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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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shwalker7  
#1 Posted : Sunday, April 24, 2011 12:16:45 PM(UTC)
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There are pros and cons of enrolling in Medicare Part B when retiring with the federal employee health benefit program. Most of what I have read seems to indicate that enrolling in Part B gives more peace of mind. It is always the out-of-pocket cost that is given as a good reason to have Part B. Another reason is that you might have a catastrophic cost sometime. Consumers’ Checkbook says that Part B will rarely saves as much money as the cost of the Part B premium. Most FEHB programs have a catastrophic limit so the savings by not paying Part B premiums seems like it would more than offset a large out-of-pocket cost in a particular year. The analysis done by Consumers’ Checkbook is very detailed and it seems to be the only encouragement I have found to support not taking Part B. However some of the posts I have read still make me wonder which is the best decision.     
shelter1  
#2 Posted : Sunday, April 24, 2011 9:28:51 PM(UTC)
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According to Walton Francis of Washington Consumers Checkbook, "Getting Part B gives you some "political insurance" against the possibility that Congress would enact some major detrimental change to retirement coverage in the FEHBP."

Another reason might be that if in the future you decided to suspend your FEHB and go with a Medicare Advantage Plan (Part C), you would need to have Part B in order to do that. Naturally, you could enroll in Part B later in life, but you could pay a substantial penalty.
bexpar55  
#3 Posted : Wednesday, August 24, 2011 3:27:04 AM(UTC)
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I have BCBS Basic and my husband is on my policy.  He will be 65 in Dec and we were trying to decide whether to take Medicare Part B.  After checking with Medicare, we decided NOT to take Part B and keep our BCBS Federal Plan.  This is what we've had for years.  When I decide to retire, he will have 8 months to pick up Part B, with NO penalty.  Since he has the option to pick it up at a later date with no penalty, we decided to stick with what we have. 

pissfir  
#4 Posted : Wednesday, August 24, 2011 10:32:23 AM(UTC)
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Doesn't BCBS pay differently (less) if you are eligible for Part B and decline to sign up for it?

OUtside  
#5 Posted : Wednesday, August 24, 2011 11:32:03 AM(UTC)
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The answer to your question is no, if you are asking about any penalty for declining Part B such as would leave retiree on the hook to pay more. And this also must not be confused with the following additional information:

If fehb subscriber is age 65 and retired, Medicare will set the rate for doctor services, even if retiree does not take Part B. Because Medicare rates are usually lower, sometimes quite lower, you might say the fehb plan then does pay less. But it would be a mistake to think that is to the detriment of the retiree, who continues to pay his usual plan co-pays. In fact, if the co-pay is based on a percentage, for example BC non PPO doctor plan allowance requires co-pay of 35%, retiree‘s co-pay will likely be less that prior to age 65, because the percentage will be of a lower overall amount (the Medicare rate).

Note that in the case of the husband discussed above, even if he enrolls in Part B pending the wife’s retirement, fehb will be his primary coverage. What does this mean? Everything, because if the Checkbook analysis mentioned above is correct that Part B will rarely save as much as the Part B premium, that comparison reflects Medicare as primary and paying 80% of Part B charges such as doctor visits.

In other words, with Part B secondary, Medicare would be paying less than 80%, probably much less, making the ’rarely save’ even more rarely saved.

OUtside  
#6 Posted : Thursday, August 25, 2011 1:14:40 AM(UTC)
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Perhaps this would be a better summary with respect to a retired spouse on family plan where the fehb subscriber is an active employee.

If the retired spouse enrolls in Part B, fehb will continue as primary and fehb rates (higher) will be used for Part B-type services such as doctor services, not the lower Medicare rates. Presumably Medicare will use its lower rates when it, as secondary insurance, makes its payment. As fehb will expect retiree to make his co-pay, this suggests it less likely Medicare’s payment will cover the co-pay.

This configuration would differ from when Medicare is primary, because when Medicare is primary, Part B would be expected to pay 80% of the Medicare rate, fehb would be expected to pay 20% of the Medicare rate, and the retiree would be expected to pay zero.

From the posting earlier in this thread, Checkbook says it is rare that in the usual case where Medicare is primary, that co-pays saved by the retiree will exceed Part B premiums paid. If this is correct, then it would seem even more rare if Medicare is secondary.

But none of this addresses the ‘peace of mind’ aspect of the Medicare decision which was also mentioned earlier in this thread. A retiree wishing peace of mind may enroll and thereby ignore Checkbook’s view as to the rarity of recovering the Part B premium. Mightn’t this also apply to the retired spouse on family plan where the fehb subscriber is an active employee?

I suppose it depends on how peace of mind is defined, how much peace of mind is considered enough peace of mind, and subscriber‘s willingness and/or ability to pay for it.

hustonj  
#7 Posted : Thursday, August 25, 2011 2:49:20 AM(UTC)
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Then there are also people like my wife . . ..  Her ongoing medical costs have been significant over the past 25 years and there are some very significant costs expected to be levied upon us in the future.
 
In any given year, her hospitalization time could be minimal to non-existant.  Every now and again, however, she spends multiple weeks (in that year) in the hospital for inpatient surgeries.  Cost averging for people like my wife make the decision pretty easy, actually.  The premiums are cheaper than the co-pay would be without them.
 
Everybody's specific situation and emotional involvement is different.
bexpar55  
#8 Posted : Thursday, August 25, 2011 2:49:47 AM(UTC)
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So much for "thinking" I might know what to do.  Now, I am totally confused.  I thought when I retired, in a couple years, and my retired spouse picked up Part B, Medicare would become the Primary and FEHB would be Secondary.  Not so???   Hmmmm, guess I need to go back and reconsider the best option for us.  Why must this be so complicated????Ouch
 
Thanks for helping me work through this.
OUtside  
#9 Posted : Thursday, August 25, 2011 6:17:02 AM(UTC)
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bexpar55, yes once you retire, if husband then takes Part B, Medicare becomes primary for him and fehb secondary (see page 122 BC brochure to confirm this).

deajv1  
#10 Posted : Friday, August 26, 2011 11:33:48 AM(UTC)
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deajv1  
#11 Posted : Friday, August 26, 2011 11:46:12 AM(UTC)
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I decided not to take Medicare part B because more and more doctors in NYC and FL are not taking Medicare. I envision that future Medicare premiums will be going  up much higher. The FEHB pools have employees from 21-65. The Medicare pool is 65-105.This a less healthier group, which in my opinion will lead to higher  premiums than FEHB. I realize that each year that I do not take part B, the premiums goes up by 10%. I am in good health and I can afford the catastrophic deductable. I prefer to have the option of selecting doctors than being restricted by Medicare. I also realize that govt and retired employees will see major changes in our health coverage by Conress.  WE ARE BROKE and cuts and increases are coming.
 
   
OUtside  
#12 Posted : Tuesday, August 30, 2011 1:23:30 AM(UTC)
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According to the thread ‘Which costs more, Medicare or FEHB?’ at this web site, all doctors are in one of three statuses with respect to Medicare: accepts Medicare assignment, does not accept assignment but accepts Medicare patients, and has opted out of Medicare/requires a private contract.

In the case of the first two, fehb rules require the Medicare rate to be used, as a payment limit on the first status and 115% of the limit on the second status. The rules apply whether or not retiree is enrolled in Part B.

In the case of the 3rd status, if doctor is not PPO, doctor can charge whatever he wants. If retiree has Part B, Medicare will not pay anything and plan BC will limit its payment to what it would have paid had Medicare paid, typically 20% of a usually low Medicare rate. Retiree would likely pay 35% of the plan allowance (Medicare rate) plus the difference between the allowance and the doctor’s charge. While the non PPO benefit would likely be higher than if retiree had Part B, no limit on the doctor’s charges means likely higher out of pocket expenses for the retiree.

In sum, if doctors are leaving Medicare or limiting the number of Medicare patients they accept, the fehb and Medicare rules should make this an issue of concern even for retirees who are not enrolled in Part B.

Disclaimer, I do not take a position for or against enrolling in Part B, and believe everyone should make their best decision after learning as much as possible about the subject.

OUtside  
#13 Posted : Tuesday, August 30, 2011 1:28:22 PM(UTC)
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A sentence from my last post should be clarified to indicate it refers to a retiree who does not have Part B:

Sentence in third paragraph should read: ‘Retiree without Part B would likely pay 35% of the plan allowance (Medicare rate) plus the difference between the allowance and the doctor’s charge.’

bexpar55  
#14 Posted : Wednesday, August 31, 2011 1:31:56 AM(UTC)
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Thanks again for your help in deciding what to do.  For us, I think we will keep my husband on my FEHB Plan, accept Medicare Part A (as given), and wait until I retire for him to pick up Part B, since there will be no penalty.  I realize none of us know what the future brings....but he has been healthy up to now, and will pray he continues to until I retire in a couple years.  I guess I look at it this way, we have done without Medicare Part B for all these years, why expect more now??? 
OUtside  
#15 Posted : Thursday, September 01, 2011 5:17:02 AM(UTC)
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Just to be clear (and the subject can always be confusing as you noted earlier), when you speak of ‘keeping’ your spouse on your fehb plan, most discussion about Medicare in this forum involves keeping fehb and possibly ‘adding’ Medicare to fehb (not leaving fehb and taking Medicare). This distinction applies after your retirement, when Medicare would become primary for your spouse, as well as prior to your retirement.

Possibly there is an exception if someone is looking at Medicare Advantage, Part C, where there are complete plans, in some ways similar to fehb, that can be cost effective alternatives to fehb. Someone noted earlier taking Part B enables going the Part C route and retiree doing this can suspend (but should not cancel) the fehb plan, and if desired can come back January following the next open season. Part C plans are generally in a managed care setting and when retiree nears age 65, advertisements from competing companies are received in the mail, sometimes lots of them.

But it is important to note with respect to ‘keeping’ fehb vs. ‘not keeping’ it, that fehb is usually the better deal vs. the Original Medicare (Parts A, B, and D), better deal meaning less expensive premiums and better benefits. For example, many people going the Medicare-alone route will require a Medigap policy (another premium to pay) to supplement their medical benefits and a Part D policy (for prescription drugs-- and another premium to pay). The Part D policy will probably not be as good as fehb and there may be a donut hole in coverage.

So, whatever your decisions are with respect to Medicare now or in future, keeping fehb is the thing to do.

OUtside  
#16 Posted : Thursday, September 01, 2011 12:02:47 PM(UTC)
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Original Medicare consists of Parts A and B only. Part D, prescription drugs, is not part of Original Medicare.

westover  
#17 Posted : Sunday, September 04, 2011 1:47:48 AM(UTC)
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There is a lot of good information and advice on this thread but I am still a little confused.  I am an active federal employee with FEHB (BC/BS Standard).  I will be 65 in October and I do not plan to retire until 2013. If I enroll in Medicare Part A and decline Part B will my FEHB (as primary) continue to pay EXACTLY the same benefits for services that would fall under Part B.  In other words, will the way my benefits are calculated change when I turn 65 simply because I am "eligible" for Medicare Part B but did not enroll.

upandup  
#18 Posted : Sunday, September 04, 2011 5:17:36 AM(UTC)
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westover wrote:
There is a lot of good information and advice on this thread but I am still a little confused.  I am an active federal employee with FEHB (BC/BS Standard).  I will be 65 in October and I do not plan to retire until 2013. If I enroll in Medicare Part A and decline Part B will my FEHB (as primary) continue to pay EXACTLY the same benefits for services that would fall under Part B.  In other words, will the way my benefits are calculated change when I turn 65 simply because I am "eligible" for Medicare Part B but did not enroll.


As long as you are an active employee, FEHB will be primary. Medicare Part A will pay secondary to FEHB for hospital stays. There will be no penalty for a "late" enrollment into Medicare Part B if you do so within the allowed window after you retire.
upandup  
#19 Posted : Sunday, September 04, 2011 5:21:17 AM(UTC)
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OUtside wrote:
So, whatever your decisions are with respect to Medicare now or in future, keeping fehb is the thing to do.
Yep. If you only keep one of Medicare B or FEHB, you want to keep FEHB. No question at all.
You can suspend (and later rejoin) FEHB if you take Medicare Part C (Advantage HMO-like plans) or Tricare, but not if you want to stick with FEHB.
Angel1955  
#20 Posted : Tuesday, October 04, 2011 1:41:43 AM(UTC)
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Well this is my first day as a retired fed.  I have been in major DC hospital for five days - local hospital for five - surprised that my co-pays or whatever those dinky bills are did not come up or close to what my Medicare B payments would be if I signed up - - My reknolwn opthamologist dropped BC/BS  - I understand there was too much to go through especially for someone that had a non-time limit eye illness. Otherside of the fence = he will see those patients that have Medicare B  = can't figure that one out  At this point that would be the reason why I would sign up with Medicare B - - Big smile
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