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Medicare and Health Care


*This is a non-medical board. This site shall not be used to seek professional, medical or legal consultation.

Medicare is health insurance for people age 65 or older, under age 65 with certain disabilities, and any age person with End-Stage Renal Disease (ESRD). There are many different parts to Medicare; with all of these options, it can be confusing.

This forum will allow members to share their experience with medicare and seek advice* on certain medicare-related situations.

To read today's top news stories on federal employee pay, benefits, retirement, job rights and other workplace issues visit FederalDaily.com.

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fedwife  
#1 Posted : Monday, June 24, 2019 8:48:32 PM(UTC)

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If you have Medicare Part B with your Federal insurance, can you please tell me if the extra cost is still worth it to you when you have years where the premium is more than the copays would have been with your insurance? Thank you for any input on the extra cost. I need to make up my mind this week, and having a hard time with that part of it.
OUtside  
#2 Posted : Tuesday, June 25, 2019 3:11:10 PM(UTC)

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fedwife, you're asking the question that Checkbook tries to answer by analyzing a vast database of healthcare statistics and boiling the results down to how average people in situations would do in similar situations to yours on an FEHB plan by plan basis. In other words, whether they would have lost or saved money given assumed health experiences of low, average or high medical expenses overall and given the insurance plan (both with and without Part B). It also will give you your worst case scenario for out of pocket costs if you have a very bad year with very high out of pocket expenses.

If someone replies to your question saying they saved money having Part B and someone else replies they lost money with Part B, that's not going to be a better answer than Checkbook which has analyzed thousands of situations and summarized them in numerical form for you to review.

You are asking a very sensible question and deserve to understand the best answer Checkbook provides.
someoldguy  
#3 Posted : Tuesday, June 25, 2019 3:24:42 PM(UTC)
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I was curious about this so I visited checkbook-dot-org and could not find any ratings of medicare or medicare part B. Lots of ratings of medical providers but nothing specific to medicare.
DISCLAIMER: You read it on an open internet forum :)
OUtside  
#4 Posted : Tuesday, June 25, 2019 6:09:19 PM(UTC)

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Go to the web site below, charge the few bucks to your credit card for a subscription, log on and answer a few questions such as age, self or self plus one, and a couple others, then review the numbers as much as you wish.

If you want clarification of what you are seeing, post questions here and I will try to clarify.

If you want to understand just how they go about formulating their analysis, I think they have a chapter on that to read. I also think they have an entire chapter discussing Medicare and how it relates to FEHB.

https://www.checkbook.org/newhig2/hig.cfm

If you are still employed, your personnel office may have a subscription you can use gratis.

Edited by user Tuesday, June 25, 2019 6:11:54 PM(UTC)  | Reason: Not specified

fedwife  
#5 Posted : Tuesday, June 25, 2019 8:35:19 PM(UTC)

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Yes, it was helpful and showed me it would cost more out of pocket to get Part B, overall. You're right OUtside, it's a great website. Thank you for the suggestion.

I think what else is making it so hard to decide is the website also says to read the articles about the advantages to Part B that outweigh the cost for "most retirees". The penalty for life really makes it hard. I wonder why have it. If we should need it down the road, it might cost too much. It is a big part of my struggle, because it is expensive for us.
OUtside  
#6 Posted : Tuesday, June 25, 2019 9:28:57 PM(UTC)

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I haven't visited the site in awhile. Please specify the section or page where your reference to 'most retirees' is referred to.

The reason the penalty works like that is bc the premium is expensive enough so that without the penalty many people would just wait to enroll until they got sick enough for it to be cost effective to have it, then they would join.

Another thing to think about, if you decide not to have it and save $ by not paying the premium, consider putting at least some of that into a savings account in case, as you say, you need it down the road.

Note that using Checkbook, you can also consider which FEHB plans would be more or less costly both having Part B and not having it. Suppose you have Part B, some plans save you a lot of money vs other plans. Similarly, without Part B, some plans cost you a lot more money than other plans. Of course, you have to pay close attention to which plans we are talking about, read the brochure, compare to your current plan, etc, which takes extra effort. When you reach Medicare age, FEHB allows you a mini open season in order to change FEHB in the middle of the year, if you want to.

Another way to go is to take Part B and then select a Medicare Advantage plan and 'suspend' (do not cancel) your FEHB plan on a temporary basis. If budget is a problem, this can be a very cost effective way to go. You have to read Advantage brochures to make your selection. If you just turned 65, you're probably received mailing solicitations from Medicare Advantage plans. They are worth a look and I think Checkbook has a section on this topic though, as far as I know, doesn't provide estimates for these types of plans.

Edited by user Tuesday, June 25, 2019 9:31:11 PM(UTC)  | Reason: Not specified

fedwife  
#7 Posted : Wednesday, June 26, 2019 7:38:36 PM(UTC)

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That sentence was in the article "What Federal Annuitants Need to Know About the FEHB Program and Medicare, in the first paragraph after the list.

We had looked at the two plans that give assistance towards the cost, but the drug part wasn't good for my husband's medications. I thought about Medicare Advantage, but then someone told me she had to switch to regular Medicare to get her knee surgery because the doctor didn't take Medicare Advantage for the surgery. I know two people that have problems with the doughnut hole and their Medicare Advantage. But it could be something down the road, which is why not getting Medicare part b now is worrisome.

Saving the money for later is a good idea.
OUtside  
#8 Posted : Wednesday, June 26, 2019 9:47:16 PM(UTC)

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Thanks for the information. Yes, I see what you are referring to.

However, read the page entitled 'Should Federal Annuitants Enroll in Medicare after age 65?' I can't explain the difference, however, if the data tables support this other page, I think that is important, for one thing, those tables should reflect the generally economical co-pays with FEHB plans (as mentioned in this other page), which means you have to have a lot of co-pays waived with Part B in order exceed the Part B premium.

If you do not take Part B (or even if you do) make sure you understand how FEHB plan allowances are based on Medicare rates after age 65 for retirees. Those rates are generally low or even quite low, and protect the retiree from high out of pocket costs for services. For example, in the political debates recently with respect possibly Medicare for all, it was pointed out the Medicare rates for in patient hospital, Medicare Part A, are so low that if hospitals had to charge such rates to everyone, not just seniors, many hospitals would go out of business. There should a page in your FEHB brochure about Age 65+ without Medicare, or similar wording, which details this subject. It's a good idea to read and understand this page thoroughly.
OUtside  
#9 Posted : Tuesday, October 1, 2019 8:53:48 AM(UTC)

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Sorry for this late comment.

To the statement above ('I think what else is making it so hard to decide is the website also says to read the articles about the advantages to Part B that outweigh the cost for "most retirees"'), I think what they are saying here is, in their cost comparison tables, where there is a plan or plans where the estimates for out of pocket costs including premiums is less for combining Part B with the fehb plan, then if 'most retirees' enroll in those plans and Part B, then those retirees are likely to come out ahead of retirees who do not take Part B.

But if your fehb plan is not one of those plans, then the estimates for your plan in the cost comparison tables should show you not coming out ahead.

Granted, it's not an easy subject and I think Checkbook could have worded the point better. For example, if 'most retirees' do not enroll in the few plans where this better outcome occurs, then it is confusing to refer to 'most retirees,' as if they do without further clarification.

Edited by user Wednesday, October 2, 2019 8:43:25 PM(UTC)  | Reason: Not specified

PattyPies  
#10 Posted : Friday, October 11, 2019 9:58:31 PM(UTC)

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I have been retired since June 2013. When I retired I was only 62 so I kept my Blue Cross Blue Shield Federal Employee plan when I turn 65 I signed up for Medicare in the middle of all this when I retired I was also diagnosed with a progressive neurological disease where I am in a doctor's office or for tests more often at night but by having Medicare and my Blue Cross Blue Shield Federal Employees I pay no co-pays, no deductibles, basically no costs other than medication and I don't fall into the donut hole. To me it's safer because no matter what happens I know it won't have to come up with all this money. On the other hand if you just keep your Blue Cross without Medicare you going to have a lot of problems because you still have that high out-of-pocket amount to reach Etc
thanks 1 user thanked for this useful post.
GSBS on 10/12/2019(UTC)
PDXbiker  
#11 Posted : Saturday, October 19, 2019 12:17:54 AM(UTC)
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I have been with an FEHB HMO plan for the last 35 years. Upon retirement and age 65 I did not opt for part B. I would have received absolutely zero reductions in copays and deductibles whether I had B or not within my HMO network. All financial benefit would have gone to the HMO in dropping off more of its costs to Medicare B. With Medicare A plus FEHB plus my HMO plan I am pretty well fully covered. Only if I desired to go out of network would B be a benefit to me. I would also require B if I wanted to join a Medicare Advantage Plan. For those with Blue Cross plans, etc. Part B is essential. But in my particular case with an HMO Medicare B gained me nothing in dollar benefits.
old fed  
#12 Posted : Saturday, October 19, 2019 8:06:29 AM(UTC)
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Originally Posted by: PDXbiker Go to Quoted Post
I have been with an FEHB HMO plan for the last 35 years. Upon retirement and age 65 I did not opt for part B. I would have received absolutely zero reductions in copays and deductibles whether I had B or not within my HMO network. All financial benefit would have gone to the HMO in dropping off more of its costs to Medicare B. With Medicare A plus FEHB plus my HMO plan I am pretty well fully covered. Only if I desired to go out of network would B be a benefit to me. I would also require B if I wanted to join a Medicare Advantage Plan. For those with Blue Cross plans, etc. Part B is essential. But in my particular case with an HMO Medicare B gained me nothing in dollar benefits.


why do you say part b is essential for those with BCBS? i opted out of b because, for me, the premiums are too expensive and i get little in return. i realize it can be essential for others.

BCBS has an out of pocket max/year which, while not insignificant,is not burdensome for me. i realize others have different circumstances with which to deal.

and as you mention the part b enrollment benefits the insurance company, not me. if they reduced my BCBS premiums based on part b enrollment i might think about it. i realize they offer $800/yr (for 2020) towards part b premium but that still is not significant in relation to my costs. plus i think i have to go chase that. just lower my premium up front and don't make me work for that and then we can talk.
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