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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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kaljor  
#1 Posted : Thursday, December 26, 2019 10:47:24 PM(UTC)

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This topic, namely figuring out the best way to go when we have the option of FEHB only, FEHB plus Medicare , or Medicare only is about as complex a topic as I've ever encountered in my life. As far as real world decisions go.

I've read every post in this sub forum, and I've visited many of the links that were recommended, and I do have an understanding of the issues that most people (including me) are concerned with. But I have to admit that translating printed brochure language to understanding the real world meaning is often beyond me. So I continue to look to understand it all, and so if you will indulge me, I'd like to ask a series of questions I have that where the answers seem vague to me in the brochures and even in this forum, which has really knowledgeable participants. I'd like to ask them just one at a time so that I can better understand the answers and the discussions that might follow, and hopefully I won't discourage the wiser forum members from answering.

My first question is about a frequent conclusion I see here. Many folks seem to advise Medicare plus BCBS Standard. So in my case for example (self only coverage) my cost for that when I turn 65 would rise from $253 to $397 per month (under the 2020 rates). And the additional benefit I would get is free co-payments, deductibles, and co-insurance. Am I correct that none of these costs are waived with BCBS Basic?

That's just step 1 of my questions.
OUtside  
#2 Posted : Friday, December 27, 2019 6:11:03 AM(UTC)

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BC Basic waives copayments in similar way as Standard (see page 150 of 2020 BC brochure), so if you are happy with Basic and know the differences between the two (Basic and Standard) and are still happy with Basic knowing the differences (example, must use PPO providers with few exceptions), you would probably be happy with Basic and Part B combined.

The folks you refer to who suggest having Standard with Part B probably haven't read up on the Checkbook suggestion that taking Part B can enable taking a less expensive fehb plan, as in the case we are talking about. The best source to read on the subject of fehb/Part B is the Checkbook open season guide, an on line subscription is available for few dollars and many agencies provide access for free. It will help you to read it carefully and save you much time.

The other thing to do is to read the entire Section 9 of your fehb brochure which will explain how the plan works with Medicare (includes page 150 mentioned above) as well as how the plan works for a retiree age 65+ who does not have Medicare. Best to read this section carefully and if you then have questions pose them here.

Edited by user Friday, December 27, 2019 9:37:35 PM(UTC)  | Reason: Added the other thing to do

Rivkah  
#3 Posted : Saturday, January 4, 2020 6:17:27 PM(UTC)
Rivkah

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BCBS customer service was great about answering all my questions and explaining how it all works.
kaljor  
#4 Posted : Saturday, November 7, 2020 10:45:45 PM(UTC)

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Reviving a thread I started 11 months ago, I'm back!

In the past year I've done a lot of reading on this topic, and although I understand the basic concepts, I can't always translate that into real world scenarios. So I'd like to ask a question that describes a very specific example and if anyone who knows can answer it, I'd really appreciate it.

My question arises from my suspicion that I wouldn't need Part B as long as I have a good quality high option FEHB plan. What I'm envisioning is not enrolling in Part B when I turn 65, but keeping a very good FEHB plan. Am I correct in saying that the most I would ever pay out of pocket in any given year would be the total of my plan premium plus the plan catastrophic limit?

Asking because I'm in pretty good health, and I can pay the normal FEHB deductibles and co-payments and co-insurance each year with no issue. What I'm worried about is that maybe 8 or 9 years after I turn 65 I find out that I need a triple bypass operation for example. In that case, would my theory above be true? Would I only have to pay my plan annual limit?

I'm leaving prescription drug costs out of this discussion because the particular drugs one needs are very individual and I didn't want to complicate the question. Also. the only drugs I need are not the medical variety (just kidding!)
OUtside  
#5 Posted : Tuesday, November 10, 2020 12:52:56 PM(UTC)

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That is correct.

If you haven't already done so, here are some important related issues to consider.

Part B is optional now but it is possible that could change some day to make it mandatory. If no waiver is provided in that case, those who did not enroll when first eligible would pay a penalty on the premium of 10% per year for each year of delayed enrollment.

Some retirees delay enrollment on their own and then decide to enroll later, perhaps because their health deteriorated. Due to the penalty for late enrollment, they likely end up paying more over the long term than they would have paid had they enrolled when first eligible.

Be sure to read and fully understand the section in your fehb brochure pertaining to over age 65 and not enrolled in Medicare.

The catastrophic provision of your fehb plan is not fixed and will likely change over time (upward). For an interesting discussion on this point, see the recent thread on this forum entitled Has the cost of Medicare Part B been worth it to you?

It is essential to understand any exclusions from your plan's catastrophic coverage, perhaps pertaining to prescription drugs of a certain type, or other services. (Note, this is a possible exception to the assumption you are trying to confirm).

It is best to consider prescription drug coverage as part of the total out of pocket expenses, one reason is they may (or may not, depending on plan provisions) be covered under the catastrophic provision, another is some plans impose smaller copays for prescription drugs if the retiree is enrolled in Medicare Part B.

Edited by user Tuesday, November 10, 2020 2:59:10 PM(UTC)  | Reason: Added note

thanks 1 user thanked for this useful post.
kaljor on 11/11/2020(UTC)
kaljor  
#6 Posted : Wednesday, November 11, 2020 4:57:20 PM(UTC)

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You raise some good points. I'll have to think them over. As to the drug coverage, your point is well taken. I have to look into that aspect of health insurance in retirement very carefully. So far I've postponed that part of it.

Edited by user Wednesday, November 11, 2020 4:58:12 PM(UTC)  | Reason: Spelling Error

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