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fedspouse  
#61 Posted : Thursday, November 5, 2015 6:04:28 PM(UTC)

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Interesting! Is this info posted somewhere?

How does Blue Cross Basic compare with this plan? Seems like it is more expensive but do you get more for the money?
Also does anyone know if the reimbursement account for Aetna Direct is a use it or lose it every year? Normally I can see Part B premiums using it all up but at the moment I have an HRA that has to be used up within 3.5 years or I lose what is left in it. That is currently reimbursing us Part B.
upandup  
#62 Posted : Thursday, November 5, 2015 9:25:09 PM(UTC)

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Originally Posted by: fedspouse Go to Quoted Post
Interesting! Is this info posted somewhere?

Not that I know of. I have obtained statistics from OPM.


Originally Posted by: fedspouse Go to Quoted Post
How does Blue Cross Basic compare with this plan? Seems like it is more expensive but do you get more for the money?

In FEHB, more expensive doesn't mean better. It means more expensive.
Blue Cross Basic is a good plan, but, even with Medicare as primary, it requires using Preferred providers.

Originally Posted by: fedspouse Go to Quoted Post
Also does anyone know if the reimbursement account for Aetna Direct is a use it or lose it every year? Normally I can see Part B premiums using it all up but at the moment I have an HRA that has to be used up within 3.5 years or I lose what is left in it. That is currently reimbursing us Part B.

It can rollover, subject to a cap.
p. 100: "Provided you remain enrolled in this Option, any unused, remaining balance in your Medical Fund at the end of the calendar year may be rolled over to subsequent years. Note: This rollover feature can increase your Medical Fund in the following year(s) up to a maximum rollover of $5,000 Self Only enrollment, $10,000 Self Plus One enrollment or $10,000 Self and Family enrollment."
charko  
#63 Posted : Friday, November 6, 2015 12:46:39 AM(UTC)

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Originally Posted by: fedspouse Go to Quoted Post
Interesting! Is this info posted somewhere?

How does Blue Cross Basic compare with this plan? Seems like it is more expensive but do you get more for the money?
Also does anyone know if the reimbursement account for Aetna Direct is a use it or lose it every year? Normally I can see Part B premiums using it all up but at the moment I have an HRA that has to be used up within 3.5 years or I lose what is left in it. That is currently reimbursing us Part B.

I found out the hard way that basic does not cover everything in the standard. This may or not be true for all other FEHB plans that offer high and low plans.
You must check the official FEHB booklet of each plan to see if it meets your needs.(wish I did) Does you having an HRA account mean you are still working? If so Direct will NOT pay. Again; you must have Medicare as Primary, which as far as I know happens when you retire and enroll in part B. While its true you can get B while your still working, It would not be Primary.
Please email Candice Sanchezcl sanchezc1@aetna.com. and ask her how part B is treated if you are still working.
fedspouse  
#64 Posted : Friday, November 6, 2015 6:08:47 AM(UTC)

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Thank you both. Charko - I am not working. My HRA was part of a buyout package from my former company where I retired from (good timing…. a buyout when I was planning on retiring anyways!). They put a certain amount of $$ in an HRA to be used for health spending. I have 3.5 more years to use it up. Every month we are getting reimbursed for our monthly health premiums that is taken out of my dh annuity. Also for his Part B. I will be 65 next month and will start Part B too. Therefore if we pick up Aetna Direct during open season it will start January 1. We are both retired and will both be on Parts A & B.
charko  
#65 Posted : Friday, November 6, 2015 9:44:44 AM(UTC)

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Like I said either call customer service and ask them or email Candice Sanchezcil and ask her. Also call customer service of your present plan and ask them what happens to the HRA if you switch plans, or if they will pay the part b premuim which might help you use it up faster. The rules might have changed, but I think not sure as long as you keep FEHB as primary, you have time to sign up with part b without plenatly. But double check this with Medicare. I have been retired for 15 years, so not really up to date on all the changes. Hope this helps.
fedspouse  
#66 Posted : Friday, November 6, 2015 11:12:37 AM(UTC)

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Originally Posted by: charko Go to Quoted Post
Like I said either call customer service and ask them or email Candice Sanchezcil and ask her. Also call customer service of your present plan and ask them what happens to the HRA if you switch plans, or if they will pay the part b premuim which might help you use it up faster. The rules might have changed, but I think not sure as long as you keep FEHB as primary, you have time to sign up with part b without plenatly. But double check this with Medicare. I have been retired for 15 years, so not really up to date on all the changes. Hope this helps.


I think maybe you misunderstood. Like my name says I am the spouse of a Federal employee now retired. My own employment was not with the Federal Gov't. My HRA is NOT through our health insurance but from my former employer as part of a buy out package. They put $x into an account to reimburse me any health expenses. Every month we submit receipts to show how much our current FEHB costs and also my dh Part B premium. They then deposit that amount into our checking account and subtract that amount off my HRA balance. It was good for up to 5 years but now there is only 3.5 years left. We will use it all up before then though. This HRA has absolutely nothing to do with our current FEHB plan (which is Aetna HMO).

My most pressing question about this Aetna Direct has been answered already. If I have more I will either call or email Candice. Thanks.

halftime  
#67 Posted : Friday, November 6, 2015 11:42:12 AM(UTC)
halftime

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My wife and I are both 66 year old retired federal annuitants. We each have self BCBS Basic and Part A. We decided to forego Part B. Unfortunately, a year later, we have a lot of data in the form of very high medical costs. After decades of very low medical costs, my wife had the proverbial bad year. Three surgeries and six chemotherapy sessions later, we have learned a lot about health care and health insurance. As of today her billed amount is $256,000 of which BC has paid $106,000 and we have paid the catastrophic limit of $5,500. The $5,500 consists of $2,500 for doctor visits, medical supplies, and surgery copays and $3,000 for prescription drug copays.

At first glance, you would think that taking Part B would have been the right decision since $2,500 would have been waived by BC. In our case though, the waived amounts would just be replaced by more prescription drug costs. The chemo bottomed out her white blood counts necessitating four Neulasta injections, each with a copay of $4,200. So, if we had Part B, the only difference would be that we would be out the Part B premiums. If I'm wrong, hopefully someone will tell me.

One of many surprises in this journey is the 30% copay for prescription drugs. I was not aware that if drugs were provided by other than a retail pharmacy or the mail order pharmacy that there was a 30% copay. When undergoing chemotherapy or surgery you have no choice but to get drugs from the hospital.
charko  
#68 Posted : Friday, November 6, 2015 12:10:32 PM(UTC)

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Sorry about your wife. BTW Fed blue cross basic is not mail order. Retail only.
fedspouse  
#69 Posted : Friday, November 6, 2015 12:14:52 PM(UTC)

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He said they got drugs through hospital pharmacy. Would that have been considered "mail order" (which is not covered)? Just trying to understand everything.
charko  
#70 Posted : Friday, November 6, 2015 1:15:41 PM(UTC)

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Once again you can not get mail order with bc&bs basic. He probably got it as a tier 3 or special drug which is the higher 30 pay.
jagfan  
#71 Posted : Friday, November 6, 2015 2:49:40 PM(UTC)

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Originally Posted by: charko Go to Quoted Post
Once again you can not get mail order with bc&bs basic. He probably got it as a tier 3 or special drug which is the higher 30 pay.


charko is correct. However, there will be a change in BCBS Basic RX benefits beginning in 2016. Mail order will be an option for Medicare A and B enrollees.


charko  
#72 Posted : Saturday, November 7, 2015 1:22:09 AM(UTC)

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Originally Posted by: jagfan Go to Quoted Post
Originally Posted by: charko Go to Quoted Post
Once again you can not get mail order with bc&bs basic. He probably got it as a tier 3 or special drug which is the higher 30 pay.


charko is correct. However, there will be a change in BCBS Basic RX benefits beginning in 2016. Mail order will be an option for Medicare A and B enrollees.




To late for me. I am leaving bc&bs and going with Aetena Direct. Big surprise, didn't have to wait for monday. Switched yesterday.
halftime  
#73 Posted : Saturday, November 7, 2015 5:38:55 AM(UTC)
halftime

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"BTW Fed blue cross basic is not mail order. Retail only."

That is true. For tier 4 and 5 specialty drugs though, you can use the Specialty Pharmacy which I believe is handled by the mail service pharmacy. It operates similarly. By the way, y'all may be interested to know that they will overnight drugs to you.

My wife had three Neupogen injections with a copay of $400 each and four Neulasta injections with a copay of $4200 each. We could have gotten them through the Specialty pharmacy for $120 total. By the time I figured all this out, she had already reached the catastrophic limit.

OUtside  
#74 Posted : Saturday, November 7, 2015 10:25:11 AM(UTC)

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halftime, thanks for your very informative comments on this thread. If memory serves, you are the first to relate that it is possible to decline Part B, experience serious and highly expensive illness, and still come out ahead saving the Part B premium.

However, it is also possible not to come ahead or to more or less break even in such circumstances, all depending on the amount and types expenses which occur and particularly the terms of the fehb plan catastrophic limitation as to what is included as well as excluded by the plan in this limitation. Everyone should pay particular attention to this aspect regardless of their Part B enrollment decision.

Thanks also for making us aware there may be more than one approach to Rx/pharmacy issues, good to keep in mind by someone facing high expenses of this kind.

Even though you would now face a 10 or 20 % premium penalty for late enrollment in Part B, the peace of mind aspect of having it is probably in your mind this open season and especially with respect to this Aetna Direct plan, which in effect will pay part of the premium cost. It would be interesting to know what you decide to do.

Good luck with your decision.
charko  
#75 Posted : Saturday, November 7, 2015 2:40:37 PM(UTC)

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Why would he have to pay the penalty for late enrollment? I was under the impression if he had fehb there would be no penalty.
OUtside  
#76 Posted : Saturday, November 7, 2015 3:33:29 PM(UTC)

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No, fehb subscribers are subject to the same penalty for late enrollment as everyone else. But in his case, a year or two into it, the penalty is relatively small so the personal account provided by Aetna Direct could still be attractive to him. He didn't say, but it is also possible he is subject to the higher Part B premium for high income retirees, which should also be taken into account.

Edited by user Saturday, November 7, 2015 3:46:55 PM(UTC)  | Reason: Not specified

charko  
#77 Posted : Saturday, November 7, 2015 4:14:43 PM(UTC)

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I still think that if you have fehb and are still working at 65. then there is no penalty for not signing up since fehb is primary. Once you retire its another story.
GoHuskers  
#78 Posted : Saturday, November 7, 2015 6:00:19 PM(UTC)

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Some people eligible for Part B may already be covered by a group health plan (GHP) based on current employment (either their own or their spouse's). When that coverage ends based on current employment ends, there is Special Enrollment Period which consists of the 8 consecutive months following the last month, during any part of which, the individual was enrolled in the GHP based on current employment status. If the individual enrolls in Part B during that SEP, there will be no penalty for late enrollment
OUtside  
#79 Posted : Saturday, November 7, 2015 6:33:22 PM(UTC)

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He said both he and spouse are age 66 and retired.
halftime  
#80 Posted : Saturday, November 7, 2015 6:35:46 PM(UTC)
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The wife and I are both retired; so we would have to pay the penalty if we opted for part B (20% for me, 10% for her). Assuming we hadn't hit the catastrophic limit and even in this year of horrendous medical costs, her waiveable copays will be about $3,000. Even without the penalty I wouldn't pay $1900 to maybe save $1100. It's all a gamble; everybody's situation is different.

As far as changing plans, we are still looking and have ordered the checkbook info, but I doubt if we change. We are down the learning curve with BCBS and are very familiar with how it works and what they pay in various situations. It's worth a fair amount of money not to have to research and learn a new plan.

Here is an interesting situation that arose this year. Just having part A, even though it was unused, cost us a couple of thousand dollars. The makers of these very very expensive drugs have programs that reimburse you for some or all of your copay. Amgen would have reimbursed us as long as we didn't have "government" insurance. They don't consider FEHB as government insurance. We were ineligible because we have part A.

I still don't understand why part A was unused. My wife had a $50,000 six hour surgery, stayed overnight in the hospital but never was "admitted".
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