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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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milton004  
#1 Posted : Thursday, December 10, 2020 9:58:13 AM(UTC)
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I turn 65 in Feb. I will take Medicare Part B, my wife is on Part B as well. I have had BCBS Basic and been happy with it. We are both in good health with few prescriptions. Focus is cheaper of coarse and I would give up the Part B rebate in Basic by enrolling in Focus. The economics still work out better if we try Focus. My question is has Focus been a good plan for those who have tried it? I am leaning towards trying it for 1 year. Thank you.
teeeeej  
#2 Posted : Thursday, December 10, 2020 6:22:39 PM(UTC)
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Originally Posted by: milton004 Go to Quoted Post
I turn 65 in Feb. I will take Medicare Part B, my wife is on Part B as well. I have had BCBS Basic and been happy with it. We are both in good health with few prescriptions. Focus is cheaper of coarse and I would give up the Part B rebate in Basic by enrolling in Focus. The economics still work out better if we try Focus. My question is has Focus been a good plan for those who have tried it? I am leaning towards trying it for 1 year. Thank you.


The optimal plans for Medicare are Aetna Direct, GEHA High and GEHA Standard.


BCBS Basic and BCBS Focus will pay nothing if you see an out of network doctor or facility. I wouldn't risk it.
GO4IT!  
#3 Posted : Friday, December 11, 2020 10:29:28 AM(UTC)
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There is an extremely good article on today’s Government Executive website/newsletter titled, “Looking for a Medicare Advantage,” by Tammy Flanagan, a Federal Benefit Specialist. Nearly all the NEW FEHB Plans associated with Medicare are ALL Medicare Advantage Plans. These generally do not pay as well overall, but they typically provide amenities such as Gym memberships, etc. I am talking about Aetna, United Healthcare, etc. Ms. Flanagan sums this up very well in the article, and I encourage everyone who has FEHB and Medicare, read it.

The Post above mine regarding BCBS is incorrect insofar as the author asserts if you are treated by an out of network doctor, there will be no payment. Medicare will be your Primary insurance, and many physicians accept Medicare in some form or fashion. Thus, Medicare will pay in this circumstance, and you probably will not be on the hook for any payment EXCEPT in very exceptional circumstances.

I changed to BCBS Basic from BCBS Standard 2 years ago, and I have no regrets whatsoever. BCBS reimburses you $800 for your Medicare Part B premiums, which is great and easy to do. I have yet to pay anything out of pocket for medical treatment, and I have multiple health problems. Ms. Flanagan notes in her article that if you take one of the FEHB Medicare Advantage Programs, you will just get one insurance card instead of two. Payments many of these Advantage Programs provide are not necessarily equivalent to regular Medicare, and tend to be less with regular Medicare Advantage Programs in associated with FEHB.. She also notes many of these Advantage Programs are notorious for markedly changing what is covered year after year. In addition, she mentions you may run into trouble if you drop one of these plans and later try to get back on FEHB insurance, or pay penalties to get back on regular Medicare. She suggested there are really too many unknowns about these NEW FEHB/Medicare Advantage Programs, and that those of us who have significant health problems may very well come out ahead using a FEHB Plan that reimburses you to keep regular Medicare. Again, please read the article. It’s brief and informative. I am staying with BCBS BASIC and regular Medicare. Good Luck!
Sante123  
#4 Posted : Friday, December 11, 2020 1:10:45 PM(UTC)
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Originally Posted by: GO4IT! Go to Quoted Post
There is an extremely good article on today’s Government Executive website/newsletter titled, “Looking for a Medicare Advantage,” by Tammy Flanagan, a Federal Benefit Specialist. Nearly all the NEW FEHB Plans associated with Medicare are ALL Medicare Advantage Plans. These generally do not pay as well overall, but they typically provide amenities such as Gym memberships, etc. I am talking about Aetna, United Healthcare, etc. Ms. Flanagan sums this up very well in the article, and I encourage everyone who has FEHB and Medicare, read it......

...Ms. Flanagan notes in her article that if you take one of the FEHB Medicare Advantage Programs, you will just get one insurance card instead of two. Payments many of these Advantage Programs provide are not necessarily equivalent to regular Medicare, and tend to be less with regular Medicare Advantage Programs in associated with FEHB.. She also notes many of these Advantage Programs are notorious for markedly changing what is covered year after year. In addition, she mentions you may run into trouble if you drop one of these plans and later try to get back on FEHB insurance, or pay penalties to get back on regular Medicare. She suggested there are really too many unknowns about these NEW FEHB/Medicare Advantage Programs, and that those of us who have significant health problems may very well come out ahead using a FEHB Plan that reimburses you to keep regular Medicare. Again, please read the article. It’s brief and informative. I am staying with BCBS BASIC and regular Medicare. Good Luck!


I don’t want to start a flame war here, but GO4IT!’s post is highly misleading. I read the article he mentioned. And let me be clear. Not one thing he attributed to Tammy Flanagan was what she actually said. First, she never said anything about getting one insurance card instead of two. FEHB MA plan enrollees DO use just one card, but she never mentioned that in her article. Second, Ms, Flanagan did not say that there are too many unknowns about the new FEHB MA plans or that folks with significant health problems would come out ahead sticking to Original Medicare + FEHB plans that offer Part B premium reimbursements. Third, she said absolutely nothing about the track record of FEHB Medicare Advantage plan options. No such plans have ever existed before, so there is no track record. What’s more, no one can speak about their “experiences” with such plans because no one has any such experience. All she actually said was “To be honest, I am not 100% confident in all of the ins and outs of this coverage, but I know much more now than I did before the start of this year’s open season.” That’s it. She then went on to talk about private sector MA plans, which she referred to as “Medicare Part C MA plans.” All but one of the bullet points and quotes in her article are about those private sector plans, not the FEHB MA plans.*** However, GO4IT! has mixed them all together. They are very different animals.

As we all know, insurance companies sell lots of different health insurance plans outside of the FEHB, and those plans are VERY different than FEHB plans sold by the same companies. The difference is that FEHB plans are better, a lot better. The new FEHB MA plans offer zero copays, zero deductibles, zero coinsurance, low premiums, low Rx costs, Part B premium rebates, coverage for all providers who accept Medicare, and coverage overseas for emergency and urgent care. They pay providers the prevailing Medicare rate and you pay nothing. They are all FEHB plans, and can be changed just like all other FEHB plans. There is no suspension of FEHB involved. (That is old news relating to private sector Part C MA plans, which operate outside of the FEHB.)

There are many plans within the FEHB. Different strokes for different folks. But we should evaluate them fairly and factually.

***Note: The one on-point comment re: FEHB MA plans came from an Aetna plan representative. Another positive quote from an alleged “enrollee” was really about one of those private sector plans. There are no actual enrollees in the FEHB MA plans until January 1, 2021

Edited by user Friday, December 11, 2020 1:15:32 PM(UTC)  | Reason: to fix a typo.

GO4IT!  
#5 Posted : Saturday, December 12, 2020 7:38:36 AM(UTC)
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Sante 123’s rant is also not entirely correct. I emphasized and deferred in my previous Post to the importance of reading the article. I am only trying to add to the conversation here. The bottom line is the NEW FEHB/Medicare Plans are Medicare Advantage Plans. They are NOT regular Medicare plus FEHB. What you have are Medicare Advantage Plans that have been tailored to work specifically with FEHB. Because they are Medicare Advantage Plans, they are an entirely separate beast than regular Medicare A & B plus FEHB as your secondary insurance. Historically, regular Medicare tends to pay more than Medicare Advantage Plans.

I went through this with my parents. They were not Federal employees, but one took regular Medicare and the other took a Medicare Advantage Program plus they both had the same secondary insurance. The one who took the Medicare Advantage Program payed significantly more out of pocket for the very same tests and treatment, while the other had no out of pocket payments. The one with the Medicare Advantage Plan could not wait until the first Open season to change back to regular Medicare. This tends to corroborate the assertion that regular Medicare pays better overall than Medicare Advantage Plans.

I cannot stress enough that Everton in this situation should not only read the article I referenced in my previous Post, but consult numerous references across the Board, In addition, I believe it is important to point out that I have had NO out of pocket expenses with regular Medicare plus BCBS Basic, and I have multiple medical problems that require medical treatment. Everyone’s circumstances are different. I thought it important to throw my 2 cents into the conversation for all to ponder.
OUtside  
#6 Posted : Saturday, December 12, 2020 3:06:41 PM(UTC)

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You're making an important point about having no out of pocket copay expenses with your enrollment in BC Basic and Medicare Part B.

But that's not the bottom line point which requires adding together plan premiums (both fehb and Medicare less any Medicare reimbursement premiums) before a total comparison can be made.

It's a bit like having an electric vehicle and saying one's fuel costs are minimal to none. If the electric vehicle purchase costs are way higher than a gas-fueled vehicle, the electric vehicle may be much more expensive despite its low fuel cost.

As I understand it, Checkbook attempts to make a bottom line comparison among the plans by including premium costs and copays based on a large healthcare data base, which would seem to be a pretty good way to do it, one reason is, they let the user provide an expectation of care expenses, low, average, or high, and then estimate the out of pocket expenses around that outlook.

Edited by user Saturday, December 12, 2020 5:14:52 PM(UTC)  | Reason: Not specified

upandup  
#7 Posted : Saturday, December 12, 2020 3:31:11 PM(UTC)

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Originally Posted by: Sante123 Go to Quoted Post

There are no actual enrollees in the FEHB MA plans until January 1, 2021


The Aetna Advantage plan has been around sine January 2020: https://www.opm.gov/heal...020/brochures/73-906.pdf

As has the UHC plan: https://www.opm.gov/heal...020/brochures/73-904.pdf

Edited by user Saturday, December 12, 2020 3:34:32 PM(UTC)  | Reason: Not specified

Sante123  
#8 Posted : Sunday, December 13, 2020 12:02:05 AM(UTC)
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The Aetna Advantage Plan began in 2020 but it did not include Part B premium reimbursement until 2021.
https://www.opm.gov/heal...021/brochures/73-906.pdf

The only nationwide UHC Advantage Plan with an FEHB Medicare Advantage Option is new for 2021. The other UHC plans were/are not available in most states.
https://www.opm.gov/heal...021/brochures/73-903.pdf

That being said, the point remains that the plans critiqued in the Flanagan article were private sector commercial plans that bear little resemblance to FEHB MA plans.
GO4IT!  
#9 Posted : Sunday, December 13, 2020 6:48:17 AM(UTC)
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A couple of points:

1. Prior to these NEW FEHB/Medicare Plans first offered this year, there were other FEHB plus Medicare Plans offered. Some began offering reimbursements toward one’s Medicare Part B Premiums a few years ago. Aetna was the first followed by BCBS Basic, and perhaps some of the other plans. NONE of these were set up, or considered to be Medicare Advantage like Programs. To the contrary, they were all set up where Medicare Parts A & B were your Primary insurer, and the FEHB your Secondary insurer. The idea being what Medicare did not cover, hopefully the FEHB Program offered with Medicare would cover the rest. The reimbursements toward some of one’s Medicare Part B premiums as an incentive for you to enroll in Medicare Part B was great.

2. Most, if not all, of the NEW FEHB/Medicare Plans first offered for the 2021 year are “set up to work like private sector Medicare Advantage Programs.” All Ms. Flanagan, or any of us can do, is compare how they will work to private sector Medicare Advantage Programs traditionally work because the FEHB Plans have been specifically tailored to work with Medicare in similar fashion to those in the private sector. What Ms. Flanagan did was make such comparisons because that is all any of us can do right now. What’s important to remember is these NEW Medicare/FEHB Programs first offered in 2021 have been specifically tailored to work in the same fashion as Medicare Advantage Programs. I am anxious to see how they end up working out a year from now. They may be the best thing ever offered, or they may appear to have many more bells and whistles for the buck, but not turn out to be so.

Recall the example I provided about my parents in the earlier Post. They each had the same Secondary insurer, which was the insurance carried by primary breadwinners employer extending into retirement. The parent who initially chose the Medicare Advantage set up had one insurance card, and all the billing was handled by the private sector former employer insurer. What they did was set up that parents secondary insurer to work with Medicare as a Medicare Advantage type program. The other parent kept regular Medicare A & B, and the secondary insurance offered by the former breadwinners employer as their secondary insurer. It was only after each parent saw the same doctor and underwent the same routine tests that the insurance payment differences became clear, The parent with the Medicare Advantage plan type of set up kept getting more medical bills than the other, but we really could not figure out why the parent with regular Medicare and the former breadwinners employers secondary insurance never seemed to get any medical bills. It was not until they happened to see the same family doctor for physicals and the same medical tests with the difference in billing that it became apparent, i.e., the parent with the Medicare Advantage Plan set up using the same former breadwinners employers secondary insurance set up to work with Medicare like an Advantage type program was billed considerable out of pocket expenses for the very same treatment and tests but the other who had regular Medicare plus the former breadwinners employers secondary insurance as secondary had no out of pocket expenses.

What I am saying about these NEW 2021 Medicare/FEHB Programs is that they appear to bet set up to work in a very similar manner as the private sector Medicare Advantage Programs. Both of my parents paid Medicare premiums and used the former breadwinners employers insurance as well. The parent who initially thought the Medicare Advantage Program set up to work with the former breadwinners employers plan due to the extra bells and whistles it appeared to offer, ended up paying more, considerably more, out of pocket.

It may very well be that these NEW 2021 FEHB/Medicare Advantage type programs may be the greatest thing ever offered, but the truth is none of us will truly know at least for another year when we can see how those of you choosing to go with them fair in 2021.

Once again, this is my 2-cents thrown into to the conversation to either ponder, or not. Good luck to all of you! Please come back next year and tell us how things turned out for you.
teeeeej  
#10 Posted : Thursday, December 17, 2020 5:34:30 PM(UTC)
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Quote:
The Post above mine regarding BCBS is incorrect insofar as the author asserts if you are treated by an out of network doctor, there will be no payment. Medicare will be your Primary insurance, and many physicians accept Medicare in some form or fashion. Thus, Medicare will pay in this circumstance, and you probably will not be on the hook for any payment EXCEPT in very exceptional circumstances.


It is 100% correct. GEHA Standard, GEHA High and Aetna Direct will pay the balance of any doctoro r facility that accepts Medicare.


BCBS Basic specifically only pays the balance on those who are in the BCBS network.

If you see a Medicare doctor or facility that is outside of the BCBS network, you will only be covered by the Medicare portion. The rest is going to be your liability. This is an unnecessary risk when GEHA and Aetna Direct have no such restriction, all that matters is if the doctor takes Medicare.

The fact that many physicians take Medicare is besides the point.

See this:

https://www.bogleheads.o...c.php?p=5572853#p5572853


FEPBlue's marketing materials are very clear about this:

https://www.fepblue.org/.../using-medicare-benefits
https://www.fepblue.org/...edicare%20and%20Blue.pdf

From FEPBlue:
Quote:

Finding a Provider
Medicare has its own network of Participating providers who accept Medicare’s assignment or payment. When you visit a provider (regardless of if they accept Medicare’s assignment), we’ll pay the difference between what Medicare pays and what you owe the provider.* You can see which providers are in Medicare’s network at medicare.gov.

*Note: Basic Option and FEP Blue Focus members must see a Preferred provider in our network. Standard Option members can see providers outside of our network.

Edited by user Thursday, December 17, 2020 5:38:20 PM(UTC)  | Reason: Not specified

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