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Retirement Planning


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jerrybauer  
#1 Posted : Tuesday, December 04, 2007 11:18:40 AM(UTC)
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Trying to decide on switching to Basic from Standard that I have had for so many years. We are all healthy. Doctors/hospital all PPO's. Rx on Basic will cost about $300 more, while I'll save about $1,400 in premiums. Extra co-pays should be offset by lower deductibles on the Basic. The monthly trip to CVS is not a problem for me. Seems like a no brainer. Am I missing anything?
Nowisthetime  
#2 Posted : Tuesday, December 04, 2007 10:13:34 PM(UTC)
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Just make sure all Doctor's and Facilities are part of the plan. If not you get zip.

I've been basic for several years and I've had no problems.
ejm604  
#3 Posted : Tuesday, December 04, 2007 11:12:14 PM(UTC)
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Their Basic is much like a nationwide HMO with no referrals. They have provisions for emergencies and with the vast network of PPO providers, should be no problem on availability of care. I've been in situations with Standard a couple of years ago where the % co-payments amounted to many hundreds of dollars, therefore the flat ones in Basic are more predictable. The prescription cost are more, but in my case are more than offset by premium reduction. One other point out@55, if you drop off your prescription at CVS or have Physician call, you can go online and have your refills at no cost shipping.
sophie3535  
#4 Posted : Wednesday, December 05, 2007 10:06:58 AM(UTC)
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no deductible and flat co-pays. I've asked the same question as you - other than prescription drugs it seems to me that Basic is a better deal, having no deductible and fixed, low co-pays.

My one prescription is a non-generic form of an allergy medicine - with Basic I pay a $30 co-pay for a month's supply. With Standard I'd pay 25%. I asked my pharmacist the price of the drug and found it was well over $100, so I'm getting a better deal with the Basic co-pay. I pay a $10 co-pay for generic drugs as opposed to "25%", again the flat co-pay may be a better deal. But I cannot get a 90 day supply of anything by mail. Like you, I find a trip to CVS not a problem.

Also, I've never had a problem finding an in-network physician. You should check to make sure your physician is in-network.

To me the flat co-pays, $20 or $30, are far preferable to a percentage of what might end up being a lot more.

I am, knock on wood, healthy and have few medical expenses. My co-pays have never added up to Standard's $300 deductible.
dmaceld  
#5 Posted : Wednesday, December 05, 2007 3:26:45 PM(UTC)
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quote:
Originally posted by sophie3535:
My one prescription is a non-generic form of an allergy medicine - with Basic I pay a $30 co-pay for a month's supply. With Standard I'd pay 25%. I asked my pharmacist the price of the drug and found it was well over $100, so I'm getting a better deal with the Basic co-pay. I pay a $10 co-pay for generic drugs as opposed to "25%", again the flat co-pay may be a better deal. But I cannot get a 90 day supply of anything by mail. Like you, I find a trip to CVS not a problem.


Prescriptions are not a better deal with Basic, except for short term meds like antibiotics. Ongoing prescriptions come via mail order at $10 for 90 day supply vs $30 at the drug store. Brand names are $35 for 90 days vs $105 at the drug store. If you have only one ongoing prescription then Basic will be cheaper. But I can tell you it doesn't take very many ongoing prescriptions, especially when you throw in one or two brand names, to cover the premium difference. In case you aren't aware of how much drugs cost, your "well over $100" per month prescription is not at all pricey. My wife and I have several prescriptions where the insurance company share of the costs are on the order of $300, $400, & $850 for a 90 day supply.

I just looked at the BCBS book for 2008. There are several areas down further in the benefits list where the Basic copay is double the Standard copay in both fixed copay or % copay, or is more limited. This is for things like therapy sessions, durable medical equipment, substance abuse treatments, etc.

If you are young and healthy and have none or one ongoing prescriptions Basic may very well make sense. If you aren't then Standard is probably the better choice. If your situation changes for the worse, you can always change the next year. That is one big plus for the way FEHB serves Feds.
dmaceld  
#6 Posted : Wednesday, December 05, 2007 3:33:42 PM(UTC)
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quote:
Originally posted by dmaceld:

I just looked at the BCBS book for 2008. There are several areas down further in the benefits list


Can you believe this board software? I tried spelling further with an 'a' and this system thought I was spelling out the word for bodily gaseous discharge and replaced four letters with ****.

A note to the board managers. Get real with the censorship rules, OK?
sophie3535  
#7 Posted : Thursday, December 06, 2007 12:17:55 AM(UTC)
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You have a good summary of side-by-side differences in the Basic vs. Standard prescription coverage.

Indeed, if one has a number of on-going prescriptions, Standard may come out better. The original poster suggested he that Basic would cost him $300 more in prescription coverage, but compared that to the increased premiums for Standard.

It really comes down to everyone doing their own math, higher premiums plus deductible vs. less drug coverage. I was just pointing out that the flat co-pays, no-deductible, and lower premiums make Basic a much better deal for someone without a lot of on-going prescriptions.
ejm604  
#8 Posted : Thursday, December 06, 2007 4:31:03 AM(UTC)
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As an example of the Standard Option benefit for medical emergency. I spent 3.5 hours in the emergency room of a PPO hospital. Final bill was $7300 with testing, allowance $4500, cost out of pocket with $250 deductible, was $700. I'd much rather pay a flat $50 with Basic.
ejm604  
#9 Posted : Thursday, December 06, 2007 4:33:08 AM(UTC)
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For 2008 the deductible goes up to $300 and  out of pocket. Same scenario would be $975 owed.
stressed  
#10 Posted : Thursday, December 06, 2007 12:47:54 PM(UTC)
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When my husband was seriously ill, and it was totally unexpected, he was in three different hospitals. The standard co-pay was $100 for each, total $300. It would have been $1200 with basic. Also, it was an emergency situation, and a number of doctors where involved. One was not a ppo doctor, and we would have had to pay all of his fee ourselves.

I don't know if we ended up paying the difference in the hospital co-payment with what we paid the doctors, but the possibility of having an out of network doctor is what worries me about basic. In an emergency situation, all kinds of doctors are involved, and you don't know who until the emergency is over.
ejm604  
#11 Posted : Thursday, December 06, 2007 9:53:14 PM(UTC)
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Emergencies are completely covered under Basic, subject to a $50 co-pay for Preferred and Non-Preferred.
For inpatient, If you use a Preferred Hospital or Facility, benefits are payable for Non-Preferred services as listed on page 13 of brochure. The hospital inpatient deductible of $100 per day, max $500 is applicable to the original admission and diagnosis.
robertray  
#12 Posted : Thursday, December 06, 2007 11:33:34 PM(UTC)
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The difference lies in the reason God made Flexible Spending Account I changed after many years of Standard because my wife and I are healthy and the RX is ok. As an earlier posts correctly points out, you can change in 12 months
stressed  
#13 Posted : Friday, December 07, 2007 8:11:00 AM(UTC)
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ejm604- my husband was in three different hospitals, went straight from one to another, and we were charged a $100 co-payment for each one. It was all related, just different stages of care. I'm really not sure if the out of pocket with standard reached what would have been $500 for the first hospital, $200 for the second, and $500 for the third on basic. I will try to figure it out. He was hospitalized almost two months.
postalwiz  
#14 Posted : Friday, December 07, 2007 8:53:48 AM(UTC)
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My out of pocket this year has been over $1400
and that is due to some very expensive
MRI's and it is best to have each individual
assess their own situations according to their health and while you can change options from year to year and plans from year to year your
medical insurance and what they do not pay
can brake you very fast and hospitals do not
wait for payment they will turn you over
a collection agency or put a lien on your property; yes been there many years ago when
my son's bill out of pocket amounted to $13000
good thing I had good credit! so folks get
your brochures out and take your individual
situation and make your own decisions as
to what is best for you!
westport63  
#15 Posted : Saturday, December 08, 2007 1:07:21 AM(UTC)
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I am on basic and thinking of switching to standard. The increased premium would be just about covered by the savings in meds using the mail Rx. There are two of us, so I suspect there would be the increased $600 in deductibles under standard.
Do I have this right? What seems harder to figure out is the costs other services, where often it is a fixed copay in basic vs. an ambiguous x% of "plan allowance" uder standard. Any good rules to go by here if figuring this out? Thanks!
ejm604  
#16 Posted : Saturday, December 08, 2007 3:11:46 AM(UTC)
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The following link gives the side by side comparison for both. Standard has 2 $300 deductibles for Family. The 15% allowance can add up for certain procedures and tests. You may have a CatScan for $2500 and BC Std allows $1800, so your % is based on $1800 or $270 out of pocket once your deductible is reached.



www.fepblue.org/open/openseasbenfcompar-07.html
westport63  
#17 Posted : Saturday, December 08, 2007 10:16:15 AM(UTC)
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Thanks for the link, it was helpful. What concerns me about Standard is the open ended nature of the %PPA charges. Surgery can be quite expensive and max you out quickly. I looked around for a plan allowance schedule but could not find any on the web.

Don't know how the Washington Checkbook model works, but it appears than under all of their scenarios, Basic comes out significantly cheaper.
I just retired and will be picking up Medicare A. The Checkbook analysis suggests a very slight improvement for Standard relative to Basic, but the latter still comes out cheaper under the different cost scenarios.
ejm604  
#18 Posted : Saturday, December 08, 2007 11:13:25 AM(UTC)
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Yes I did the Checkpoint Guide also. Walt Francis the advisor who put together the guide, had said on Mike Causey's program, "Unless your drug cost are extremely high(Several thousands)the Basic program is excellent, as many providers are Preferred." With Med Part "A" you will have no inpatient admission co-pay.
stressed  
#19 Posted : Sunday, December 09, 2007 8:19:04 PM(UTC)
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I totalled most of my husband's bills from his long hospital stays, and the increase to 15% (standard) made a big difference. Basic would have cost less, and that's not counting the $300 deductible if it hadn't been reached yet.
jeopardy  
#20 Posted : Monday, December 10, 2007 2:44:50 AM(UTC)
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How does this affect the dental portion? The basic option doesn't cover any basic dental (non-accidental) services.

Also, we have the BCBS DentalBlue (only available in a few states) -- would that pick up the slack if we switched from standard option to basic on our BCBS policy?
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