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xplorer  
#1 Posted : Tuesday, October 10, 2017 5:06:21 PM(UTC)
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Having been a retired participant in the federal employees health insurance program for many years, and having Medicare parts A and B for myself and my wife, allow me to share my comparison of the Blue Cross, GEHA, and Aetna Direct programs. I originally had Blue Cross standard option, switched to Blue Cross basic option, then to GEHA standard option, and finally this year to Aetna Direct. Medical benefits under all of these options for us were ESSENTIALLY IDENTICAL, with Medicare Parts A & B. Switching from Blue Cross Standard to Blue Cross Basic saved us about $150 per month in premiums. Switching from that to GEHA saved us further about $100 per month in premiums. Switching from that to Aetna Direct cost us about $12 more per month in premiums….BUT saved us about $3000 for the year. This was for two reasons: Aetna sets up an $1800 health fund which can be used to pay non-covered medical expenses including Medicare premiums, and secondly, Aetna pays $1000 more for hearing aids than does GEHA…and I did get hearing aids this year.

In addition, Aetna Direct has no co-pay for most generic prescriptions by mail order. This however might be offset by the fact that a few generics are considered “non-preferred”, and for these few there is a $105 co-pay for a 90 day supply by mail order (though, strangely, these are cheaper if bought from a local pharmacy!).

Now, we did pay a price of sorts for these savings. We had to watch our $1800 health fund like a hawk, for Aetna did on a couple of occasions erroneously charge prescriptions to our health fund….which of course reduces the amount available to reimburse for Medicare premiums. It took me a solid month to get the first occasion of this corrected. Reimbursement for my hearing aids was very slow, and also required followups with Aetna. Then when I filed a claim for reimbursement of Medicare premiums, they at first rejected my claim because they said the wrong reimbursement form was submitted….even though this was the form Aetna’s own representative had told me by phone call to submit, and contained the same information as the new form they required! To their credit, they were always polite and always answered my email inquiries immediately. They do correct their mistakes, but it is aggravating to have to watch it all so closely.

So, if one does not mind having to carefully watch things and follow up when necessary, Aetna Direct can save you a bunch of money. I will stick with them.
OUtside  
#2 Posted : Tuesday, October 10, 2017 6:19:20 PM(UTC)

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If prescriptions are not paid from the health fund account, how are they paid?
xplorer  
#3 Posted : Wednesday, October 11, 2017 2:43:14 AM(UTC)
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They are paid by Aetna, under the normal coverage. 100% in the case of most generic drugs if done by mail order.
OUtside  
#4 Posted : Wednesday, October 11, 2017 4:29:52 AM(UTC)

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Thanks.

If the Rx are not generic and paid by Aetna 100%, then you would normally have a co-pay which I guess would mean you would have a choice to pay from the health fund or directly out of pocket yourself?

So I see your point about having to watch the health fund balance like a hawk.
xplorer  
#5 Posted : Wednesday, October 11, 2017 5:24:56 AM(UTC)
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Correct. If the drugs are brand, Aetna pays around the same percentage that other insurers pay, and the co-pay would come from the health fund, thus reducing the amount of the health fund available to pay toward your Medicare Part B premiums.
Sante123  
#6 Posted : Wednesday, October 11, 2017 8:58:32 AM(UTC)
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HDHP plans give the enrollee discretion re: when to use the medical savings account. CDHP plans do not because the “fund” belongs to the insurance company, not you. Aetna Direct is a CDHP, not an HDHP. 100% of the contract price for drugs and non-preventive covered services comes right out of the medical fund account until it is exhausted. The deductible, which would normally kick in after the fund balance is zero, is waived for Medicare Parts A+B enrollees.

Terms like co-pay and co-insurance apply only to the Traditional Insurance part of the plan. Traditional Insurance does not kick in until after the fund is zeroed out and any applicable deductible has been paid by the enrollee. For Medicare Part A+B enrollees, since there is no deductible, and co-pays/co-insurance are waived for most everything except drugs, that means the medical fund comes first, then Traditional Insurance drug coverage, not both at the same time.

To get the full benefit from the medical fund, enrollees should use 100% of it to get reimbursed for annual Part B premiums. They should do this a/s/a/p each year.
xplorer  
#7 Posted : Wednesday, October 11, 2017 9:49:22 AM(UTC)
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I was told by an Aetna representative that you cannot be reimbursed in advance for Medicare premiums. Therefore one can't file for reimbursement of $1800 from the health fund until he had already paid $1800 in Medicare premiums. But it really makes no monetary difference. If, for example, I purchased from a local pharmacy a prescription requiring a $5 co-pay, the $5 is deducted from my health fund, leaving $1795 available for Medicare premiums. But if I had already received $1800 reimbursement for Medicare premiums, I would pay $5 cash to the pharmacy. Either way, I am out $5.
Sante123  
#8 Posted : Wednesday, October 11, 2017 10:47:51 AM(UTC)
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Originally Posted by: xplorer Go to Quoted Post
I was told by an Aetna representative that you cannot be reimbursed in advance for Medicare premiums. Therefore one can't file for reimbursement of $1800 from the health fund until he had already paid $1800 in Medicare premiums. But it really makes no monetary difference. If, for example, I purchased from a local pharmacy a prescription requiring a $5 co-pay, the $5 is deducted from my health fund, leaving $1795 available for Medicare premiums. But if I had already received $1800 reimbursement for Medicare premiums, I would pay $5 cash to the pharmacy. Either way, I am out $5.


1)There is a thread in this FEHB section titled “How to Get a Medicare Payment Receipt”. It talks about how it is not strictly necessary to wait until the end of the year before seeking reimbursements.
2) I just called Aetna Direct and they explained that the medical fund does operate like a CDHP for non-Medicare enrollees, but NOT for those with Medicare Part A+B. This means that the listed co-pays and co-insurance for drugs apply from the get-go, even when you still have money in the medical fund. Unusual, but good to hear.
3) The treatment of generic drugs is quite good under Aetna Direct, but the max payable for 30-day supplies of brand name and non-formulary prescriptions can be up to 3x more than GEHA. Something to consider for those to whom such meds apply.

fedspouse  
#9 Posted : Sunday, October 15, 2017 5:23:19 AM(UTC)

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One thing to keep in mind for those not familiar with Aetna Direct is that the health fund is NOT $1800 BUT$900/person. If you are single you are getting $900.

Also, as someone else finally mentioned, if you get a generic prescription at the local pharmacy they deduct $5 from your health fund. Makes no difference if that $5 comes from prescriptions or Part B. It is still $5 that you owe.

Sante123- I don't understand your #2. Could you please explain that to me? I am on Medicare Part B.

We don't need fancy drugs at high costs (yet... anyways) but one thing to keep in mind is that the maximum out of pocket is $6850 (I believe that is about what it is) whereas many other health plans have much higher amounts. Unless I was told wrong by customer service it also includes drugs.

As for the reimbursement of ongoing expenses such as Part B I was told to submit a form. Then I have to call every month for them to reimburse me. I've done this 1x so far and it worked. Seems a silly way to do it but it is what it is. Jan 1 will have to submit a new form with the new Part B amounts.
freeageless  
#10 Posted : Sunday, October 15, 2017 1:26:44 PM(UTC)
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Originally Posted by: fedspouse Go to Quoted Post
One thing to keep in mind for those not familiar with Aetna Direct is that the health fund is NOT $1800 BUT$900/person. If you are single you are getting $900.

Also, as someone else finally mentioned, if you get a generic prescription at the local pharmacy they deduct $5 from your health fund. Makes no difference if that $5 comes from prescriptions or Part B. It is still $5 that you owe.

Sante123- I don't understand your #2. Could you please explain that to me? I am on Medicare Part B.

We don't need fancy drugs at high costs (yet... anyways) but one thing to keep in mind is that the maximum out of pocket is $6850 (I believe that is about what it is) whereas many other health plans have much higher amounts. Unless I was told wrong by customer service it also includes drugs.

As for the reimbursement of ongoing expenses such as Part B I was told to submit a form. Then I have to call every month for them to reimburse me. I've done this 1x so far and it worked. Seems a silly way to do it but it is what it is. Jan 1 will have to submit a new form with the new Part B amounts.


Sante,

I too do not understand what your #2 in your above-mentioned post means, and I too would appreciate a further explanation of what your #2 means.
Sante123  
#11 Posted : Sunday, October 15, 2017 2:45:19 PM(UTC)
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fedspouse and freeageless:

In post #6 above, I elaborated on the exchange between xplorer and Outside. Claims that get processed directly through a CDHP plan do not offer you a choice as to how the bill is paid. What's more, a health reimbursement arrangement (aka HRA or fund) is typically never used to pay co-pays or co-insurance. Instead, it's used to pay 100% of the contract price of whatever non-preventive drug or service you are getting. So, if a visit costs $250, that's what gets deducted from your fund. If a drug costs $150, that's what comes out of your fund. Not some fixed dollar amount (co-pay) or a fixed percentage of the cost (co-insurance). In a standard CDHP plan, the fund pays for everything until it is exhausted. Then you pay 100% of the contract price under the deductible until you have met the deductible limit. Then, and only then, do you encounter such things as co-pays and co-insurance, which are part of a plan's "traditional insurance coverage." And that is also what the plan brochures say. I felt that this was being overlooked in the discussion of Aetna Direct, so I said so. (FWIW: I based my comments on my prior experience as an APWU CDHP enrollee, and a lot of reading on the subject of FEHB and non-FEHB CDHP and HDHP plans.)

I already knew that Aetna Direct's wrap-around coverage for Medicare enrollees set it apart from other CDHP plans. I also knew that Medicare has priority in paying medical claims, so the secondary plan is only paying what's left. But, since Traditional Medicare does not cover most prescription drugs, the issue of drug claims still seemed to be subject to the "HRA Fund pays first" principle. Just to be sure, I contacted Aetna Direct and asked them specifically about this. The rep said that my understanding was correct with respect to how Aetna Direct handles claims for folks who have not yet signed up for Medicare Parts A+B. However, she said that the plan handles those who are covered for Parts A+B a little differently. For them, the liability for drugs is limited to just the co-pay or co-insurance, whichever applies to the drug in question. And the medical fund, if it is not already zeroed out, pays just that co-pay or co-insurance amount. This seems quite unusual, but that is what the rep said. And that is what I wrote in post #8 above.

She may have been mistaken. But if she was not, this is a plus, because it means the fund will not have to be used to pay more for something than one would pay if they had a zero fund balance. That, in turn, means one does not have to prioritize the reimbursement of Medicare premiums as the best use of the medical fund's money.

Edited by user Sunday, October 15, 2017 2:51:40 PM(UTC)  | Reason: Tweaking to enhance clarity.

Sante123  
#12 Posted : Monday, October 16, 2017 7:21:40 AM(UTC)
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I’d like to add some additional considerations into the mix when comparing BCBS, GEHA and Aetna Direct.

1) GEHA and BCBS offer coverage in all counties in all states plus the District of Columbia. However, in 26 states, Aetna Direct does not provide coverage in all counties. In order to enroll, you must live or work in a covered county. The number of counties not covered in some states can be quite numerous. In those counties, all providers are out of network. This is a substantial disincentive to enroll in Aetna Direct for persons not covered by Medicare Parts A+B.

2) New for 2018, BCBS Basic now offers a $600 Medicare Reimbursement Account to pay for Medicare premiums.

Edited by user Wednesday, November 29, 2017 2:03:30 PM(UTC)  | Reason: To correct info re: Medicare Reimbursement.

OUtside  
#13 Posted : Monday, October 16, 2017 6:32:15 PM(UTC)

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Regarding the ability to direct how the Health Savings Account is used (or not being able to direct how it is used), I believe this was discussed previously on this forum but not concluded.

Suppose the subscriber has the HSA and also a BENFEDS dental enrollment. The dental insurance pays after the FEHB insurance has paid. Subscriber typically would like to preserve the HSA account as long as possible, but if the HSA can be used for dental expenses up to a certain amount, say $800, does the dental insurance require the entire $800 be paid from the HSA prior to its paying anything?

It would seem so but suppose the entire HSA has been used, does the dental insurance realize it was just a matter of timing and nothing can be expected from the HSA account at that point?

Also, in the analysis earlier, dental benefits are an important element comparing the two plans. But if subscriber has the separate dental enrollment, wouldn't this override the advantage of a few hundred dollars that the one FEHB plan provides in dental benefits? Counting that few hundred dollars in dental benefits is important comparing the two FEHB plans. but I think if the retiree is really considering his/her dental situation and what it could cost, they ought to seriously consider a BENFEDS dental plan.
Sante123  
#14 Posted : Monday, October 16, 2017 7:22:30 PM(UTC)
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Originally Posted by: OUtside Go to Quoted Post

Suppose the subscriber has the HSA and also a BENFEDS dental enrollment. The dental insurance pays after the FEHB insurance has paid. Subscriber typically would like to preserve the HSA account as long as possible, but if the HSA can be used for dental expenses up to a certain amount, say $800, does the dental insurance require the entire $800 be paid from the HSA prior to its paying anything?

It would seem so but suppose the entire HSA has been used, does the dental insurance realize it was just a matter of timing and nothing can be expected from the HSA account at that point?


Aetna Direct’s medical fund isn’t strictly speaking an HSA. It’s an HRA, which does not accept deposits from the enrollee and pays no interest. It also does not count as insurance. Section 5(g) of the brochure states that there is no non-accidental dental benefit under this plan. So, even though FEHB insurance has priority over any FEDVIP coverage, there is no FEHB dental benefit payable. Thus, FEDVIP coverage is all that matters. After the dental claim is finalized, an enrollee can submit a paper claim to Aetna Direct for reimbursement via the fund of any out of pocket expenses paid. Been there, done that with APWU CDHP and posted about it on this site.


Originally Posted by: OUtside Go to Quoted Post

Also, in the analysis earlier, dental benefits are an important element comparing the two plans. But if subscriber has the separate dental enrollment, wouldn't this override the advantage of a few hundred dollars that the one FEHB plan provides in dental benefits? Counting that few hundred dollars in dental benefits is important comparing the two FEHB plans. but I think if the retiree is really considering his/her dental situation and what it could cost, they ought to seriously consider a BENFEDS dental plan.


The answer is yes, which is why I posted the following when discussing cost comparisons under the GEHA FEHB Open Season thread...
“Note: The advantage calculation described above is different if we talk about self+1 instead of self-only, and different still if FEDVIP dental and/or vision plans are involved.“
jagfan  
#15 Posted : Tuesday, October 17, 2017 3:42:40 AM(UTC)

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Originally Posted by: OUtside Go to Quoted Post

Also, in the analysis earlier, dental benefits are an important element comparing the two plans. But if subscriber has the separate dental enrollment, wouldn't this override the advantage of a few hundred dollars that the one FEHB plan provides in dental benefits? Counting that few hundred dollars in dental benefits is important comparing the two FEHB plans. but I think if the retiree is really considering his/her dental situation and what it could cost, they ought to seriously consider a BENFEDS dental plan.


Perhaps I am misinterpreting the above post. However, it is my understanding that GEHA plan subscribers would not need a separate FEDVIP dental enrollment and the associated costs. In addition to the limited basic dental benefits offered in the plan, subscribers can obtain the expanded Connection Dental benefits. Below is excerpt from GEHA brochure:

"Free to all GEHA health plan members, Connection Dental® can reduce your costs for dental care. Connection Dental is a network of more than 140,000 provider locations nationwide. Participating providers have agreed to limit their charges to reduced fees for GEHA health plan members. As a GEHA health plan member, you can take advantage of this program in addition to receiving basic dental benefits provided under the GEHA health plan. To find a participating Connection Dental provider in your area, call 800-296-0776 or visit www.geha.com. Please confirm provider participation prior to your visit."

OUtside  
#16 Posted : Tuesday, October 17, 2017 7:20:16 AM(UTC)

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I think you are referring to an enrollment where the network of providers gives you discounted prices for their services, for example, a crown typically costing, say, $1200, they would charge you less, say, $1000 (these are made-up numbers just for discussion purposes). FEDVIP enrollment, on the other hand, would give you discounted services but also cost sharing. For example, you might be charged $1000 for the crown but insurance would pay half of that, so your out of pocket cost would be $500 less with the FEDVIP plan.

If you are interested in this, a good way to approach it is to ask your dentist about it, is he/she in the discount network and/or the FEDVIP network plans? Does he/she think you would realize savings from either enrollment? Would you be better off in the real insurance (FEDVIP) enrollment?

And there is always that possibility looming over us as we age, especially at Medicare age, things wear out and don't work like they used to, to think about.



Sante123  
#17 Posted : Tuesday, October 17, 2017 9:45:59 AM(UTC)
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jagfan:

The GEHA health plan dental benefit is a good deal since it provides basic coverage for no extra premium. But how about those who have more than basic dental needs? Well, as you pointed out, GEHA members also get to use the GEHA Connection Dental network and pay 100% of its discounted prices if they wish. As a member of both the GEHA health and federal dental plans, I wondered why I had not thought more about this non-FEHB dental benefit. It turns out I had, but opted for FEDVIP coverage instead. Here are some factors to consider:

1) GEHA has its FEDVIP dental plan, which uses its Connection Dental Federal network, and a non-FEDVIP dental plan called GEHA Connection Dental Plus, which uses its Connection Dental network.

2) Aside from the explicit dental benefts offered under GEHA's FEHB health plans, it also offers what you commented on, i.e. the opportunity for GEHA health plan members to utilize the GEHA Conection Dental network even if they don't sign up for one of the dental plans.

3) The GEHA Connection Dental Federal network includes those providers who have signed up directly with GEHA as well as those who belong to the CIGNA dental network and the Careington Dental network. All together, that comprises over 340,000 provider locations. As dental plans go, that's a big network. About the same size as MetLife.

4) The GEHA Connection Dental network just includes providers who have signed up directly with GEHA. It comprises approximately 150,000 provider locations. So, a smaller number of in-network providers.

5) Within each zip code, there is a schedule of maximum allowable charges. This is the most that GEHA will allow, before cost-sharing is calculated. The list of prices is available online and applies to the GEHA Connection Dental Federal Network.

6) The allowable charges for the Connection Dental Network are not the same as the allowable charges for the Connection Dental Federal network. And there is nowhere to look them up because the contracts governing those providers vary too much. [I just verified this information today with a GEHA phone rep.]

7) The allowable charges under GEHA's FEDVIP plan are pretty low for basic stuff, but tend to be higher than MetLife's for many of the class C "major" services. It's important to note that GEHA pays the same benefit regardless of whether the provider is in or out of network. This formula offers an incentive for members since they are not penalized for going out of network. And it offers providers reasonable pricing for big ticket items to keep them on board.

8) GEHA's FEHB dental benefits pertaining to X-rays, cleanings, exams and topical fluoride applications are duplicated under the FEDVIP plan, so those FEHB "savings" go away if a member has both the FEHB and FEDVIP plans. However, the small benefit for fillings and extractions remains and is paid IN ADDITION TO the applicable FEDVIP benefits.

9) So.....anyone with fairly low dental expenses might not need to buy a supplemental dental plan. However, the savings one might expect from paying Connection Dental Network prices might be difficult to determine in advance.
jagfan  
#18 Posted : Tuesday, October 17, 2017 11:19:33 AM(UTC)

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OUtside and Sante123 - appreciate the clarification. In addition to the FEDVIP Connection Dental I didn't realize they had a Connection "discount" plan. I am familiar with their FEDVIP plan because that is the plan I am currently using. My spouse has been using MetLife for years. He recently had a crown and "should" be good for awhile. We are considering switching his medical plan to GEHA or Aetna Direct. And in my analysis, I'm trying to factor in the benefits and costs between the plans.
freeageless  
#19 Posted : Tuesday, October 17, 2017 12:02:37 PM(UTC)
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Originally Posted by: Sante123 Go to Quoted Post
jagfan:

The GEHA health plan dental benefit is a good deal since it provides basic coverage for no extra premium. But how about those who have more than basic dental needs? Well, as you pointed out, GEHA members also get to use the GEHA Connection Dental network and pay 100% of its discounted prices if they wish. As a member of both the GEHA health and federal dental plans, I wondered why I had not thought more about this non-FEHB dental benefit. It turns out I had, but opted for FEDVIP coverage instead. Here are some factors to consider:

1) GEHA has its FEDVIP dental plan, which uses its Connection Dental Federal network, and a non-FEDVIP dental plan called GEHA Connection Dental Plus, which uses its Connection Dental network.

2) Aside from the explicit dental benefts offered under GEHA's FEHB health plans, it also offers what you commented on, i.e. the opportunity for GEHA health plan members to utilize the GEHA Conection Dental network even if they don't sign up for one of the dental plans.

3) The GEHA Connection Dental Federal network includes those providers who have signed up directly with GEHA as well as those who belong to the CIGNA dental network and the Careington Dental network. All together, that comprises over 340,000 provider locations. As dental plans go, that's a big network. About the same size as MetLife.

4) The GEHA Connection Dental network just includes providers who have signed up directly with GEHA. It comprises approximately 150,000 provider locations. So, a smaller number of in-network providers.

5) Within each zip code, there is a schedule of maximum allowable charges. This is the most that GEHA will allow, before cost-sharing is calculated. The list of prices is available online and applies to the GEHA Connection Dental Federal Network.

6) The allowable charges for the Connection Dental Network are not the same as the allowable charges for the Connection Dental Federal network. And there is nowhere to look them up because the contracts governing those providers vary too much. [I just verified this information today with a GEHA phone rep.]

7) The allowable charges under GEHA's FEDVIP plan are pretty low for basic stuff, but tend to be higher than MetLife's for many of the class C "major" services. It's important to note that GEHA pays the same benefit regardless of whether the provider is in or out of network. This formula offers an incentive for members since they are not penalized for going out of network. And it offers providers reasonable pricing for big ticket items to keep them on board.

8) GEHA's FEHB dental benefits pertaining to X-rays, cleanings, exams and topical fluoride applications are duplicated under the FEDVIP plan, so those FEHB "savings" go away if a member has both the FEHB and FEDVIP plans. However, the small benefit for fillings and extractions remains and is paid IN ADDITION TO the applicable FEDVIP benefits.

9) So.....anyone with fairly low dental expenses might not need to buy a supplemental dental plan. However, the savings one might expect from paying Connection Dental Network prices might be difficult to determine in advance.


Sante and Jagfan,

I live in the Arlington, VA DC area. I have GEHA, but not GEHA's or any FEDVIP plan. Unfortunately, I just had to have a root canal and a crown. I went to a specialist who only took one plan-and that plan was CIGNA preferred or CIGNA VIP. I thought about signing up at Open Season with GEHA FEDVIP, but his office manager told me that they do not take GEHA FEDVIP-even though GEHA says that they are a part of the CIGNA network. I then called GEHA BENFEDS and they told me that some dentists do not take CIGNA GEHA FEDVIP dental. I also called CIGNA and they told me that have different CIGNA VIP plans-and that dentist does not take GEHA BENFEDS dental.

I tolked to several dentists office managers in this area. All that I talked whether they were in network or took no dental insurance told me that if they had to choose one dental FEDVIP dental plan, that they would choose AETNA Dental BENFEDS. The reason that most of them gave was they stated that AETNA BENFEDS Dental has more dentists and specialists in their plan.

jagfan  
#20 Posted : Tuesday, October 17, 2017 1:39:47 PM(UTC)

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freeageless

I've been a participant in the FEDVIP dental program since inception. The lack of in network providers is a problem with all the plans. I've changed plans four times over the years in order to stay with my provider. He has opted out of all except Delta Dental and GEHA. I will need to call the office this week and check on his status for 2018. Most of the established providers in my area are not in network with any plan but will file the insurance papers for you. With GEHA Connection FEDVIP, you can see any provider but if he/she is not in network plan to more out of pocket. I did notice that the "chain" dental corporations in my area are in network for most plans. But I'm not familiar with the quality of services they provide.
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