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Medicare and Health Care


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gyuris  
#1 Posted : Monday, March 19, 2012 8:18:32 AM(UTC)
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I retired under LEO FERS  and now live permanently abroad.   I have Basic  Blue Cross / Blue Shield  FEHB which reimburses my and my family's medical expenses,  after deducting the copays.   I know that Medicare does not cover any overseas medical expenses like Blue Cross does.

My 2 questions are: 

1) in about 10 years, after I become eligible for Medicare, will I be automatically  converted  to Medicare even though I can't get any benefits from it, ( because I am living foreign. ) 

2) After I reach this mandatory conversion age, will my FEHB  Blue Cross still cover the same way for my overseas expenses, or will I lose coverage because now Medicare will be part of the FEHB equation?

 I am aware of the penalties involved if I did not enroll when 65 and wait to enroll till later.

But that is exactly my dilemma.   FEHB vs.  Medicare

Should  I or shouldn't I enroll in Medicare (part B) when the time comes  if I and my immediate family (spouse and young son) are now living overseas.  Are there any advantages or disadvantages to doing it either way.   I am afraid I would I be throwing away money at Medicare part B premiums when I cannot use them if living overseas. 

Since I am under the impression that it is mandatory enrollment in Medicare when the time comes (I am FERS),  then Medicare would be my primary health insurance and  the BC/BS would pass to be be my secondary coverage. Is this all correct, or am I wrong?

If I am right,  and I am automatically enrolled in Medicare when I get to be of age, how would that affect my overseas medical claims?

If  I am wrong  and the Medicare enrollment is indeed optional and if I decide to NOT enroll in Medicare (i.e. do nothing when I get to be 65),  will my Blue Cross health insurance stay as is,  or will I have problems processing my overseas medical claims?  And in the instances when I travel back to the US, (less than 30 days per year),  and should I need to get any emergency medical treatment then, how would my FEHB insurace handle that?



Anybody have any direct experience or more thoughts / advice about this?

Sorry for the long post.


Thanks.
ChuckBux  
#2 Posted : Tuesday, September 03, 2013 12:41:04 AM(UTC)
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Did you ever figure this one out? I am rapidly approaching the same circumstances and have not found an on-line answer to this question.
OUtside  
#3 Posted : Tuesday, September 03, 2013 4:30:58 AM(UTC)
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Medicare is optional for the retired fed. There is no mandatory enrollment in Medicare.

BCBS brochure, page 130, makes this clear with this statement: ‘The decision to enroll in Medicare is yours.’

You are correct to pay attention to the penalty for late enrollment because no one knows whether enrollment will always be optional in future

It is not easy to make a case for cost effectiveness for Part B for someone with an fehb plan. The reason for this is that generally fehb co-pays are low or reasonable, therefore, to attain waived co-pays exceeding the cost of Part B premiums is not so easy.

Some people reading page 134 of BCBS brochure misinterpret the information and assume Medicare is required for the retired fed because post age 65 Medicare rates are used setting fehb allowances whether or not retiree has Medicare. I am not sure how this would apply to you overseas but apparently rates and allowances are set for you now, as you say you are reimbursed by BCBS after making your payment to provider. Given this, I would guess something similar would occur after you reach age 65. If you read page 134 from the standpoint of overseas and understanding how it states Medicare rates will be used, perhaps you could pose a further question here for discussion about this important aspect of the fehb/Medicare interface.

I anticipate one question might be ‘will I pay more out of pocket if I don’t have Part B?’ The answer is no, you will continue to pay your usual fehb co-pays which generally would be the same as prior to your turning 65 or possibly less.

Many people, including me, had to read page 134 more than once to understand it thoroughly.   A correct understanding of this page is recommended along with the other pages of brochure related to Medicare.OUtside2013-09-03 12:47:37
Viking  
#4 Posted : Tuesday, September 03, 2013 6:04:30 AM(UTC)
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I believe that Medicare does not work overseas.
OUtside  
#5 Posted : Thursday, September 05, 2013 1:23:37 PM(UTC)
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Quoted from above: -I anticipate one question might be ‘will I pay more out of pocket if I don’t have Part B?’ The answer is no, you will continue to pay your usual fehb co-pays which generally would be the same prior to your turning 65 or possibly less.-

This above statement is true for retiree in US but is probably not true for retiree living overseas. Note, if it is not true, it is not because retiree does not have Part B (which happens to be the subject question raised by this thread).

In order to explain why it is probably not true, let’s take an example in US where it is true, in order to emphasize the differences.

According to BCBS page 134 of brochure, after age 65, absent Part B, retiree will continue to pay usual out of pocket co-pays (includes deductible, co-pay, coinsurance, etc).   In addition, plan allowance will be based on the Medicare rate, which is usually a low, sometimes quite low, rate (if not familiar, google ‘doc fix’), and doctor who does not accept assignment will be limited to charging 115% of the Medicare rate. Retiree will pay the extra 15% out of pocket.

For an example, BCBS Standard for doctor non PPO requires subscriber to pay 35% of plan allowance plus difference between the doctor’s charge and the plan allowance. Say retiree is < age 65, makes a visit to this doctor, the doctor’s charge is $200, and plan allowance is $150. Subscriber age < 65 would pay 35% of $150 ($52.50) plus the difference between $200 and $150 ($50), for a total out of pocket of $102.50.

Now, suppose retiree is age 65+, all other particulars are the same except importantly the Medicare rate applicable to age 65+ retiree without (or with) Part B would be used and it would be lower, let’s guess $120, and doctor does not accept Medicare assignment. BCBS will use this rate for plan allowance = $120. In addition, doctor will be limited to charging 115% of $120 = $138. Retiree’s out of pocket co-pay would then be 35% of $120 ($42) plus the difference between $138 and $120 =$18; for a total out of pocket of $60. In other words, the retiree age 65+ would pay $42.50 less for this visit than a younger retiree.

So the point seems to be, doctor overseas would not be subject to the fehb law limiting maximum amount charged to 115% of a low rate and BCBS would use Medicare rate (low) as its plan allowance, in effect widening the gap which the retiree must pay out of pocket. Let’s say the overseas doctor charged $200 as above and Medicare rate is $120, also as above. Retiree would pay 35% of $120 plus the difference between $200 and $120, for a total of $122, or twice as much as retiree in US age 65+ and about 20% more than retiree in US age < 65 years.

Referring back to your original question #2, you asked:  After I reach this mandatory conversion age, will my FEHB  Blue Cross still cover the same way for my overseas expenses, or will I lose coverage because now Medicare will be part of the FEHB equation? And the answer is, there is not a mandatory conversion as Medicare is optional. You will have the same coverage but your out of pocket co-pays will probably be more as explained above.

You then went on to say,  ‘But that is exactly my dilemma.   FEHB vs.  Medicare.’ And the answer to that is, not really because having Part B would not change your overseas situation, also as explained above.

IMHO.
upandup  
#6 Posted : Thursday, September 05, 2013 3:44:06 PM(UTC)
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OUtside, because Medicare doesn't provide coverage outside of the US (with a couple very limited exceptions), the rules are different. The FEHB plan is not limited by Medicare charges for services that would not be covered by Medicare if the member had Medicare.

http://www.gpo.gov/fdsys/pkg/USCODE-2011-title5/html/USCODE-2011-title5-partIII-subpartG-chap89-sec8904.htm
OUtside  
#7 Posted : Friday, September 06, 2013 12:56:07 AM(UTC)
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Thanks for the guidance, upandup. Accordingly, I would re-write the 2nd to last paragraph of my last post as follows:

Referring back to your original question #2, you asked:  After I reach this mandatory conversion age, will my FEHB  Blue Cross still cover the same way for my overseas expenses, or will I lose coverage because now Medicare will be part of the FEHB equation?

And the answer is, there is not a mandatory conversion as Medicare is optional. You will have the same coverage and your out of pocket co-pays, etc will probably be more or less the same as prior to turning age 65. (See BCBS brochure, page 116 re overseas claims for details).

I looked briefly at page 116 but did not see Medicare discussed there. Perhaps overseas charges tend less than US charges such that the ‘customary percentage’ of billed charges when used for plan allowance also tends lower even without a Medicare component. It would be interesting to read OP’s post about going billing rates overseas for similar care as provided in US in this regard.
TotallyRetired  
#8 Posted : Friday, September 06, 2013 2:10:14 AM(UTC)
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gyuris wrote:
I am under the impression that it is mandatory enrollment in Medicare when the time comes (I am FERS),  then Medicare would be my primary health insurance and  the BC/BS would pass to be be my secondary coverage. Is this all correct, or am I wrong...


Gyuris,

My understanding is that Medicare Part A (hospitalization) is required for all federal retirees over age 65. We can't opt out of Part A.

I do not intend to live abroad but have a short list of foreign countries on my vacation bucket list. For this reason, I am very interested in responses to your question.

Let's say I am age 66, get hit by a car in a third world country, & spend a month in a hospital in that country. My understanding is that neither Medicare Part A or my FEHB will cover my hospital bill.TotallyRetired2013-09-06 10:15:58
OUtside  
#9 Posted : Friday, September 06, 2013 4:30:47 AM(UTC)
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TotallyRetired, your understanding of required enrollment in Medicare is totally incorrect. Please explain your source of information.

Also, why do you suppose BCBS brochure, page 130, states ‘The decision to enroll in Medicare is yours,’ not to mention scads of other fehb brochures too many to mention here?

Totally?OUtside2013-09-06 12:43:02
TotallyRetired  
#10 Posted : Friday, September 06, 2013 4:56:25 AM(UTC)
TotallyRetired

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OUtside wrote:
...Please explain your source of information...


My source of information is a family member who said he had thoroughly researched the issue, so I don't have a cite for you.

If you believe there is an OPM policy that we do not have to enroll in Medicare Part A, I will defer to your expertise. I am here to learn.

My insurance is GEHA & I am not entitled to Tricare.



upandup  
#11 Posted : Friday, September 06, 2013 5:04:39 AM(UTC)
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If you are 65, receiving Social Security, and eligible for premium free Medicare Part A, then you must take part A. The only downside to that is that HSA contributions are then no longer possible (there is a lawsuit about that). It has nothing to do with OPM.
OUtside  
#12 Posted : Friday, September 06, 2013 7:21:45 AM(UTC)
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Here’s GEHA’s comparable wording (page 98) to the BCBS page mentioned earlier:

‘The decision to enroll in Medicare is yours. We encourage you to apply for Medicare benefits three months before you turn age 65. It’s easy. Just call the Social Security Administration toll free number (800) 772-1213, TTY: (800) 325-0778 to set up an appointment to apply. If you do not apply for one or more Parts of Medicare, you can still be covered under the FEHB Program. If you can get premium-free Part A coverage, we advise you to enroll in it. Most Federal employees and annuitants are entitled to Medicare Part A at age 65 without cost. When you don’t have to pay premiums for Medicare Part A, it makes good sense to obtain the coverage. It can reduce your out-of-pocket expenses as well as costs to the FEHB, which can help keep FEHB premiums down.’

upandup’s explanation refers to receiving SS which applies to you if you are FERS and receive SS. Note that the Medicare handbook says if you receive SS you will automatically be enrolled in both Parts A and B but if you do not need Part B, follow the instructions that come with the card to send the card back (2013 Medicare and You, page 17). ‘If you keep the card, you keep Part B and will pay the premium.’

There isn’t much of a downside having Part A when premium free as it is for most fehb retirees, perhaps that is the reason the GEHA paragraph is not clearer about Part A. This subject might also explain why from time to time someone argues (incorrectly) Part B is mandatory. Perhaps this explains the OP’s concerns about Part B especially from an overseas point of view.   In any case, I am glad to have the matter clarified as upandup has done here a 2nd time.

Page 90 and 91 in GEHA brochure should help answer the other questions you raised about receiving care overseas if you have GEHA.
TotallyRetired  
#13 Posted : Friday, September 06, 2013 8:50:02 AM(UTC)
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upandup wrote:
If you are 65, receiving Social Security, and eligible for premium free Medicare Part A, then you must take part A.


UpandUp,

I am retired under CSRS-Offset. As you may already know, CSRS-Offset retirees are eligible to apply for Social Security at age 62.

A family member who had researched Medicare for federal retirees told me that Part A would be free to me at age 65 & that I must take it. He also (correctly) told me that Part B is optional & that I could keep my FEHB if I wanted to. (I do.)

When I start planning an overseas vacation, I will buy a private short-term health insurance to cover any medical issues for that trip. The same family member who advised me about Part A will be a good source of information on private short-term health insurance, as he is an experienced international traveler.    Thank you for your post.
upandup  
#14 Posted : Friday, September 06, 2013 11:38:10 AM(UTC)
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TotallyRetired wrote:

Let's say I am age 66, get hit by a car in a third world country, & spend a month in a hospital in that country. My understanding is that neither Medicare Part A or my FEHB will cover my hospital bill.

FEHB will cover your hospital bill subject to the normal cost-sharing, plan allowance determinations, and benefits provided. All FEHB plans provide coverage worldwide. Some of the HMO or other regional plans cover only emergency care out of the US or cover foreign care as out-of-network. All of the national Fee For Service plans cover care outside of the US at the in-network level, whether emergency care or routine care. Medicare (A or B) won't pay claims for services rendered outside of the US (with some minor exceptions).
darster  
#15 Posted : Friday, September 06, 2013 12:01:07 PM(UTC)
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upandup wrote:
If you are 65, receiving Social Security, and eligible for premium free Medicare Part A, then you must take part A. The only downside to that is that HSA contributions are then no longer possible (there is a lawsuit about that). It has nothing to do with OPM.


You don't need to be eligible to receive SS in order to get Medicare Part A for free. Most federal employees, including CSRS, have been paying the medicare tax for years and thus are eligible to sign up for part A for free when they turn 65.

From OPM and FEHB

You are entitled to Part A without having to pay premiums if you or your spouse worked for at least 10 years in
Medicare-covered employment. (You automatically qualify if you were a Federal employee on January 1, 1983.)




darster2013-09-06 20:31:39
upandup  
#16 Posted : Friday, September 06, 2013 12:24:38 PM(UTC)
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darster wrote:

You don't need to be eligible to receive SS in order to get Medicare Part A for free. Most federal employees, including CSRS, have been paying the medicare tax for years and thus are eligible to sign up for part A for free when they turn 65.

That is correct. But that is not what I am talking about. The question was about a REQUIREMENT to take Part A. That requirement is tied into the receipt of Social Security payments.

You do not require Social Security to get Part A. You are required to take Part A if eligible for fee-free Part A if you are receiving Social Security.
darster  
#17 Posted : Friday, September 06, 2013 12:28:38 PM(UTC)
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upandup wrote:
darster wrote:

You don't need to be eligible to receive SS in order to get Medicare Part A for free. Most federal employees, including CSRS, have been paying the medicare tax for years and thus are eligible to sign up for part A for free when they turn 65.

That is correct. But that is not what I am talking about. The question was about a REQUIREMENT to take Part A. That requirement is tied into the receipt of Social Security payments.

You do not require Social Security to get Part A. You are required to take Part A if eligible for fee-free Part A if you are receiving Social Security.


Ok, I understand what you are saying now.
TotallyRetired  
#18 Posted : Friday, September 06, 2013 6:14:21 PM(UTC)
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UpandUp,     For my records, I will confirm coverage via an e-mail to GEHA customer service, then post what I find out. (BTW, there is absolutely no doubt in my mind that you are correct on this.)     

Here is my question for GEHA:

If I am age 65+ & covered under Medicare Part A (only) & GEHA High Option, would I be covered under these scenarios:

--Hospitalized while in a foreign country on vacation?

--Hospitalized while in a foreign country on a long-term volunteer assignment sponsored by a U.S.-based nonprofit organization?

--Hospitalized while living in a foreign country?
TotallyRetired2013-09-07 07:27:31
OUtside  
#19 Posted : Friday, September 06, 2013 8:20:45 PM(UTC)
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Here are the words from GEHA’s 2013 brochure page 90 on overseas claims:

‘For covered services you receive in hospitals outside the United States and Puerto Rico and performed by physicians outside the United States, send a completed Overseas Claim Form and the itemized bills to: GEHA, Foreign Claims Department, P.O. Box 4665, Independence, MO 64051-4665. Obtain Overseas Claim Forms from www.geha.com.
If you have questions about the processing of overseas claims, contact us at
(877) 320-9469 or by email overseas@geha.com. If possible, include a receipt showing the exchange rate on the date the claimed services were performed. Covered providers outside the United States will be paid at the PPO level of benefits.’

For any interest there may comparing GEHA and BCBS on this, GEHA uses the ‘PPO level of benefits’ vs. BCBS’s ‘Preferred benefit levels using either a customary percentage of the billed charge or a provider-negotiated discount as our plan allowance.’
TotallyRetired  
#20 Posted : Friday, September 06, 2013 10:36:26 PM(UTC)
TotallyRetired

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OUtside wrote:
Here are the words from GEHA’s 2013 brochure page 90 on overseas claims:

‘For covered services you receive in hospitals outside the United States and Puerto Rico and performed by physicians outside the United States, send a completed Overseas Claim Form and the itemized bills to: GEHA, Foreign Claims Department, P.O. Box 4665, Independence, MO 64051-4665. Obtain Overseas Claim Forms from www.geha.com.

This process works well, at least it did several years ago. The reason I know this is because I once submitted a claim for a family member who was injured while skiing in a foreign country.

I had a bit of communication difficulties with the foreign hospital staff as I didn't speak their language. They were very nice; however, and found a fluent English speaker to help me out with pulling together the paperwork for the GEHA claim. TotallyRetired2013-09-07 07:28:44
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