For those affected by IBM's transfer of approximately 30% of its pension pool to Prudential/MetLife, this is a description of the process known as "Pension Risk Transfer". It is some measure of comfort that this process is regulated by the federal government:
https://www.investopedia.com/terms/p/pension-risk-transfer.asp
Today I helped someone who's 90 year old mother is on a UHC Medicare retiree plan from a major corporation. How ironic. The mother is a patient in a rehab facility and receiving PT. UHC just denied providing more days in rehab because it's "not medically necessary" even though the primary care doctor said she should stay in the facility for another 90 days. Her offspring is jumping through hoops trying to appeal the UHC denial.
Why would a Medicare Advantage plan deny and make it difficult to get medical care? It's all about making money. The primary way Medicare Advantage plans make money is by "managing care". That's a clever way of saying they make sure the amount of care their policy holders receive in claim payouts does not exceed the amount of money allotted to provide medical services.
At the beginning of every year, Medicare gives Medicare Advantage plans a fixed amount of money to use for each policy holder. If the policy holder doesn't need much medical attention, then the Medicare Advantage plan gets to keep the money. If the policy holder gets very sick, the Medicare Advantage plan does everything it can to discourage the policy holder from continuing in the plan and/or carefully "manages" the policy holder's treatment. The plan could make the case to Medicare for getting more money for a very sick policy holder, but it's a lot easier to "manage" the treatment. Often, the plan become so ornery in that management, the policy holder decides to switch to original Medicare. Perhaps a deliberate strategy? Sick policy holders are not good for business.
Original, traditional Medicare is a federal government insurance pool. The federal government is not about making money, it's about providing healthcare. In fact, when analysis is done, the federal government is more cost effective at providing healthcare coverage than Medicare Advantage plans.
In the following analysis, Kaiser Foundation found people more often switch from Medicare Advantage to original Medicare than the other way around. It most often happens when people also have Medicaid. Then they don't have to worry about being able to buy a Medicare Supplement plan (aka medigap) to cover coinsurance and deductible costs. Medicaid does it. The rules for getting medigaps vary from state to state. Many states don't prevent insurance companies from denying or doing underwriting to significantly raise the premium of a medigap if someone switches from a Medicare Advantage plan to original Medicare. Do you know the rules in your state?
If you have original, traditional Medicare with a medigap, you have the best health insurance insurance money can buy. Isn't that the most important thing to have at this stage of our lives? Don't throw it away because IBM is telling you some BS about their UHC Medicare Advantage plans. Next thing you know, Joe Namath is going to appear on their brochures.
I called the UHC IBM phone number to find out more about the IBM UHC Medicare Advantage Plan coverage in 2023 and how the "stipend" works because a lot of information is floating around and I wanted to be somewhat accurate in writing this post. There isn't a lot of information about the UHC plans. The website retiree.uhc.com/ibm has a lot of "coming soon" information. The agents who answer the phone are very kind but all they want to do help enroll people into one of the two plans (which is so premature it's insane). I am not going to describe the plans because there isn't much information about them beyond that there are two plans and one is more expensive than the other. They are the Essential Plan and the Enhanced Plan.
As regards the stipend (don't call it an HRA!!!), it is true the stipend is only available to users of the "Essential Plan" and it seems to be about $1,300. HOWEVER, the Essential Plan has a maximum annual out of pocket cost of $5,000 for the year and an Rx deductible of $395. The Enhanced Plan maximum annual out of pocket is $750 and an Rx deductible of $50. Even though there is a monthly premium for the Enhanced Plan (about $130/mo), why one would ever get the "Essential" Plan is unknown (at least by me) because of that max out of pocket (which is often talked about as MOOP).
I specifically asked if UHC policy holders could go to Sloan Kettering or City of Hope. The answer I got was no. That's no surprise. I just wanted to verify it.
Reminder, I will never, ever enroll in a Medicare Advantage plan no matter how good it "looks" on paper because I believe they are Medicare DisAdvantage plans if you get really sick.
This next part has nothing to do with UHC Medicare Advantage Plans but it is about our benefits.
I asked UHC what happens to people who have "FHA" money left in their account. How does that work in terms of accessing the money to cover medical costs? Of course, the UHC agent didn't know. She gave me another number that put me into IBM pension information and when I hit the number for Medicare information I was right back in the UHC call center. I don't know what will happen with that money, but if you have an FHA and can prepay 2023 premiums in 2022 you might want to spend out your FHA before you lose it if you don't intend to use the Medicare Advantage plans.
There are two other IBM benefits I asked about and the UHC agent really had no idea what I was talking about. These benefits are probably disappearing but IBM has not mentioned anything about it. You might recall that IBM told us they would jump in and help with the cost of drugs for the rest of the year if the retiree had spent about $8,000 out of pocket. IBM also would help with the cost of home care (which is not covered by Medicare no matter what the plan) when the retiree spend about $6,500 and also do it for the rest of the year. These were described in IBM's "About Your Benefits" Publication.
I wrote in a prior post that I believe IBM is stealing compensation money from retirees. I talked to a friend who is a lawyer and they sort of agree. The next step for me is to find a class action lawyer who agrees.
I know too much about the dastardly things Medicare Advantage plans do to people. At this stage of our lives, the most important thing is having access to the best health care we can get. The stress of dealing with an MA plan that denies or delays treatment can be really bad.
I want to know that I can just call up and make an appointment at Sloan Kettering, should I need to do so, and my insurance is not going to be denied. I want to know that I can go see any Medicare doctor without needing a referral. I want to know my insurance won't second guess what my doctor recommends as treatment or that I cannot get the medications I need because I cannot pick a stand alone Rx plan that best fits my medication coverage at least cost. I just looked at Sloan, Mayo Clinic, MD Anderson, Cleveland Clinic and City of Hope. They all accept original Medicare. They accept "some" MA plans and then say "check with your insurance". That's not good enough.
Edited on 9/18/2022:
Yesterday, IBM had two major announcements for retiree benefits. The US retiree pension fund that supports 100,000 retirees are now annuities administered by Prudential and MetLife. The payout will be the same, but the federal protections are gone. There is no ERISA oversight for annuities, meaning there are no federal guarantees we will get our payouts for the rest of our lives. I am sort of surprised because I thought IBM "made money" when the pension was overfunded. Maybe the rocky stock market helped them decide they didn't need the risk of having to fund the pension if it was under funded and if the annuities go bust, well that's not their problem. Anyway, if you haven't seen anything about it, this link does a good job describing it:
https://www.pionline.com/pension-risk-transfer/ibm-offloads-16-billion-pension-liabilities-annuity-purchases
This was a big shock but the other big shock is what happens to our HRA funding. In 2023, you will only get HRA funding $1,300 only if you enroll into one of the two Medicare Advantage plans structured for IBM by United Health Care. You must pick the "basic" Medicare Advantage plan and funding will only cover you copays. For those of us in Original Medicare with a Medicare Supplement, we get NO money if we want to continue in that structure.
This is dreadful for a couple of reasons. First and foremost, United Health Care is a miserable company. They are all about making life as difficult as possible both for providers and policy holders. They require pre-approvals on almost anything that is costly such as surgical procedures, DME or prosthetics. They second guess doctor recommended procedures and won't pre-approve treatment. They control the prosthetics that can be used for things such as knee replacements, they require referrals any time you want to see a specialist. Most importantly, they deny, deny, deny, full well knowing people will give up and not get a procedure if it is a pre-approval or pay a claim if the service has been delivered and then denied because appealing a denial is complicated. Even if you do the appeal right, they somehow manage to screw up the process and will make you crazy until you appeal 2 or 3 times.
How do I know? I have been advising people about Medicare and how to handle denials and appeals for many years. UHC screws up everything. Don't even bother to try to call them if you have a problem. They will spin you in circles. You must do written appeals and file written grievances to get their attention. I don't know if is on purpose or as a way to get providers and/or policy holders to give up and go away. I bet it is on purpose.
Why force us onto a Medicare Advantage plan, and the one that has less benefit? A guess. Maybe we are not croaking fast enough and IBM is tired of providing HRA funding. It will essentially eliminate the medical benefit for retires without having to announce that they are breaking a promise. UHC probably gets some money for each policy sold and then controls the amount of services people get so retirees won't go through the full stipend. Many Medicare Advantage plans make money strictly from the federal government and have a zero premium and very low copays but they also control access to medical services so maybe IBM doesn't even have to give UHC money. Want the latest cancer treatment? So sorry. You wanted a pace maker? Your doctor didn't make a good enough case for it. Denied. Getting something like $200 a pop from IBM for each MA plan sold is not chump change to UHC who likely promises to dramatically cut IBM cost because UHC will control access to medical services thereby limiting the reimbursements.
I am sad. I never thought IBM would get to this. I understand why they wanted to get out of managing a pension or managing health insurance policies. It is ancillary to their business. I initially wasn't happy about losing the insurance IBM provided before 2013 (which was fabulous) and being pushed to Via Benefits but, at least it gave me choices. It is a low blow to force all Medical eligible retirees into Medicare Advantage plans and a really low blow that the company providing the policies is United Health Care. Even Humana is a better company!!! Really, a low blow. It means retirees will get sub-par medical treatment because of a dodgy insurance company that is only interested in making money and could care less about the well being of policy holders. The IBM company executives don't care either. They need to squeeze every penny out of piddling programs to pay their fabulous executive bonuses. Sad. Really sad.
Do you remember when we were told our retiree benefits were "part of our salaries"? IBM told us not to quit and go to other companies that paid better salaries that didn't offer those benefits because, when factored in, IBM's salary was better! I wish I had that documentation. The company is basically stealing our earned income. Isn't that illegal?
This recent report about Medicare Advantage plans says it all!
Medicare eligible recipients are inundated with attempts to deceive recipients into providing personal identity information to either steal from them, steal their identity, or steal from Medicare.
The most important thing to know about Medicare, Social Security or IRS is these federal agencies NEVER call unless the caller has first called them and asked for a call back. If a federal agency wants to communicate with a Medicare and/or SSA recipient, it is always done using postal service mail.
The second most important thing to know is never, ever, give any caller your full Medicare number or your Social Security number (SSN). If they are legitimately calling you, they will already have that information and might ask you to provide the last four digits to be sure they are talking to the right caller.
Unfortunately, we all have lapses in judgement, particularly when a caller is ever so polite and seemingly trying to be an advocate. The same holds true for Medicare TV commercials that seem so interested in helping you get the best possible deal. There really is no such thing as "free". However, marketers know people love the word "free".
If you or someone you know was tricked into providing identity information there are things to quickly do to counteract the scam.
First and foremost, everyone should freeze their credit rating accounts before they ever have a problem. No one can open a credit card or take out a loan using stolen ids if credit rating accounts are frozen. It's a little annoying to unfreeze an account if you want to do something like sign up for a new credit card or switch a cable service. It's devastating and often irreparable if someone exploits your personal information for their own gain and your accounts weren't frozen.
There are three credit rating agencies. Call and freeze your account in each one:
If your credit rating accounts are frozen it goes a huge way toward thwarting fraud, but it may not stop thieves from trying to do other things. What else do you need to do or not bother to do?
Telling the police you have been scammed is a waste of time. They just don't have the capacity to pursue low level criminals who likely live in a foreign country. Don't waste your time filing a report.
Medicare, however, is quite interested in knowing what happen. It is bilked of millions of dollars due to fraudulent claims submitted by scammers. Immediately notify Medicare (1-800-633-4227) if you lost your Medicare card or inadvertently gave your Medicare number to a scammer. They will put a block on your account and help you get a new Medicare card. Medicare is open 24 hours a day, 7 days a week.
If you are scammed into giving someone your Social Security Number, call Social Security (1-800-772-1213) to notify them of the situation. Scammers will try to get Social Security to change the bank account where your SSA benefit check is deposited. If you notify SSA that you have been scammed they will put an alert on your account.
Also call your bank and they will put a lock on your bank accounts so there can be no unauthorized access.
Medicare published this brochure which has more advice about protecting your Medicare resources:
https://www.medicare.gov/Pubs/pdf/10111-Protecting-Yourself-and-Medicare.pdf
Stay safe!
I wrote a post earlier this year about the estimates for Medicare costs in 2022. About a month ago, Medicare announced the 2022 cost and it was a shock how much the part B fee will increase. It will be $170.10 (an increase of $21.60). They provided some rational about why it was a huge jump. It wasn't a particularly satisfying list of reasons and focused on the cost of the new Alzheimer's drug that was just approved even though there have been reports that doctors are unimpressed and not prescribing it.
However, maybe there is another reason. There is also a substantial cola increase for your SSA benefit in 2022 as compared with prior years and it is 5.9%. The SSA cola increase in the past 5 years has been very small by comparison. It's just a guess, but the coincidence of a hefty part B fee increase coinciding with a hefty SSA cola increase is ironic, don't you think?
There are other Medicare cost increases that are worth noting. Reminder, as these costs go up, so will the cost of your Medicare supplement premium increase. If you use Medicare Advantage, your perceived cost might not "go up" but your access to networks, part B drugs, prosthetics and other benefits might "go down". The MOOP for Medicare Advantage plans did not change and remains at $7,550 for in-network and $11,300 for combined in-network and out-of-network.
If you got a letter from your 2021 part D (aka Rx) insurance plan about your plan being consolidated into another plan OR your part D plan is being terminated you must pay attention to that letter for two reasons.
First, if your part D plan is being terminated, you MUST buy a new part D plan before the end of FEBRUARY 2022. If you wait until January to buy that new plan, you will not have part D insurance during January. Your coverage will begin February 1, 2022. If you wait until February to buy the new plan, you will not have part D insurance until March 1, 2022. As important to consider, if you get your HRA benefit based on having bought the part D from Via Benefits (and bought your medigap another way), you will lose access to your HRA funding until you buy the new part D plan, which must be purchased through Via Benefits.
A more subtle problem with part D plans is plan consolidation. Again, you should have received a letter from your 2021 plan about this if it affects your plan. Again, this problem only applies to people who did not buy their medigaps from Via Benefit. If your part D plan is being folded into, aka consolidated into another plan, you still have to "buy" that plan through Via Benefit even though the move to the new plan is automatic. Also, if the plan you are automatically being moved to is not in Via Benefit's inventory, then you must change to a part D plan Via sells.
You HAVE to read the ANOC notice you receive every year from your part D and Medicare Advantage plans to make sure the change the insurance company makes does not affect your access to your HRA. Reminder, Via Benefits is an insurance broker. If you don't buy at least one medical plan through them, you will lose access to your HRA for the year. That's a costly mistake.
Last week I think I changed to a new part D plan for 2022. I write "I think" because the Via Benefits website is the least intuitive website I have ever used.
The sign on to Via makes me feel like I am trying to hack into Fort Knox. But I did manage to sign on. Then I clicked the "shop" icon and bumbled through the menus to get to part D plans and select the plan I wanted to buy. One would think once one selects a plan and puts it into the cart then it would be easy to "check out". Fat chance.
I fumbled and bumbled around until I landed back on the Via main page and, as a guess, clicked on the link to go to the description of my policies. Maybe there are instructions somewhere on the site to do that. It sure wasn't obvious to me. It is in that menu the user "purchase process" is completed.
I sort of completed the "buying" process and provided an electronic signature. It's "sort of" because the last time I looked on the site, the part D policy I want for 2022, it is "pending approval". What they have to approve is beyond my comprehension. Medicare, on the www.medicare.gov website, allows me to change my part D policy during Medicare Open Enrollment by just clicking an enroll button. In fact, I can change it as many times as I want between Oct 15 and Dec 7th.
I already buy a medigap from Via Benefits which fills the requirement of buying one policy from them, so I really don't need to jump through the hoops of the Via Benefits website or call them to spend 30 minutes on the phone to make this plan change. One would therefore think they would make it as easy as possible because they get commission for the sale if I buy it through them.
What I also realized, is that I don't even need to ask for reimbursement of the part D premiums for the new plan. I typically use up my HRA account money by about September of the year. The premium for the new plan is about $7/mo or $84/year. Not exactly a barn burner in terms of chewing through the HRA funds. Bottom line, if Via doesn't "approve" the plan change by mid November, I will cancel the purchase and enroll through Medicare.
10/26/21 Update:
The new plan was "approved" by Via Benefits. When I get the enrollment materials from the new plan, that will be when I trust the process!
