IBM Medicare Via Benefits "Medicare and You" Book Fall Enrollment for 2022

 A couple of days ago I received my 2022 copy of the "Medicare and You" book and is excellent!  It explains the options for Medicare coverage more clearly than any previous edition and is a great way to reexamine your Medicare choices.  Reminder, for many states if you switch from Original Medicare with a medigap to a Medicare Advantage plan it is a permanent switch because you won't be able to buy a medigap policy if you switch back.  Original Medicare without a medigap is not a wise choice.
   

The estimates for the cost of Medicare coverage are starting to surface.
    
It is estimated that the part B fee will increase to $158.50 (up from $148.50). Everyone above a annual income of about $18,000 gets to pay that every month regardless of the structure of their insurance. People with high incomes pay even more depending on their annual income from 2 years ago (it's called IRMAA).

The estimate for the part B deductible is $217 (up from $203). 

The estimate for the part D maximum before obtaining catastrophic coverage is $7,050. That number include your cost + discount amount from pharmaceutical companies that was negotiated by your insurance policy so your out of pocket is in the range of $5000 before you get your drugs for 5% of the negotiated price.  Even so, it is a lot of money!  The part D deductible estimate is $485 (up from $445). Ugh.
    
It looks like the maximum out of pocket (MOOP) for Medicare Advantage plans will remain the same ($7,550) and can be as much as $11,300 for PPO plans.  Reminder, that does not include the cost for part D, only out of pocket health costs.  The way the Medicare Advantage plans pass along the cost increases describes is through premiums, higher copays or reduced networks.  

Look at your ANOC.  Make sure your drugs are covered in 2022. Make sure your doctors will still take your plan if you use Medicare Advantage. Pick a plan that gives you the right coverage. You have between October 15th and December 7th to do it!

IBM Medicare Via Benefits Medicare Brochures and Fall Enrollment for 2022

 In the last post I provided a link to a specific Medicare brochure about Medicare coverage of "Home Care".  There are 97 more brochures available on www.medicare.gov describing Medicare coverage in great detail that range from the coverage for diabetic equipment to the structure of Medicare prescription drug insurance. Some of them are excellent! I suggest you go to the site and look through the whole list: https://www.medicare.gov/publications  

     

This is the time of year to refresh your Medicare knowledge and get ready for Fall Open Enrollment.  FOE runs from October 15 thru December 7 and during that time you can change your Medicare coverage for 2022.  In September, you will get an "Annual Notice of Change" from your Medicare insurance providers.  Look at it!  Make sure the plan you currently have is still the right plan for you in 2022. 

     

 For those on Original Medicare, that means it's the time to make sure your part D drug insurance will continue to cover your prescriptions and do it at "best price" in 2022.  If not, enroll in a new plan!  If the part D insurance is how you "get" IBM HRA funding because it is the only insurance you buy through them, then work with Via Benefit to find a better plan.  If not, call 1-800-MEDICARE (633-4227) to get help and enroll or do it online at www.medicare.gov (find a plan) before December 8, 2021.  The FOE is NOT for your Medicare Supplement (aka medigap). The rules on when, or if, you can change your medigap depend on your state.  Call your State Health Insurance Assistance Program to find out the rules if you want to make a change as sometimes Via Benefits has inaccurate answers (you can find the state organization phone number at https://www.shiphelp.org/)

   

For those on Medicare Advantage plans, call Via Benefits or go to the website to find out what plans they sell.  You must buy your MA plan through Via to get your HRA money because you must buy a "Medicare plan" to get the money (dental and vision insurance do not count). Make sure the doctors you want to use will take a plan you want to use, the drugs you take are on their formulary, AND what the "Maximum Out Of Pocket" is in 2022 (in 2021 it can be as high as $7,550). Investigate these things, whether for your current plan or for a plan you might want to buy in 2022. 

IBM Medicare Via Benefits Medicare Home Care Coverage

There is a great deal of confusion about Medicare home care coverage. It's one of the top reasons why people ask for help with Medicare. It is compounded by Medicare Advantage plans sometimes offering benefits not available to Original (Traditional) Medicare policy holders.  It makes no sense to not have benefits be exactly the same. Unfortunately, that's a political problem that is difficult to solve. Just realize, when you "get" coverage (such as bathroom equipment) in a Medicare Advantage plan, you "lose" coverage (such as access to doctors nationwide) in Original Medicare. However, no matter what type of Medicare insurance you have, the fundamental principles of home care coverage are the same. 

   

It's simple. Medicare does not cover long term custodial care.  That means: Medicare does not cover the cost of hiring someone to come into your home to feed you, dress you, clean for you or do other chores, such as food shopping.  There is insurance available to cover those services but it is very expensive if your income is above the federal poverty limit.  Long term care insurance might provide some custodial care coverage. If you don't have LTC insurance, you have to pay out of pocket for that kind of help. On the other end of the spectrum, for federal poverty level income people without assets, Medicaid provides custodial care. Qualifying for Medicaid differs from state to state as do the services provided by Medicaid. 

     

Medicare does cover short term care which primarily revolves around a home bound patient needing medical assistance to recover from a medical problem.  The following brochure is provided by Medicare and details home care coverage for both Original Medical and Medicare Advantage.  It is very comprehensive: 

https://www.medicare.gov/Pubs/pdf/10969-medicare-and-home-health-care.pdf

      

All too often, people don't pre-plan actions should they need custodial care. Typically, the need arises as a "surprise" and is the worse time to figure it out. At a minimum, be informed about what is or is not covered by Medicare, Medicaid and long term care insurance and educate your family too.  Identify organizations available in your state that can help your family if you do need such care. On the other side of the spectrum, don't be pushed into unwarranted long term custodial care when the medical problem is temporary and can be remedied with Medicare home care coverage. 

Also, tell your family about home care benefits available from IBM I described in February 2020:   https://ibmmedicare.blogspot.com/2020/02/ibm-medicare-via-benefits-ibm.html

IBM Medicare Via Benefits IBM announcement of splitting into two companies

 In October 2019 IBM announced it would be splitting into two public companies.  

This is a link to the SEC filing:

https://www.sec.gov/Archives/edgar/data/51143/000110465920113260/tm2032661d1_ex99-1.htm

In this filing there is a "TBD" regarding what happens with the pension plan.  It will have to belong to one of the companies if both of them are public companies.

This is an excerpt from the BBC and is a lot easier to read:

International Business Machines (IBM) has announced it will split into two public companies.

The move is an attempt to shift its focus to higher-margin businesses like cloud computing and artificial intelligence.

A new company focusing on legacy IT infrastructure will be named and spun off next year.

It marks the latest shift by the world's first big computing firm to diversify away from its traditional businesses.

IBM Medicare Via Benefits Medicare Advantage advertising during fall open enrollment 2020

This year I thought about smashing my TV to bits rather than wait for yet another commercial about Medicare Advantage plans to end. AND, I don't watch that much "free TV".  It was insane. I cannot imagine what it was like for social media users.  

Here's why I found it so upsetting.  The commercials were incredibly misleading and bordered on being outright lies.  In the past, these kinds of commercials were slapped down by the FCC for being duplicitous. Where is the FCC? Why was the head of HHS not in a rage over how the ads were trying to trick people into signing up for subpar insurance? Where was AARP as a defender of seniors?  There seems to be no "watchdog" who is willing to slap down the insurance industry. I am all for honest capitalism but this is corruption.

I am writing this post knowing the readers of this blog are highly unlikely to be swayed by the drivel in Medicare Advantage advertising.  However, if you know people who are vulnerable, please help them "see the light" about the Medicare Advantage ads.  There is no such thing as "free".  Everything has a price.  Even when people don't have to pay for healthcare, the price is being so poor they cannot afford it and the places where they can go to get care are incredibly limited. Help your friends, please help them understand those Medicare commercials are a pile of BS. 

IBM Medicare Via Benefits Medicare Recipient Insurance Cost Analysis from 2007 - 2021

 This information is updated to include 2021 cost information. 

https://drive.google.com/file/d/1rfKZhgninJGJqgcvAYcc8txskhLGnVpK/view?usp=sharing

It was originally posted in a blog entry on March 2020 at:

 http://ibmmedicare.blogspot.com/2020/03/ibm-medicare-via-benefits-medicare-cost.html

IBM Medicare Via Benefits HRA FSA Reimbursement for part B 2021 Process

 Maybe you are like me.  I received a postcard from Via Benefits maybe a month ago and barely looked at it.  At least I didn't throw it away.  It was about automatic premium reimbursement.  I've been doing that for my part D and medigap so I tossed the postcard in the Medicare mail pile and wondered when I was going to get my form in the mail to setup the automated monthly reimbursement for part B in 2021 like I did in 2018 and 2019.  

A friend called yesterday and was asking me questions about how to fill out his 2021 form because he has an IRMAA (he is a retired executive). IRMAA is a premium differential higher income people pay to be in Medicare (but don't call it a tax!)  We talked through the form he received and I realized I had not received my part B form. I called him back to ask when he received it and he said he called Via to request it be mailed.

Smart me, I decided I would just print mine off the Via Benefits website. I knew how to print forms off the Via website! Fat chance. Such began my decent into insanity. It took a couple of tries but I did succeed in logging on.  It had been a while since I'd been on the site. I tried to find "forms" but the website had been redesigned.  I crawled all over the main site and the reimbursement site and no forms were anywhere.  Then I tried to do a search.  The "HELP" function circulated but never loaded so I couldn't do a search.  I went back through every menu item again and couldn't find forms.  

It was time to composed a hate filled message to submit as a "ticket" and I decided to further work out my aggression by sweeping leaves off the back deck.  Then I looked at that damn post card. It was about how to get part B reimbursement but they never say on the card that it is only for people who don't have IRMAA so he couldn't have used it.  I went back to the website, determined to learn how I could do it (the postcard said I could do it online) and how he could have done it because of  his IRMAA.

Here's what I learned.  If you don't have an IRMAA and still have the postcard, you can mail in the response card and they will turn on automatic reimbursement for part B.  If you threw out the postcard, you can call or turn it on in your Via Benefit reimbursement profile. If you have an IRMAA, call Via to get the form like he did OR do a recurring premium reimbursement function and fill out the questions in the function fields using "Medicare" as the insurance company.  You then have the option of printing out the "form" created by the application to mail with a copy of you SSA letter or submit it online and upload an image of your SSA letter.  

Of course, I bitterly complained to Via Benefits in their survey.  It seems to me they do not field test their redesigns on seniors. At the very least, there should be a stellar "Help" function that will actually load. I think it is elder abuse!

IBM Medicare Via Benefits Medicare Insurance is INSURANCE - like house insurance or car insurance!!!

This is a philosophical post.  It's appropriate because, years ago when I started the blog, I said I was "Plato pondering the meaning of health insurance".

I don't know why this is true, but I experience it over and over as I counsel people.  Most people do not look at medical insurance the way they look at car insurance, house insurance or life insurance.  The right objective for any insurance is to rarely use it unless something really bad happens.  House and car insurance are supposed to rarely used. Predictable things aren't covered. If houses are build in an earthquake zone, people cannot even get earthquake insurance. If someone has a lot of car accidents they have to pay a whole lot for car insurance and become "assigned risk".  Those policies never cover small stuff. If my house needs a repair, I pay for it.  If my car needs new tires, I pay for it.  

Why do people believe their Medicare insurance has to pay for every thing they need medically? Be sure Medicare insurance will pay for the BIG things.  It's the same as being sure insurance covers a house flood or a one car crash.  Two years ago, unfortunately, our two cars were demolished when a tree fell during a storm.  Boy, was I glad we had good car insurance.  Up until that time, we paid a whole lot of car insurance premium money for years and years and rarely used it. We are lucky we haven't needed to use to our house insurance. I'm really glad I didn't used my life insurance when I had a policy!

Buy Medicare insurance that is good for covering the "big" things that might happen even if it costs you more to do it and it doesn't cover small things like a doctor copay.  Big things are things such as long hospital stays, inpatient physical and occupational therapy sessions, chemotherapy treatments, or limb loss prosthetics. If you are paying premiums and don't need to use you Medicare insurance, that's a good thing, not a bad thing.

Medicare Advantage advertisements and insurance brokers don't talk about the cost of covering BIG things.  They talk about little stuff like primary doctor copays or dental cleanings.  When a BIG thing happens, people on those plans often face astronomical bills and it can be financially devastating because those plans fall apart. It is also when people learn about the terms of their Medicare Advantage insurance policies.  

 

IBM Medicare Via Benefits part D 2021 Planfinder (for 2021 plan selection) Update

October 31, 2020 update:

 According to CMS, the problems with Medicare planfinder function are fixed.  If you decide to switch to a new part D plan, before you make the change, call the phone number at the bottom of the detailed information for the plan that is in planfinder and verify the drug coverage and costs.  If you are making a switch by calling Via Benefits or 1-800-MEDICARE, do the same thing.  Write down the name of the person you speak to at the insurance company, the time and the date.  This way if there is a problem in January you have the ability to contest and change to another plan because of "special circumstances". You do that by calling 1-800-MEDICARE and using the phrase "special circumstances SEP" when you ask to change to another plan.

October 26, 2020 post:

There are, once again, problems with the Medicare planfinder function.  The "add a drug" function is incomplete because the drug selection list doesn't have all the drugs covered by Medicare. If a drug is covered, it is no guarantee it will be covered for you if you are using it for an "off label" condition even though your doctor prescribed it. The price stated might not be the price you will pay in 2021.

It is very hard  to figure out if all of drugs a user wants are covered by a given plan unless the user goes into deep details on the plan.  The most confounding aspect is there is no guidance to tell users that if a drug is not covered, then the cost of that drug does not "count" in the calculations to determine costs for the three drug phases.  

Complain, complain, complain to your federal and STATE government representatives.  How are seniors supposed to be able to make good choices when they have bad data?  Complaining to HHS is a waste of time.  Complaining to your drug plan is even more so.  Complain to your elected officials.  Complaint to your governor, your state and federal representatives, your state attorneys general, and your consumer protection agencies.  COMPLAIN

IBM Medicare Via Benefits Medicare Hospital cost data for 2021

 In 2019 I wrote a blog post about the significant difference in cost for a hospital stay coverage for Original Medicare with an "N" Medicare Supplement insurance policy, and a Medicare Advantage (MA) plan with a $0 premium, but an out of pocket maximum cost (MOOP). 

MA plans are significantly more expensive if you need a lengthy hospital stay. It also is expensive if you are unlucky and have several hospital stays 60 days apart. I updated the table comparison for 2021 since that MA MOOP number has significantly increased.  The original post explains more about the table and was written  September 21, 2019: http://ibmmedicare.blogspot.com/2019/  

The table update for 2021. The average premium of an "N" plan is about the same in 2021. The highest premium for an N plan (which is NYC) is about $200/mo:

Phase	Original Medicare +  Medigap N at $150/mo	Sample (actual) 2021 Medicare Advantage plan $0 premium
Hospital Benefit Period (Every 60 days)	$1452 deductible Paid by Medigap N plan	No deductible
Hospital Days copays Every Benefit Period	$0 days 1-60  $363 days 61-90  $726 for 60 lifetime days All copays paid by Medigap N	$400 days 1-5 $0 days 5-90 $? lifetime days (not described in planfinder)
If exceed 150 days in hospital	All Medigaps provide this extra benefit of 365 addition lifetime days with $0 copay	No Medicare Advantage plans have this benefit  Patient pays all hospital costs after 150 days
Maximum hospital stay cost for 2021	$1800 for 2021 (Medigap premium $150 x 12)	$7,550 for 2021 (if within 150 day limit)