to original Medicare and since it only pays as a secondary there is no specification for what medical procedures will be covered - only the degree to which it will cover your original Medicare deductibles and coinsurance (e.g., copays).
I wrote that paragraph because people are still anguishing over which medigap insurance company is better or worse or whether the doctor will accept the plan. There isn't a better or worse and there is no doctor network involved in the payment process . Every insurance company is issuing EXACTLY the same policy that works in EXACTLY the same way as second payer to original Medicare. CMS automatically sends the claim to the medigap for processing. The doctor is not involved at all. Therefore, the only way to pick an insurance company is based on PRICE.
OK - so I wanted to buy the lowest price medigap F high deductible plan in my zip code. I looked on www.medicare.gov to find out who offers policies and called the company that sells the lowest premium F high deductible policy several times plus I sent emails. They never returned my calls or responded to my emails. I wasn't surprised as I had heard this same result from several people over the past four years that I have been helping people with Medicare questions. I don't know why they list as selling the policy and have actually filed a complaint with the department of insurance a year ago but never heard from them either!
I was able to reach an agent for the next lowest premium insurance company on my list. The policy was $10/month more expensive. However, this monthly premium is still $28/month cheaper than the policy Extend Health offered. I had to buy through an insurance agent as it is the only way they sell the insurance. The agent came to our house to sell us the medigap policy which also did not please me. I deliberately told her when I made the appointment that I was only interested in buying a medigap F high deductible policy but I suspected she would try to sell us every product offered by the company. And that is exactly what happened. We said no to burial insurance, long term care insurance, annuity insurance ..... Try as we might to short circuit the sales pitch she pressed on. After about an hour of sales pitch we were getting really cranky so she finally filled out the paperwork for us to buy the medigap F high deductible plans. This insurance company also requires automatic payment out of our checking account which I do not like but kept reminding myself the premium difference for us was $56/month for these 2 policies versus the EH offered polices. Wow, that was so much easier then just going online and enrolling in IBM group insurance! I wish Dr. Rhee would get a boil for every lie he is telling. His body would be covered.
I also wanted to revisit the math surrounding medigap plans. People are still confused about which plan to pick. Here is another way of looking at which medigap plan to buy. I'll use myself as an example. I am pretty healthy but I have a couple of medical conditions that require monitoring and it seems I end up in ER about once a year for something stupid like a sprained ankle, an infected cat bite or a gall bladder attack. Even so, my medical bills are typically around $4000/year total. Medicare covers 80% of that so if I did not have secondary insurance I'd pay about $1000/year between copays and deductibles. If I pay a medigap annual premium of $3000/year to immediately get 100% secondary coverage and only get $1000 worth of payments from the policy it seems to me to be a waste of money. I'd rather pay $1048/year premium and the $1000 out of pocket. Especially since the $2048 will be totally covered by my HRA subsidy and I will still have almost $1000 left to use for my part D coverage.
If I really get sick then I know my insurance and out of pocket cost will cap at $3158. At that point the F high deductible plan will take over. So, I am betting $158/year that I will stay well. Not a bad bet.
I know, I know ... I keep saying that but I shake my head over what IBM has done to all of us. It's not right. We made IBM a great company by providing our expertise and labor. Although I am not a Marxist, I do believe our labor had great value and we made IBM prosper by providing it. In return IBM made a promise to value our labor via retiree health insurance. We earned these benefits and now IBM is stealing from us.
Original entry on 10/26/13
My spouse and I bought our medigap policies a few days ago but it wasn't easy to do. I started the selection process by looking at Extend Health offerings. As I have said in previous posts, they offered very few choices and the ones they did offer were not from the lowest price products available in my zip code for medigap F high deductible. So, Extend Health was not a good place for me to buy a medigap.
Medigap insurance is what is called indemnity insurance. To quote Wikipedia - "an indemnity is a generalized promise of protection against a specific type of event by way of making the injured party whole again." In the case of a medigap the indemnity is defined very precisely by the particular letter associated with your insurance policy. Each type of policy (A,B, F, K, L, N ...) specifies when the insurance policy will pay and when it will not pay. The payment is always secondary to original Medicare and since it only pays as a secondary there is no specification for what medical procedures will be covered - only the degree to which it will cover your original Medicare deductibles and coinsurance (e.g., copays).
I wrote that paragraph because people are still anguishing over which medigap insurance company is better or worse or whether the doctor will accept the plan. There isn't a better or worse and there is no doctor network involved in the payment process . Every insurance company is issuing EXACTLY the same policy that works in EXACTLY the same way as second payer to original Medicare. CMS automatically sends the claim to the medigap for processing. The doctor is not involved at all. Therefore, the only way to pick an insurance company is based on PRICE.
OK - so I wanted to buy the lowest price medigap F high deductible plan in my zip code. I looked on www.medicare.gov to find out who offers policies and called the company that sells the lowest premium F high deductible policy several times plus I sent emails. They never returned my calls or responded to my emails. I wasn't surprised as I had heard this same result from several people over the past four years that I have been helping people with Medicare questions. I don't know why they list as selling the policy and have actually filed a complaint with the department of insurance a year ago but never heard from them either!
I was able to reach an agent for the next lowest premium insurance company on my list. The policy was $10/month more expensive. However, this monthly premium is still $28/month cheaper than the policy Extend Health offered. I had to buy through an insurance agent as it is the only way they sell the insurance. The agent came to our house to sell us the medigap policy which also did not please me. I deliberately told her when I made the appointment that I was only interested in buying a medigap F high deductible policy but I suspected she would try to sell us every product offered by the company. And that is exactly what happened. We said no to burial insurance, long term care insurance, annuity insurance ..... Try as we might to short circuit the sales pitch she pressed on. After about an hour of sales pitch we were getting really cranky so she finally filled out the paperwork for us to buy the medigap F high deductible plans. This insurance company also requires automatic payment out of our checking account which I do not like but kept reminding myself the premium difference for us was $56/month for these 2 policies versus the EH offered polices. Wow, that was so much easier then just going online and enrolling in IBM group insurance! I wish Dr. Rhee would get a boil for every lie he is telling. His body would be covered.
I also wanted to revisit the math surrounding medigap plans. People are still confused about which plan to pick. Here is another way of looking at which medigap plan to buy. I'll use myself as an example. I am pretty healthy but I have a couple of medical conditions that require monitoring and it seems I end up in ER about once a year for something stupid like a sprained ankle, an infected cat bite or a gall bladder attack. Even so, my medical bills are typically around $4000/year total. Medicare covers 80% of that so if I did not have secondary insurance I'd pay about $1000/year between copays and deductibles. If I pay a medigap annual premium of $3000/year to immediately get 100% secondary coverage and only get $1000 worth of payments from the policy it seems to me to be a waste of money. I'd rather pay $1048/year premium and the $1000 out of pocket. Especially since the $2048 will be totally covered by my HRA subsidy and I will still have almost $1000 left to use for my part D coverage.
If I really get sick then I know my insurance and out of pocket cost will cap at $3158. At that point the F high deductible plan will take over. So, I am betting $158/year that I will stay well. Not a bad bet.
Wednesday, October 23, 2013
IBM Extend Health transition HRA Beneficiary Letter - MAKE SURE YOU GET & READ IT
Update 11/24/13:
Just so you know - you should receive a letter back from IBM confirming your selection. I sent in my notorized form several weeks ago and just received a letter back from IBM confirming my choice of "no survivor coverage".
On October 14, 2013 IBM sent out a two page flier/letter about the HRA survivor benefit. This letter is a legal document. Make sure you get this very important letter as it affects how much money your will get in your HRA account.
Read the letter, then read it again and make sure you understand it. You need to take overt action on how you want your survivor benefit to be processed. Here is the crazy part. It doesn't matter if you are single or married or have eligible dependents --- you MUST take action or, by default, your subsidy will automatically be reduced. I'll say it again because it is rather unbelieveable -----
In order to keep your entire subsidy - you must elect "NO IBM SURVIVOR COVERAGE", notarize the form (it is on the back of the two page flier) and mail the form to the Budco processing company by December 16, 2013. There is a second deadline of January 16, 2014 during which you can submit a form to change your first selection so that gives you the chance to change the default.
Just so you know - you should receive a letter back from IBM confirming your selection. I sent in my notorized form several weeks ago and just received a letter back from IBM confirming my choice of "no survivor coverage".
On October 14, 2013 IBM sent out a two page flier/letter about the HRA survivor benefit. This letter is a legal document. Make sure you get this very important letter as it affects how much money your will get in your HRA account.
Read the letter, then read it again and make sure you understand it. You need to take overt action on how you want your survivor benefit to be processed. Here is the crazy part. It doesn't matter if you are single or married or have eligible dependents --- you MUST take action or, by default, your subsidy will automatically be reduced. I'll say it again because it is rather unbelieveable -----
IF YOU TAKE NO ACTION YOUR HRA SUBSIDY WILL BE PERMANENTLY REDUCED EVEN IF YOU DO NOT HAVE AN ELIGIBLE SPOUSE OR DEPENDENTS
In order to keep your entire subsidy - you must elect "NO IBM SURVIVOR COVERAGE", notarize the form (it is on the back of the two page flier) and mail the form to the Budco processing company by December 16, 2013. There is a second deadline of January 16, 2014 during which you can submit a form to change your first selection so that gives you the chance to change the default.
Tuesday, October 22, 2013
IBM Extend Health Enrollment Experience ---- Update and Confusion
Written on 10/30/13 -- Correction and Update
I just got off the phone with a friend who tried to "enroll" in the same drug plan he already has. He was told that he cannot do that because then Extend Health will not be the insurance agent on record and he will not be entitled to his HRA subsidy. He talked to three different EH people and they all said the same thing. He now has to pick a new drug plan because it is still better to do that then to buy an EH medigap plan which is substantially more expensive than what he can get on the open market.
Even though I asked an agent before I enrolled if we could use the same part D plans as we already had and then I asked the enrollment agent again when we enrolled if we could just reenroll in the same plan - they both are wrong. I am told that our enrollment will be rejected. Now, when will they tell us this? Beats me. I was going to just let it go until they caught it but am not sure that is a good idea. I just spent a couple of hours trying to sort through our alternative choices. None of which are great.
So, I called Extend Health once I decided on the changes and explained the situation. The Benefits Agent said there was no need to change a thing as my spouse and I are properly enrolled. This is insane ---- just insane. I will just wait it out and see what happens.
Written on 10/22/13
Today my spouse and I enrolled in Extend Health plans so we can get our subsidies. The call took approximately one hour and most of that time was spent listening to boiler plate scripts and/or repeating our names and addresses so that we could be recorded for each plan we enrolled into. We each enrolled in a part D prescription drug plan that we already are using so that we can get our subsidies and we each enrolled in the VSP vision plan. We did not enroll in a dental plan as the one that was offered was worthless. I told them we did not want to setup any automatic premium payments to be paid out of our checking account for any of the insurance plans but at step 2 of the enrollment process the step 2 agent insisted that it was required by VSP to do so. I relented and let a one time payment be taken from our checking account for the VSP plan. Yes, there are two different agents for the enrollment process. The first agent "helps" select a plan and then you are transferred to a second agent that actually does the enrollment.
I asked the first EH agent if they could sell me a medigap F high deductible plan from Banker Conseco as that is one of the least expensive F-HD plans available in my zip code. They said they could not. I didn't think they could but it was worth asking. I have an appointment with a Banker Conseco agent later this week to buy the medigap plans directly from the insurance company.
I also told the first EH agent that I knew exactly what I wanted and to please skip any discussion of the plans available in my zip code. They quickly did so and did not try to pursue it at all. I believe that is why our enrollment process only took a hour. Although the enrollment process went smoothly, it is still a ridiculous process. There is so much script reading and prerecorded listening to make sure EH cannot be accused of misleading an enrollee that it is truly obnoxious. At one point as we listened to one of the prerecordings we could hear the agent yawning. That was a highlight of the whole process!
I have been writing much about being sure you know exactly what you want before your enrollment appointment. My experience confirmed how really important it is to do so.
I just got off the phone with a friend who tried to "enroll" in the same drug plan he already has. He was told that he cannot do that because then Extend Health will not be the insurance agent on record and he will not be entitled to his HRA subsidy. He talked to three different EH people and they all said the same thing. He now has to pick a new drug plan because it is still better to do that then to buy an EH medigap plan which is substantially more expensive than what he can get on the open market.
Even though I asked an agent before I enrolled if we could use the same part D plans as we already had and then I asked the enrollment agent again when we enrolled if we could just reenroll in the same plan - they both are wrong. I am told that our enrollment will be rejected. Now, when will they tell us this? Beats me. I was going to just let it go until they caught it but am not sure that is a good idea. I just spent a couple of hours trying to sort through our alternative choices. None of which are great.
So, I called Extend Health once I decided on the changes and explained the situation. The Benefits Agent said there was no need to change a thing as my spouse and I are properly enrolled. This is insane ---- just insane. I will just wait it out and see what happens.
Written on 10/22/13
Today my spouse and I enrolled in Extend Health plans so we can get our subsidies. The call took approximately one hour and most of that time was spent listening to boiler plate scripts and/or repeating our names and addresses so that we could be recorded for each plan we enrolled into. We each enrolled in a part D prescription drug plan that we already are using so that we can get our subsidies and we each enrolled in the VSP vision plan. We did not enroll in a dental plan as the one that was offered was worthless. I told them we did not want to setup any automatic premium payments to be paid out of our checking account for any of the insurance plans but at step 2 of the enrollment process the step 2 agent insisted that it was required by VSP to do so. I relented and let a one time payment be taken from our checking account for the VSP plan. Yes, there are two different agents for the enrollment process. The first agent "helps" select a plan and then you are transferred to a second agent that actually does the enrollment.
I asked the first EH agent if they could sell me a medigap F high deductible plan from Banker Conseco as that is one of the least expensive F-HD plans available in my zip code. They said they could not. I didn't think they could but it was worth asking. I have an appointment with a Banker Conseco agent later this week to buy the medigap plans directly from the insurance company.
I also told the first EH agent that I knew exactly what I wanted and to please skip any discussion of the plans available in my zip code. They quickly did so and did not try to pursue it at all. I believe that is why our enrollment process only took a hour. Although the enrollment process went smoothly, it is still a ridiculous process. There is so much script reading and prerecorded listening to make sure EH cannot be accused of misleading an enrollee that it is truly obnoxious. At one point as we listened to one of the prerecordings we could hear the agent yawning. That was a highlight of the whole process!
I have been writing much about being sure you know exactly what you want before your enrollment appointment. My experience confirmed how really important it is to do so.
IBM Medicare No Grandfathering of HRA reduction for current surviving spouses
I helped someone this morning who is a surviving spouse. IBM is not grandfathering her subsidy allotment. They are reducing her subsidy in 2014. Isn't there something about stealing from widows and orphans that is villian material? Wow - how low can IBM truly go? I guess really low.
IBM Medicare Aetna PPO & HMO participants don't use Extend Health
I just helped someone this morning who used an IBM Aetna PPO plan in 2013. She will be able to use that Aetna PPO plan for 2 more years. The same deal applies for people who used the Aetna HMO plan. She doesn't use Extend Health to enroll and there is no dealing with Extend Health for any reimbursements. She uses the IBM Service Center to enroll. Because she is still on a corporate group plan she also will be able to keep her Met Life Dental plan and her Anthem Vision plan.
These Aetna plans were corporate group plans created for a consortium of companies know as Retiree Health Access. I will guess that there were a lot of IBM retirees enrolled in these plans and it would have dramatically affected the price structure of the plans for them to abruptly drop out. What a pity that people who were on Aetna Integration plans which were also offered out of RHA weren't given the same option.
What a shame that IBM is phasing out of Aetna RHA. That is a real corporate health exchange that put us in a big insurance pool because it was funded and used by many companies. It gave us excellent choices and my bet is the cost of our insurance would not have dramatically risen because of the size of the insurance pool. Of course, it meant that IBM would have to spend all the subsidy money instead of betting we will be bumbling idiots and forget to do the paperwork to suck all the money out of our HRA accounts. Shame on IBM for being so ruthless. Shame, shame, shame.
These Aetna plans were corporate group plans created for a consortium of companies know as Retiree Health Access. I will guess that there were a lot of IBM retirees enrolled in these plans and it would have dramatically affected the price structure of the plans for them to abruptly drop out. What a pity that people who were on Aetna Integration plans which were also offered out of RHA weren't given the same option.
What a shame that IBM is phasing out of Aetna RHA. That is a real corporate health exchange that put us in a big insurance pool because it was funded and used by many companies. It gave us excellent choices and my bet is the cost of our insurance would not have dramatically risen because of the size of the insurance pool. Of course, it meant that IBM would have to spend all the subsidy money instead of betting we will be bumbling idiots and forget to do the paperwork to suck all the money out of our HRA accounts. Shame on IBM for being so ruthless. Shame, shame, shame.
Saturday, October 19, 2013
IBM Extend Health Choosing the Best part D Plan
OK, my title for this post is misleading as there is no such thing as the "best" part D plan. There are a just a number of variables to consider when selecting a part D plan. Choose the plan that best fits the variables that are the most important to you. Everything I am about to write applied when you were using IBM's prescription drug plan. However, most people just used the IBM plan without considering these variables.
- The Formulary - is the criteria that relates to the plan's drug list. It is a complex term meaning what drugs will this insurance plan cover. Part D insurance plans are allowed to decide which drugs they cover. The only regulation applied by Medicare is for drugs that the plan cannot cover - by Medicare law. (They are drugs that treat conditions like anorexia, hair loss, infertility and erectile dysfunction.)
The best way to pick the right formulary is to base it on the drugs you CURRENTLY take. On www.medicare.gov plan finder will show whether or not a particular plan covers your drugs. There is no way to predict what drugs you will need to take and it doesn't make sense to pay a big premium for a part D plan because it has a big formulary. And, even if it does cover lots drugs - the new drug you need might not be on the list!
IF you are prescribed a drug during 2014 that is not on your plan's formulary, your plan will decline coverage. You must appeal the denial! Get a letter from you doctor stating why you need the drug and appeal the plan decision using Medicare's appeal process. It may take a couple of iterations of appeal to get a third party review, but the plan will usually cover your drug - just for the rest of the year. During fall open enrollment in 2014 you will need to select a new part D plan for 2015 that includes your drug in its formulary.
- Drug restrictions - is the criteria the part D plan imposes for the particular drug you use. There are several ways restrictions come into play. The plan may require you to go through "step therapy" to try another, less expensive drugs to treat your condition before they will allow you to fill a prescription for your drug (even though you currently use the drug). The plan might limit the amount of your drug that can be purchased during a given period of time. All drug restrictions are described on www.medicare.gov for each plan. You have to look at the details of the plan to find them. It may also be worthwhile to call the plan and make an agent tell you the restrictions or find the restrictions on the plan's website. Make sure you take notes and names when you gather information about restrictions or lack thereof. It is important evidence if you need to file an appeal because you feel you were misled about drug restrictions.
- Pharmacy Network - is the criteria for where you get prescriptions filled. When you first enter plan finder on www.medicare.gov you pick pharmacies you'd like to use. The results for each plan will tell you whether those pharmacies are in that plan's network. Pay attention to the results because they will use words like "in network" and "preferred network". The pharmacies that are "preferred" provide the lowest cost coverage and is the basis for the annual cost computation. There is also information about mail order services. Not all plans provide mail order services or it may cost more to use such services.
- Total Annual Cost - is the criteria for how much your out of pocket cost will be in 2014. The estimate shown by plan finder includes the monthly premiums for the plan, any deductible, and the copays based on the drug tier assigned to your drugs. The higher the drug tier the more your copay. My recommendation - pick the plan that fulfills your criteria for the first 3 variables that provides the lowest total annual cost.
Tuesday, October 15, 2013
IBM Medicare extendhealth.com/ibm Some Retirees just got the EH letter
Yesterday someone told me they just received the information about the transition to Extend Health and what they received was different information. They had only been using IBM dental and vision insurance in 2013. Medical was covered by their spouse's insurance plan.
Of course, neither Extend Health nor IBM Service Center explained to a subset of retirees why it took so long for them to receive transition information when the rest of us have been blabbing about this since the end of August. I believe it has to do with Medicare law and the fact that private plans are not allowed to begin their marketing for "open enrollment" until the beginning of October. That is why you are now seeing the flood of mail and ads on TV about Medicare Advantage plans. So, maybe Extend Health didn't send out information to a subset of retirees until the beginning of October because Extend Health did not want to be accused of breaking the law. I keep saying this - Extend Health is basically an insurance agent.
The IBM retirees who did not use an IBM medical plan (whether it was the IBM supplemental plans, the Aetna Integration plans or most of the Medicare Advantage plans) are not eligible for a "Special Enrollment Period" which occurs when a corporate group plan is ending. The medical plan these people use is NOT ending. The retirees using the Aetna PPO plan are also NOT eligible for an SEP because the IBM Aetna PPO plan is not ending.
This SEP (there are many types of SEPs) allows Medicare eligible people to enroll in a new medical plan and begin coverage up to 63 days after the end of their current plan. This SEP started with IBM's announcement to retirees and continues into 2014 for 63 days. There are no marketing limitations for someone in an SEP. (That is why people about to turn 65 are flooded with mail and phone calls from private insurance companies.) IBM retirees with this SEP are allowed to pick a new medical plan 63 days into 2014 but coverage wouldn't begin until the first of the next month. To ensure continuous insurance coverage, EH uses the date 12/31/13 as the deadline for enrollment in one of their plans but buried in their literature is the fact that you actually can enroll in the beginning of 2014.
If you are NOT currently using an IBM medical plan that ends on 12/31/13, you do NOT have an SEP. You are eligible for the normal Medicare Open Enrollment (aka fall enrollment) which begins today, Oct 15, 2013, and ends midnight on Dec 7, 2013. There are other implications that are important. There is no "guarantee issue" right to get a medigap supplemental plan. For example, if you were using IBM's Aetna PPO and want to switch to Original Medicare with a medigap - depending on where you live - your state law may allow insurance companies to DENY to sell you a medigap plan, add riders to exclude pre-existing medical conditions and/or charge higher premiums based on your medical condition or age.
Extend Health is sending out brochures to the retirees without this SEP that describe Medicare Advantage plans. EH assumes you will not want to switch to Original Medicare if you are using a Medicare Advantage plan. That is misleading because in several states that have continuous enrollment for medigap, this is the time to switch to Original Medicare and get a medigap. Also, if 2013 is the first year you tried a Medicare Advantage plan you are allowed to switch back to Original Medicare with a medigap.
Reminder, if you are already using Original Medicare with a medigap the rules for when you can switch to a different medigap plan with "guarantee issue" are state determined and are not tied to Medicare open enrollment. For example, in California you can only do it on your birthday.
Reminder, these convoluted Medicare rules/laws are brought to you by your federal and state legislators who often times are influenced by insurance company lobbyists. And retired federal legislators are not required to use Medicare when they turn 65. They have their own federal plan.
Of course, neither Extend Health nor IBM Service Center explained to a subset of retirees why it took so long for them to receive transition information when the rest of us have been blabbing about this since the end of August. I believe it has to do with Medicare law and the fact that private plans are not allowed to begin their marketing for "open enrollment" until the beginning of October. That is why you are now seeing the flood of mail and ads on TV about Medicare Advantage plans. So, maybe Extend Health didn't send out information to a subset of retirees until the beginning of October because Extend Health did not want to be accused of breaking the law. I keep saying this - Extend Health is basically an insurance agent.
The IBM retirees who did not use an IBM medical plan (whether it was the IBM supplemental plans, the Aetna Integration plans or most of the Medicare Advantage plans) are not eligible for a "Special Enrollment Period" which occurs when a corporate group plan is ending. The medical plan these people use is NOT ending. The retirees using the Aetna PPO plan are also NOT eligible for an SEP because the IBM Aetna PPO plan is not ending.
This SEP (there are many types of SEPs) allows Medicare eligible people to enroll in a new medical plan and begin coverage up to 63 days after the end of their current plan. This SEP started with IBM's announcement to retirees and continues into 2014 for 63 days. There are no marketing limitations for someone in an SEP. (That is why people about to turn 65 are flooded with mail and phone calls from private insurance companies.) IBM retirees with this SEP are allowed to pick a new medical plan 63 days into 2014 but coverage wouldn't begin until the first of the next month. To ensure continuous insurance coverage, EH uses the date 12/31/13 as the deadline for enrollment in one of their plans but buried in their literature is the fact that you actually can enroll in the beginning of 2014.
If you are NOT currently using an IBM medical plan that ends on 12/31/13, you do NOT have an SEP. You are eligible for the normal Medicare Open Enrollment (aka fall enrollment) which begins today, Oct 15, 2013, and ends midnight on Dec 7, 2013. There are other implications that are important. There is no "guarantee issue" right to get a medigap supplemental plan. For example, if you were using IBM's Aetna PPO and want to switch to Original Medicare with a medigap - depending on where you live - your state law may allow insurance companies to DENY to sell you a medigap plan, add riders to exclude pre-existing medical conditions and/or charge higher premiums based on your medical condition or age.
Extend Health is sending out brochures to the retirees without this SEP that describe Medicare Advantage plans. EH assumes you will not want to switch to Original Medicare if you are using a Medicare Advantage plan. That is misleading because in several states that have continuous enrollment for medigap, this is the time to switch to Original Medicare and get a medigap. Also, if 2013 is the first year you tried a Medicare Advantage plan you are allowed to switch back to Original Medicare with a medigap.
Reminder, if you are already using Original Medicare with a medigap the rules for when you can switch to a different medigap plan with "guarantee issue" are state determined and are not tied to Medicare open enrollment. For example, in California you can only do it on your birthday.
Reminder, these convoluted Medicare rules/laws are brought to you by your federal and state legislators who often times are influenced by insurance company lobbyists. And retired federal legislators are not required to use Medicare when they turn 65. They have their own federal plan.
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