IBM Group Medicare Advantage 2023 Pros & Cons
If you are an IBM retiree you have probably already received a notice about their changing retiree plans to a United Healthcare Group Advantage Plan.
A number of our clients are IBM retirees who chose to work with us in years past and have asked my opinion on the new Group Advantage Plan choices. I have read the material and have seen the presentation by United Healthcare, and I believe it certainly deserves some comments and clarifications. That is what I will do with this video, review the IBM Group Medicare Advantage 2023 Pros & Cons.
Let’s start with the fact that IBM has stated that nothing will change with your plan unless you act. Change is not automatic.
If you are still using Via Benefits for a supplement, as of January 2023 you are no longer incentivized to use them, so and I am pretty sure we can lower your premiums. The supplement plans they offer are specially priced for those who have chronic health problems need a guaranteed issue plan. If you are not in such poor health that you need a guaranteed issue, you will be pleasantly surprised when you let us compete for your business. There is a link in the upper left corner and video summary below to contact us. Our services are free to the consumer.
A dose of reality here: IBM retirees who went with Via Benefits years ago because they were told that is what they have to do to get the IBM subsidy, now are forced to make a change or lose the IBM subsidy. They are in overpriced supplement plans and have now lost a subsidy that at least reduced the cost somewhat.
So how long before this new choice changes? I don’t know but let’s take a look at the choices.
Caveat Emptor – UHC Sales Presentation
The information about the Advantage Plans program has been presented by United Healthcare via an online presentation and a direct public internet link.
As with all sales presentations there is a caveat emptor factor. We can’t fault United Healthcare for wanting to or trying to sell their plan. In doing so, they are presenting in the best light possible and leaving you to figure out what is not said. I am going to fill in those gaps and clarify areas that confused my clients or left them with a false impression.
United Healthcare is offering you to choose one of two different Group Medicare Advantage Plan PPOs, one is called Essential, the other Enhanced.
These are custom designed Medicare Advantage Plans. But they are still Medicare Advantage plans with the same limitations of an individual Medicare Advantage PPO.
The presentation used “scary clever” wording that has mislead some of my clients into believing the plans have benefits they don’t have.
Medigap Benefit Association
Let’s start with this slide from the presentation:
In the first line they state that the plans have combined features of a Medicare supplement, Part D and Medicare Advantage Plans. This is the first of a series of comments that led people I have talked with to believe this is some enhanced Medicare Advantage Plan. It’s not. By the way, all Medicare Advantage plans are custom designed. Some are custom designed for your area, some for a specific group, like these.
The plans being shown for 2023 are Medicare Advantage Prescription Drug plans. They are nothing more than a Medicare Advantage PPO with a bundled Part D plan. I have looked at all the material provided, including the Summary of Benefits and cannot find any specific feature of a Medicare supplement within these plans. None.
Benefit Categories – Not All Benefits
There are two terms I would like to outlaw from Medicare Advantage Plan lingo because they have resulted in confusion and misunderstanding by both Medicare agents and the public.
The first is that Advantage Plans have all the benefits of Medicare Part A and Part B
Which is what they say here.
That is not true.
Medicare Advantage plans do not have all the benefits of Part A and Part B. They have benefits from ALL the same categories of coverage. There is a difference. Big difference.
It’s like saying that Ponderosa Steakhouse has all the same meals as Ruth’s Chris steak house. They are both steakhouses. But they are not the same.
I will give a real-life example of this in a moment.
Term #2 that I would ban is also coming up in just a moment. Bear with me.
Right after this part of the presentation, they state that with these Advantage Plans have all the Rights & Privileges of Medicare.
Medicare Rights & Privileges
Just to be clear, your Medicare rights refer to a non-discrimination clause and that you are to be treated with respect. It also has to do with your right to appeal. It has nothing to do with benefits. You can Google it on the Medicare.gov website. The timing and emphasis on this statement has confused some listeners that are my clients, leaving them to believe it has something to do with benefits.
An important difference that should be noted is that with Original Medicare Part A & B if you want to appeal a decision, you appeal directly to Medicare. When you have an Advantage Plan you are trading in your Medicare A & B for the Advantage Plan. You must deal with the insurance company, not Medicare.
Yes, you have the right to appeal, but you are working with the for-profit insurance company not Medicare.
You Cannot See Any Provider
Slide # 03
This is the slide that broke the camel’s back with me and motivated me to make this video. In my professional opinion it leaves the viewer to believe what is not true. It certainly would not pass muster in my company. There are several things wrong with this slide that I find not acceptable
They use this chart to associate the benefits of their plan with that of a Medicare supplement. They are not the same. Not even close.
This goes to the second statement I would love to see banned because it has confused so many people. We often hear people present an Advantage PPO and say “You can see any doctor that accepts Medicare. If they are not in-network they will be out-of-network.” Some have even added the clause “Just like a Medicare supplement”
In this case, they state that with the United Healthcare Advantage Plan PPO You “Can” see any medical provider that accepts Medicare, and the Plan.”
To be accurate, this should be rephrased. The word “Can” needs to be replaced with “you may ask any doctor that accepts Medicare if they will accept your United Healthcare Advantage Plan as an out-of-network provider. They can and often do say no.” They are under no obligation to accept your plan.
This is not like a supplement where any doctor that accepts Original Medicare will accept your supplement. Not only “can” you see them, Medicare and your supplement will pay the bill.
I had a client about four years back who had developed cancer. She had a PPO Advantage Plan. She wanted to see certain cancer specialist who were not in network. Her life was at stake, and she wanted the best care she could get. Every doctor she asked said NO. They did not want to accept her Advantage plan PPO. By the way, the insurance company she had here plan through was the second largest Advantage Plan insurer in the state.
It was one of the greatest and last disappointments of her life.
Mayo Clinic Does Not Accept Advantage Plans
Another case, just a week or so ago, Mayo clinic released a letter, I believe the third consecutive year for this letter, stating they do not accept Medicare Advantage Plans. If you want treatment at Mayo Clinic – in Florida or Arizona you must have Original Medicare and preferably a supplement.
I can go on, if want more of my thoughts on this please see my video titled Medicare Advantage Plans Explained.
With original Medicare and a supplement, you can see any medical provider in the U.S. or its territories as long as they accept Original Medicare. They will accept any Medicare supplement from any insurance provider. They can do this because they do not bill the supplement. They bill Medicare. Medicare then electronically informs the supplement of what it is to pay and when.
In addition, no insurance company can interfere with your care. There are no preauthorization requirements, there is no insurance company denying a treatment your doctor wants to provide to you.
UHC does require pre-authorization before allowing your doctor to provide recommended care and may not allow all or what is recommended.
I like this “All the features you want?” I want all the medical recommendations made by my doctor without having to ask permission from an insurance company.
This chart is also in error regarding Worldwide coverage, the most popular Medicare supplement plans, supplement Plan’s G, N, C, D, F, M all provide international emergency coverage. They have for 13-years. I wonder how United Healthcare missed this on their chart?
Again, I have more examples than I can put in this video, plus two separate reports from the Inspectors General of Health & Human Services one dated in 2018, the other in 2022 – both discussing the denial and delay of care that is rampant in Medicare Advantage Plans.
But, what I have next here should fall under the category of “Doing your due diligence” before making a decision.
I would like to thank my friend and fellow Medicare YouTuber Christopher Westfall for pointing out this article to me It is linked below and deserves a full read and even mentions United Healthcare.
Wait, didn’t they say earlier that Advantage plans cover everything Medicare Part A and B cover? This is less coverage. How could this be?!
Well, they both cover physical therapy. That’s the category. It’s just that Medicare covers the physical therapy you need as recommended by your doctor. Advantage plans often cut you off when the bill is too high.
This is a great article with a lot of information and real-life examples that include United Healthcare. I hope you read it.
Last slide, then I am going to wrap up and show you where you should look for more information and What should have been on this presentation.
Whenever you see a statistic that is, for all practical purposes 100%, you should question the methodology behind the result. In this case, 99.9% members continue to see chosen provider is misleading.
This is very likely measured after the fact. In other words, it is only measuring the people who have already chosen to go with the advantage plan. Assuming people check with their providers first, just going with the plan would and should eliminate all those whose providers do not accept the plan.
That is the only way you can get to 99.9% in a country where only 45% of all doctors accept any Medicare Advantage Plan.
This statistic is like saying that 99.90% of policy holders who submit a claim to United Healthcare are insured by UHC. Yes, because those not insured by United Healthcare wouldn’t submit a claim to United Healthcare.
Like I said earlier, scary clever wording.
Read the Summary of Benefits
I suggest if you are considering this that you go to the Summary of Benefits – you will find it under Plan Guide – starting on Page 24.
Go to the link they provided https://retiree.uhc.com/ibm/ click on Coverage and Benefits, then Plan Guide. Then page 24 and on.
Then also look at what these plans will cost.
In my opinion, the Essential Plan is comparable to most any other individual Advantage plan PPO out there.
The Enhanced Plan is better but comes at a premium.
You need to weigh the good and bad here relative to your other choices.
In many states, you can get a Plan G supplement, the best healthcare available in the US, plus a Part D for what the Enhanced Plan cost. Then you would have no worries about healthcare coverage and networks.
But you need to consider everything.
Consider that the benefits of these Advantage plans change every year. That is why there is an annual open enrollment, so you can review the changes and choose a plan for the next year. If you like shopping for health insurance, then an Advantage plan is a great choice. You don’t get to do that with a supplement because they are guaranteed renewable. The benefits never change. No need for an annual enrollment.
Of course, Also Consider the IBM subsidy. Is that an amount of money that is worth the limitations of an Advantage Plan? Only you can decide that. IBM has already shown a propensity to change plans and force a change to keep the subsidy. But my company tag line is “Make an informed decision”. I hope this video helps in that regard.
There are extra benefits to consider, but please remember benefits like gym memberships and dental can be taken away or substantially modified every year. When you look at the summary of benefits, remember you are looking at the 2023 plans. The 2024 plans will likely be different. As will the 2025, 26 and so on.
All those extra benefits can be purchased on an individual basis. That makes them yours. They can’t be taken away.
Just a couple weeks ago I published a video called “Medicare Advantage Plans Explained – the secret of Who and Why.” It goes through the demographics of people who make specific Medicare choices, including those who choose a Medicare Advantage Plan and separately a Group Medicare Advantage Plan.
It is worth seeing. It’s always helpful to know what your peers have chosen and why.
Just a Fancy Sales Presentation
The bottom line is – what I saw was a fancy sales presentation, but there is nothing fancy about the Group Medicare Advantage Plans. They are simply Advantage plans that provide an incentive to the employer. They have all the benefits and limitations of an Individual Advantage Plan PPO.
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