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Sante123  
#21 Posted : Saturday, November 21, 2020 12:07:51 PM(UTC)
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Originally Posted by: jagfan Go to Quoted Post
The Aetna Medicare Advantage plan sounds interesting. In my situation, however, I'm not sure it would be a good fit. I use Mayo Clinic in Florida for all medical care, primary and specialty. Upon reviewing the types of insurance accepted at the clinic, Medicare Advantage plans are mentioned but it is unclear whether any are currently under contract. Their list of contracted plans does not include any Medicare Advantage plans, however, the list is always being updated and a phone call could be made to confirm. I don't want to take any chances, so I will stay with Aetna Direct.


Good luck with whatever plan you go with.

It’s best not to lump commercial Medicare Advantage plans in with the FEHB MA plans. The FEHB plans are fundamentally different with far fewer limitations and much larger service areas. Here is what Aetna tells providers about claims and contracts: Aetna Guidance to Non-Participating Providers

The Mayo Clinic Florida website Q&A section says....

Does Mayo Clinic accept Medicare?
Yes, Mayo Clinic is a participating Medicare facility in Rochester, Minn., in Florida and at all Mayo Clinic Health System locations.
Mayo Clinic in Arizona does not currently accept assignment for Medicare Part B (medical and professional services) but, does participate in Medicare Part A (hospital services).


It goes on to say......

Does my insurance cover my scheduled appointments?
Please contact your insurance company for benefit-specific information. You may provide your insurance company with Mayo Clinic Tax ID number to determine if Mayo Clinic is in network.

Mayo Clinic's campus in Florida:
Mayo Clinic: Tax ID No. 59-3337028
Mayo Clinic Hospital: Tax ID No. 59-0714831


Since they participate fully with Medicare Parts A and B at the Florida facility, you should be good to go. It should not matter if they have a contract with the Aetna Medicare Plan PPO network or not. Of course, if you care to find out if they do, you can contact Aetna and give them the above tax ID info for Mayo Clinic Florida.

Hope this info helps you with your decision.
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jagfan on 11/21/2020(UTC)
OUtside  
#22 Posted : Saturday, November 21, 2020 4:05:12 PM(UTC)

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I think this plan is not on the Checkbook list I saw today, it seems. I deleted a post I had made a few minutes ago about plan Z26, but I think the other plan is Z26R.
Sante123  
#23 Posted : Saturday, November 21, 2020 6:27:41 PM(UTC)
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Originally Posted by: OUtside Go to Quoted Post
I think this plan is not on the Checkbook list I saw today, it seems. I deleted a post I had made a few minutes ago about plan Z26, but I think the other plan is Z26R.


The fact is that the FEHB MA plans, including this one, are spinoffs of their respective generic FEHB plans. The way they have been structured, you must first join the generic plan. Then, if you want the MA variant, you complete step two, by which you share the particulars re: your Medicare A+B enrollment. If you do this, you end up in the MA plan variant, which has substantially different benefits. Both the generic and the MA variants of each plan share the same FEHB plan code. You might ask “why don’t they just create a new plan code for each FEHB MA plan?” I don’t know for sure, but suspect that it’s for legal reasons. Perhaps, this process is why they are able to get around the previous requirement that one needed to suspend FEHB in order to join an MA plan.

This brings us to the Checkbook Guide. It needed to identify the features and benefits of each FEHB plan. And each plan has always had its own plan code. Except this year that’s no longer true. So, how could they list plans that are totally different but share the same plan code? The solution was to add an “R” to the end of the plan code for the MA variant. They also added the word “Retirement” to the name to further differentiate the MA variant from the generic version. This is their own unofficial code. Now, they don’t say that this is what they’ve done, but it’s clear (at least to me) that it is. The proof is that the official plan brochures for plans that have MA variants have no plan codes that end with an “R.” They just have the original three generic codes, one each for Self, Self + One and Self + Family. Just try to imagine how the Guide could spell out all these schizophrenic plan details under one listing with one name. Can’t be done.

Now you know why I used the phrase “slightly confusing” to describe plans like these.

Edited by user Saturday, November 21, 2020 11:10:44 PM(UTC)  | Reason: Not specified

fedspouse  
#24 Posted : Sunday, November 22, 2020 12:48:19 PM(UTC)

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Did you confirm that this new plan Aetna Medicare Advantage lets you go to any doctor that accepts Medicare assignment? Aetna Advantage has a PPO network. What about the Medicare variant?
Sante123  
#25 Posted : Sunday, November 22, 2020 1:31:13 PM(UTC)
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Originally Posted by: fedspouse Go to Quoted Post
Did you confirm that this new plan Aetna Medicare Advantage lets you go to any doctor that accepts Medicare assignment? Aetna Advantage has a PPO network. What about the Medicare variant?


Yes. All of the MA info I commented on pertains to the Aetna Medicare Advantage plan. The FEHB brochure offers a mixture of info re: the Medicare and non-Medicare variants of the Aetna Advantage plan. For a more focused look at the answer you want, read the last two links in my post #1 of this topic as well as the link I provided in post #21.
fedspouse  
#26 Posted : Sunday, November 22, 2020 1:54:43 PM(UTC)

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Thanks for the links. The link in post 21 makes it seem like the doctors collect copayments, etc but the link in post 1 show definitively $0 for in and out of network.
Sante123  
#27 Posted : Sunday, November 22, 2020 2:36:04 PM(UTC)
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Originally Posted by: fedspouse Go to Quoted Post
Thanks for the links. The link in post 21 makes it seem like the doctors collect copayments, etc but the link in post 1 show definitively $0 for in and out of network.


Yes, in that post 21 link, Aetna uses some general language that fits a larger universe of MA plans that contains more than just the one we are interested in here. Some have copayments or coinsurance, but as you see this one definitely does not.
Sante123  
#28 Posted : Monday, November 23, 2020 10:29:10 AM(UTC)
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This morning I called Aetna to get greater clarification re: coverage for participating providers who do not accept Medicare assignment. The existing written guidance is a bit imprecise, so I wanted them to spell things out....and they did. The word is that this Aetna Medicare Advantage plan can be used for any provider who accepts Medicare and this plan, both those who accept Medicare assignment and those who do not. As in most (all?) other FEHB plans, enrollees who see providers who accept Medicare, but not Medicare assignment, will have to pay the provider and then file a claim for reimbursement. The only providers that this plan cannot be used for are those that have completely opted out of Medicare.
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FlowerGirl on 11/23/2020(UTC)
OUtside  
#29 Posted : Monday, November 23, 2020 3:15:06 PM(UTC)

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FWIW, here is a copy of a post from a recent similar thread which involved the APWU Advantage plan:

Here is the quote from page 137:'Medicare will
be primary for all Medicare eligible services. Members must use providers who
accept Medicare's assignment.'

One of Checkbook's excellent tenets: 'Trust plan brochures.'

One issue to resolve is that providers who do not accept assignment can charge up to 115% of the Medicare rate. And the plan says there will not be a copay for the Medicare rate, but does not say one way or the other (that I could find) who pays the other possible 15%. It does say, however, on page 90 'We do not waive any costs if the Original Medicare Plan is your primary payor.' So, who is the subscriber that this statement is talking to? The only one I can think of is a retiree who has Parts A and B but has not opted in to the Advantage option of the plan.

Edited by user Monday, November 23, 2020 4:31:59 PM(UTC)  | Reason: added last paragraph

freeageless  
#30 Posted : Monday, November 23, 2020 6:26:45 PM(UTC)
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Originally Posted by: FlowerGirl Go to Quoted Post

In order to get the $75 a month benefit to help pay for Medicare Part B, their brochure states on page 92 that your Social Security check will be credited each month for $75. That doesn’t help me since I don’t have Social Security benefits. My payments for Part B come out of my annuity check from OPM. I inquired about that and the agent seemed to think it works the same way; my annuity check will be credited. I’m going to call again later this afternoon to see what the next agent has to say about this.

Well, I’ve been on the phone most of the day to get an answer to the $75 reimbursement conundrum. I talked to OPM, per Aetna; Aetna per OPM; Medicare per Aetna. The fourth and last agent at Aetna really did try her best. Her suggestion was that perhaps I should call back at the end of the week when, maybe, they will have an answer. Maybe.


Sante,
Like FlowerGirl, I have the exact sake question that she has: My payments for Medicare Part B also come out of my monthly annuity check from OPM. Do you know of anything in writing that addresses this issue from Aetna or elsewhere. I too have called Aetna, and been given the run-around. In other words how do we get the reimbursement? I would like to know how can I see it in writing?


Sante123  
#31 Posted : Monday, November 23, 2020 7:27:23 PM(UTC)
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Originally Posted by: freeageless Go to Quoted Post
Originally Posted by: FlowerGirl Go to Quoted Post

In order to get the $75 a month benefit to help pay for Medicare Part B, their brochure states on page 92 that your Social Security check will be credited each month for $75. That doesn’t help me since I don’t have Social Security benefits. My payments for Part B come out of my annuity check from OPM. I inquired about that and the agent seemed to think it works the same way; my annuity check will be credited. I’m going to call again later this afternoon to see what the next agent has to say about this.

Well, I’ve been on the phone most of the day to get an answer to the $75 reimbursement conundrum. I talked to OPM, per Aetna; Aetna per OPM; Medicare per Aetna. The fourth and last agent at Aetna really did try her best. Her suggestion was that perhaps I should call back at the end of the week when, maybe, they will have an answer. Maybe.


Sante,
Like FlowerGirl, I have the exact sake question that she has: My payments for Medicare Part B also come out of my monthly annuity check from OPM. Do you know of anything in writing that addresses this issue from Aetna or elsewhere. I too have called Aetna, and been given the run-around. In other words how do we get the reimbursement? I would like to know how can I see it in writing?


The Aetna Advantage Plan FAQ page contains the following text:

How will the plan lower my Medicare Part B Premium?

Once you have completed the 2-step enrollment process, Medicare will have the necessary information to reduce your Part B premium. Your Social Security account will be credited $75 per month (up to $900 a year). If you pay your premium on a quarterly, semi-annual, or annual basis, you will see a reduction in your premium in the amount equal to the number of months.

While unlikely, it may take a few months to see the credit to either your Social Security check or premium statement, but you will be reimbursed for any credits you did not receive during this waiting period.


The above info can be found on this page link: FAQ Page
freeageless  
#32 Posted : Tuesday, November 24, 2020 2:23:38 AM(UTC)
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Originally Posted by: Sante123 Go to Quoted Post
Originally Posted by: freeageless Go to Quoted Post
Originally Posted by: FlowerGirl Go to Quoted Post

In order to get the $75 a month benefit to help pay for Medicare Part B, their brochure states on page 92 that your Social Security check will be credited each month for $75. That doesn’t help me since I don’t have Social Security benefits. My payments for Part B come out of my annuity check from OPM. I inquired about that and the agent seemed to think it works the same way; my annuity check will be credited. I’m going to call again later this afternoon to see what the next agent has to say about this.

Well, I’ve been on the phone most of the day to get an answer to the $75 reimbursement conundrum. I talked to OPM, per Aetna; Aetna per OPM; Medicare per Aetna. The fourth and last agent at Aetna really did try her best. Her suggestion was that perhaps I should call back at the end of the week when, maybe, they will have an answer. Maybe.


Sante,
Like FlowerGirl, I have the exact sake question that she has: My payments for Medicare Part B also come out of my monthly annuity check from OPM. Do you know of anything in writing that addresses this issue from Aetna or elsewhere. I too have called Aetna, and been given the run-around. In other words how do we get the reimbursement? I would like to know how can I see it in writing?


The Aetna Advantage Plan FAQ page contains the following text:

How will the plan lower my Medicare Part B Premium?

Once you have completed the 2-step enrollment process, Medicare will have the necessary information to reduce your Part B premium. Your Social Security account will be credited $75 per month (up to $900 a year). If you pay your premium on a quarterly, semi-annual, or annual basis, you will see a reduction in your premium in the amount equal to the number of months.

While unlikely, it may take a few months to see the credit to either your Social Security check or premium statement, but you will be reimbursed for any credits you did not receive during this waiting period.


The above info can be found on this page link: FAQ Page


Sante,
Thank you but I do not see where that answers the specific question. Does that mean that those of us who do not receive Social Security will see the Medicare reduction credit on our monthly OPM retirement statement which shows our monthly Medicare premium?

Edited by user Tuesday, November 24, 2020 2:29:46 AM(UTC)  | Reason: Not specified

teeeeej  
#33 Posted : Tuesday, November 24, 2020 6:41:35 AM(UTC)
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Originally Posted by: freeageless Go to Quoted Post
Originally Posted by: Sante123 Go to Quoted Post
Originally Posted by: freeageless Go to Quoted Post
Originally Posted by: FlowerGirl Go to Quoted Post

In order to get the $75 a month benefit to help pay for Medicare Part B, their brochure states on page 92 that your Social Security check will be credited each month for $75. That doesn’t help me since I don’t have Social Security benefits. My payments for Part B come out of my annuity check from OPM. I inquired about that and the agent seemed to think it works the same way; my annuity check will be credited. I’m going to call again later this afternoon to see what the next agent has to say about this.

Well, I’ve been on the phone most of the day to get an answer to the $75 reimbursement conundrum. I talked to OPM, per Aetna; Aetna per OPM; Medicare per Aetna. The fourth and last agent at Aetna really did try her best. Her suggestion was that perhaps I should call back at the end of the week when, maybe, they will have an answer. Maybe.


Sante,
Like FlowerGirl, I have the exact sake question that she has: My payments for Medicare Part B also come out of my monthly annuity check from OPM. Do you know of anything in writing that addresses this issue from Aetna or elsewhere. I too have called Aetna, and been given the run-around. In other words how do we get the reimbursement? I would like to know how can I see it in writing?


The Aetna Advantage Plan FAQ page contains the following text:

How will the plan lower my Medicare Part B Premium?

Once you have completed the 2-step enrollment process, Medicare will have the necessary information to reduce your Part B premium. Your Social Security account will be credited $75 per month (up to $900 a year). If you pay your premium on a quarterly, semi-annual, or annual basis, you will see a reduction in your premium in the amount equal to the number of months.

While unlikely, it may take a few months to see the credit to either your Social Security check or premium statement, but you will be reimbursed for any credits you did not receive during this waiting period.


The above info can be found on this page link: FAQ Page


Sante,
Thank you but I do not see where that answers the specific question. Does that mean that those of us who do not receive Social Security will see the Medicare reduction credit on our monthly OPM retirement statement which shows our monthly Medicare premium?


That would be logical if that's where Medicare gets deducted.
Sante123  
#34 Posted : Tuesday, November 24, 2020 7:08:45 AM(UTC)
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@freeageless:

You wanted guidance in writing. This happens to be the only related text available that I could find. What it means is that Aetna presumed that those who get no monthly Social Security benefit would pay their Medicare premiums directly to CMS through periodic billing, usually quarterly. (BTW, that’s how I used to do it.) CMS and Social Security are part of the same department, HHS. As a result, it’s easier to coordinate the matter of the premium rebate either via a monthly SSA benefit or a periodic Medicare premium billing statement. Just as it’s easier for newly-retired individuals to coordinate the shift from Medicare premium billing to withholding premiums from an SSA benefit, (for those who transition from Medicare-only status to Social-Security-recipient-with-Medicare-Part-B status.) From what I’ve read over the years, the transition from OPM pension withholding to SSA benefit withholding is less smooth.

Does that mean you can’t arrange to a) receive a separate payment for your premium rebate OR b) have OPM/CMS adjust the premium withholding amount on your pension statement, or c) switch to periodic direct billing of Medicare premiums so Aetna/CMS can adjust your statements to reflect the premium rebates? Not necessarily. But there isn’t anything else in writing that I could find to show you.

If I were you, I’d switch to quarterly billing of Medicare premiums and then let Aetna/CMS factor in the premium rebates. But that’s just me. You may have other options, such as the ones I listed.
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freeageless on 11/24/2020(UTC)
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