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Medicare and Health Care


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jagfan  
#1 Posted : Thursday, September 20, 2012 6:34:50 AM(UTC)
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Healthcare, dental and vision premiums announced by OPM today.  Average increase for healthcare premiums is about 3% unless you are a member of Compass Rose.  Their increase is significant - just shy of 7%.  Athough still one of the more premium friendly plans if eligible for their association, their rate gap is narrowing. 
upandup  
#2 Posted : Thursday, September 20, 2012 2:14:28 PM(UTC)
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I wonder if there are some errors in the premium rates posted. The PDF has been removed. However, the magic of Google brings it back to life: http://webcache.googleusercontent.com/search?hl=en&site=&source=hp&q=cache%3Ahttp%3A%2F%2Fwww.opm.gov%2Finsure%2Fhealth%2Frates%2Fnonpostalffs2013.pdf

The increases in Compass Rose over the past couple of years (coinciding with the change to United HealthCare for network access--perhaps unrelated, however) have led to a more marked price difference between it and Foreign Service. The plans have similar benefit structures and fields of membership, and used to have the same provider network. If I were in CR, I would give FSBP some thought--their premiums have been very stable.
jagfan  
#3 Posted : Thursday, September 20, 2012 9:05:30 PM(UTC)
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I hadn't noticed the pdf being removed because I downloaded the original.  Will watch for the new version. 
 
Sent the board of directors an email about my concerns about the significant rate increase.  They must have anticipated negative feedback because the following reply was rec'd a few hours later:
 

"We on the CRBG Board of
Directors do recognize that the change in CRBG’s Health Plan premiums appears
relatively large and understand the inevitable frustrations that come with the increase.
CRBG for years has been able to keep its rates
relatively low compared to other FEHB plans and, although this has meant less
out-of-pocket cost for out members, it now means that a dollar-for-dollar
increase relative to other, more expensive plans represents a larger percentage
change (as a basic illustration, a $1 increase from $10 to $11 represents a 10%
change, whereas the same $1 increase from $15 to $16 represents only a 6.6% change).


We realize that our members
have alternative options, and we understand that some are likely to explore
these during open season. I do believe that CRBG’s Health Plan premiums remain
competitive among other High-Self and High-Family FEHB plans that are open to our current members.
We and CRBG's Officers and
staff continually strive to maintain high-quality coverage and customer service
along with competitive premiums; and while some recent transitions have come
with some problems, CRBG’s Officers and staff have remained committed to resolving these and providing the best service possible."


phauser  
#4 Posted : Friday, September 21, 2012 12:37:13 AM(UTC)
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My Aetna HDHP premiums are going up around 10%.  This was really a surprise to me because my spouse and I had both received letters stating that OPM was receiving a rebate from Aetna because Aetna had not spent enough on our medical expenses (ACA requirement).  I would feel sure that others were also reciving a rebate.  The rebates are supposed to go into a fund held by OPM to lower the premiums for that plan for the next year.  But then our premiums went up 10%!  I don't understand.  Did this happen to anyone else? I included the info on this rebate below:

The U.S. Office of Personnel Management (OPM) published a letter and FAQ for federal employees regarding the ACA-mandated Medical Loss Ratio (MLR) for Federal Employees Health Benefits Program (FEHBP) plans in an August 22, 2012 Benefits Administration Letter. The FAQ explains the basic framework of the MLR standard and clarifies that:

  • whether an FEHBP plan owes a rebate is determined based on all of a carrier’s line of business (e.g., large group) within a given state;
  • any rebated owed by an FEHBP plan shall be paid directly to OPM, the policyholder for all FEHBP plans, as required by FAR §31.201;
  • any rebate paid by an FEHBP plan shall be deposited into the contingency reserve of that health plan and shall be used to directly reduce the cost of the next year’s premiums for that plan; and
  • FEHBP enrollees will receive a notice from their plan indicating whether the plan did or did not meet the MLR standard.  
upandup  
#5 Posted : Friday, September 21, 2012 12:39:08 AM(UTC)
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Also, it is important to note that the overall premium increase is about 7%, but, due to the FEHB structure, the employee share is increasing by 16-20%.

"For most employees and annuitants, the Government contribution equals the lesser of:
(1) 72 percent of amounts OPM determines are the program-wide weighted average of premiums
in effect each year, for Self Only and for Self and Family enrollments, respectively, or (2) 75 percent of the total premium for the particular plan an enrollee selects."
http://www.opm.gov/insure/health/reference/handbook/fehb03.asp#govshare



upandup2012-09-21 08:45:42
peachy1200  
#6 Posted : Friday, September 21, 2012 6:41:30 AM(UTC)
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HoOuchw much does the BCBS spend on the NURSE ADVICE LINE?? I have called a couple of times and was told to see a Doctor or go to the emergency room. Any one could give that advice without being a nurse... How much money could BCBS save by eliminating this? and How much lower would our premiums be.. It does NOT require a registered nurse to be told to go to Doctor or to Emergency Room..In my experience this NURSE ADVICE LINE IS WASTEFUL SPENDING OF MY PREMIUM DOLLARS!! OuchOuchOuch
jagfan  
#7 Posted : Friday, September 21, 2012 6:58:32 AM(UTC)
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peachy1200 wrote:

this NURSE ADVICE LINE IS WASTEFUL SPENDING OF MY PREMIUM DOLLARS!! OuchOuchOuch
 
I agree that service is a waste of money.  And when I was with BCBS, they were always sending out marketing material about the nurse call line.  The nurses have algorithms to follow but if there is no immediate emergent action to be taken prior to going to the ER, the end result no matter what the issue is always the same old story.  Go to the doc or ER.
GSBS  
#8 Posted : Friday, September 21, 2012 7:42:27 AM(UTC)
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jagfan wrote:
 
I agree that service is a waste of money.  And when I was with BCBS, they were always sending out marketing material about the nurse call line.  The nurses have algorithms to follow but if there is no immediate emergent action to be taken prior to going to the ER, the end result no matter what the issue is always the same old story.  Go to the doc or ER.
 What a great answer jagfan when it comes to the Blue Cross/ McKesson Blue Connections or whatever they are calling it. GSBS2012-09-21 17:42:19
dhacker56  
#9 Posted : Friday, September 21, 2012 10:01:33 AM(UTC)
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NALC went down. It is lower than it was for 2011.
dhacker562012-09-21 18:07:09
tcmitts  
#10 Posted : Tuesday, September 25, 2012 11:19:01 PM(UTC)
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Compass Rose premiums paid by the employee are actually about to increase 19.3 % for 2013.   For example, the bi-weekly
premiums for the high option for a family were $148.96 in 2012, and will be going to $177.78  per bi-weekly pay
period next year (rates are from the OPM web site and from the Compass Rose 2012 brochure) .   The 7%  figure cited for the rate increase  appears to be the increase in the overall premium (Government + Employee shares).    For 2013, the Government share increases 3%, but the employee sees an increase of over 19% in their premiums.   Ouch!


I’ve used CR for a number of years and they’ve always provided reasonable service for a reasonable  price…but….with this large an increase about the happen,  I’ll definitely be shopping around during the upcoming open season.





ESPN1204  
#11 Posted : Wednesday, September 26, 2012 5:50:57 AM(UTC)
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I came across the 2013 FEHB rates that are now posted on the OPM Website. I noticed that the particular plan I am considering has taken a considerable rise over the last 2 years. My understanding based on the OPM handbook regarding FEHB is that the federal government covers 72% - 75% of the said insurance plan, whichever is less. That seems to make sense, except for the part of the weighted average based on participants. That being said, if one were to do simple math looking at the new rates for the New York Aetna Family Open Access Plan you would see a rise of $267 per month from 2012 to 2013. Of that amount, the employee is obligated to pay $244.70, which is nearly 95%. Based on the numbers given for monthly amounts, the total premium is $1695.66 of which the government pays $920.73 (55%) and the employee pays $774.93 (45%). I am trying to understand what I am missing based on these numbers, neither one of them is even close to 72-75%.

fedman53  
#12 Posted : Wednesday, September 26, 2012 8:43:54 PM(UTC)
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Yes, the Federal Gov't pays a certain percentage of FEHB premiums based on 'Gov't' calculation, BUT there is an upper limit to the government portion, which for 2013 is $424.95 biweekly or $920.73 monthly. Anything over that you pay!! So if the FEHB plan you have had a big price increase over last year, you will pay more as the Gov't portion upper limit does not increase anywhere close to some premium increases. To me that is a red flag about that plan. I dumped Aetna years ago as I can get the same coverage and copays for a quarter the cost!

Even the premium costs for different sub-plans within an FEHB plan can have different percentages the employee pays. Look at BCBS standard and Basic for 2013. For BCBS STANDARD premium is $625.09, Gov't pays $424.95 (max) or 68% and employee pay $200.14 or 32%. BCBS Basic premium is $553.30. Gov't portion is $414.98 (based on some gov't calculation) or 75% and employee pays $138,31 or 25%.
upandup  
#13 Posted : Thursday, September 27, 2012 7:57:55 AM(UTC)
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ESPN1204 wrote:
]My understanding based on the OPM handbook regarding FEHB is that the federal government covers 72% - 75% of the said insurance plan, whichever is less. That seems to make sense, except for the part of the weighted average based on participants.

To put it this way--the government contribution is the lesser of:
A. 72% of the weighted average across all of FEHB. This year, that is $190.84 (biweekly) or $413.49 (monthly) for single coverage and $424.95 (biweekly) or $920.73 (monthly) for family coverage.
B. 75% of the actual premium for the particular plan.

Once plans exceed the 72% weighted average cap, then 100% of the premium increase is applied to the employee portion, thus distorting the percentage increases. 

upandup2012-09-27 16:03:19
Ryos  
#14 Posted : Thursday, September 27, 2012 8:53:31 AM(UTC)
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tcmitts wrote:






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Compass Rose premiums paid by the employee are actually about to increase 19.3 % for 2013.   For example, the bi-weekly
premiums for the high option for a family were $148.96 in 2012, and will be going to $177.78  per bi-weekly pay
period next year (rates are from the OPM web site and from the Compass Rose 2012 brochure) .   The 7%  figure cited for the rate increase  appears to be the increase in the overall premium (Government + Employee shares).    For 2013, the Government share increases 3%, but the employee sees an increase of over 19% in their premiums.   Ouch!


I’ve used CR for a number of years and they’ve always provided reasonable service for a reasonable  price…but….with this large an increase about the happen,  I’ll definitely be shopping around during the upcoming open season.






Wow.  I always used to think their premiums were great relative to the benefits but this year they'd have priced me out of interest if I'd wanted to keep them.  My high deductible plan didn't go up too much so I guess I'll be sticking with it barring a change due to moving.
phritzg  
#15 Posted : Monday, October 08, 2012 6:10:22 AM(UTC)
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I have found 2013 plan brochures for BCBS and for the various Aetna plans online today.  Bluecross is at http://www.fepblue.org/downloads/2013-service-benefit-plan-brochure.pdf  and Aetna's  various plans are at http://www.aetnafeds.com/pdf/2013/2013CDHPHDHPBrochure.pdf

I found these links by googling "blue cross 2013 fehb plan" and "aetna 2013 fehb plan".  It is possible that other brochures may be found in a similar manner.
upandup  
#16 Posted : Monday, October 08, 2012 12:37:03 PM(UTC)
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phritzg wrote:
I found these links by googling "blue cross 2013 fehb plan" and "aetna 2013 fehb plan".  It is possible that other brochures may be found in a similar manner.
The websites of most of the plans have been updated with the 2013 brochures. The OPM site should be updated soon.
Mr.Nobody  
#17 Posted : Tuesday, October 16, 2012 10:41:09 PM(UTC)
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I'm also in Aetna HDHP and got the same letter regarding rebate.  I just checked out the new premium and found the same thing, monthly premium (paid by ourselves) increased by almost 10 bucks, which brings the cost of Aetna quite close to GEHA HDHP.

Last time around, GEHA was about 10bucks more per month with slightly better benefits.  I may consider switch to GEHA this year.  Any inputs?


phritzg  
#18 Posted : Wednesday, October 17, 2012 1:11:37 AM(UTC)
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I am going to switch to NALC and save over $100/month over the Aetna CDHP Wisconsin rate, which went up about $69/month.  I already am a retired NALC member, so I won't have to pay an associate dues fee.  Besides, I get all my care through the Veterans Administration, with no copayments of any kind because I am in Priority Group 1.  I keep FEHB so my wife has health insurance if I die.  
dhacker56  
#19 Posted : Wednesday, October 17, 2012 1:41:21 AM(UTC)
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phritzg-  you will have to pay associates dues.  Granted it is a pittance but you will pay it.

upandup  
#20 Posted : Wednesday, October 17, 2012 4:29:25 AM(UTC)
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Mr.Nobody wrote:
I'm also in Aetna HDHP and got the same letter regarding rebate.  I just checked out the new premium and found the same thing, monthly premium (paid by ourselves) increased by almost 10 bucks, which brings the cost of Aetna quite close to GEHA HDHP.

Last time around, GEHA was about 10bucks more per month with slightly better benefits.  I may consider switch to GEHA this year.  Any inputs?



I have the GEHA HDHP and am happy with it. The plans are very similar, but there are some differences.

The HSA contribution and deductibles are the same. The coinsurance is lower with GEHA (5% v. 10%), but GEHA has a higher out of pocket maximum. The Aetna vision coverage gives you a flat rate of $100 for reimbursing for eyewear every two years, while GEHA has an Eyemed plan with in- and out-of-network benefits. GEHA's dental coverage is 50% for preventive care, but it is valid at any provider (based on their allowance) and also gives some flat-rate payments for fillings, while Aetna gives 100% preventive care, but only from in-network providers. GEHA provides overseas coverage at in-network rates, while Aetna treats non-emergency care rendered overseas as out-of-network. The two plans also use different PPO networks, so that is also a point to consider. There are other differences, but those are the main ones off the top of my head.

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