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Medicare and Health Care


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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.

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postalwave  
#1 Posted : Saturday, November 4, 2017 5:56:46 AM(UTC)
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BCBS w/ Medicare: Standard vs. Basic

I have been doing research to determine the best way forward for me with health care coverage when I am eligible for Medicare and have found an interesting item. I have had BCBS FEP Standard since the beginning of my employment but the Basic option in now looking very interesting at this point for 2018. With Medicare parts A & B the actual coverages seem very similar . The main difference is the lack of out-of-network coverage with the Basic option, this would seem to be mostly mitigated by Medicare A&B coverage with services that participate in Medicare. Now the ~$85/month premium difference comes strongly into play. Now add to this that Basic has a $600/annum health account included that is used to pay for Medicare part B and for me this is roughly a $1400 difference. I would add that for those that are presently using the Mail Order Pharmacy with the Standard Option that is now available with the Basic Option for those on Medicare .

Please do your own research, especially with your health care providers participation in BCBS FEP.

It is one of those 'It seems too good to be true' things, so please if you find a flaw in my research let me know.

Good links for info
https://www.fepblue.org/...plans/compare-plans-2018

https://media.fepblue.or...es/2018_SBP_Brochure.pdf

https://media.fepblue.or...BPMEDGLBK2018_Digi_3.pdf

https://www.opm.gov/heal...ans=N61NY104NY111NY314NY

Note : Medicare options are not always spelled out on these links.in BCBS FEP.

GO4IT!  
#2 Posted : Sunday, November 5, 2017 10:41:56 AM(UTC)
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postalwave,

I am in the very same situation. I have had BCBS since I began my Fed Employment, and Medicare Part B started a few months ago for me. After I read through information, I reached the conclusion to stay with BCBS Standard, mainly because of the Mail Order Pharmacy and cost of prescriptions overall. Apparently, I must have read comparative language from a year ago. I thought I had this all worked out, but now I am going to go over the websites you provided. I see where the Mail Order Pharmacy is now covered by BCBS Basic. So, now the basic difference is prescription drug costs, and out of network providers. Thank you for this information. I wish BCBS Standard would reimburse for Medicare Part B, as I tend to prefer to stay with the insurance I know and understand so well.
postalwave  
#3 Posted : Sunday, November 5, 2017 11:32:15 AM(UTC)
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Twiggy
Please post any observations you may have. I am still very skiddish about making a change and afraid I have missed a salient point. For myself it would seem staying in network is not an immanent problem only potential.

I consider myself a reasonably intelligent individual but sorting health care options out is daunting, I can only imagine how difficult it must be for folk with more complicated health issues under stress.

Regards,
David
GO4IT!  
#4 Posted : Monday, November 6, 2017 5:59:23 AM(UTC)
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Hi David,

I am one of those more complicated cases with a number of chronic health conditions and several RX’s. I spent a couple of hours reading through all the websites you posted. Thank you so much for the updated information. Some of the things I previously perused must have been from last year.

At this point, I am as skittish as you, and reluctant to change. The potential of having a non-network physician treat me in an ER or hospital may be higher because of the number of my health conditions. Historically, before Medicare Part B, I have been billed for radiologists, lab physicians, etc., and other non-network providers consulted about test results, even though the places where the tests were performed were in-network. Of course, one has no choice when this occurs.

Because I have a number of health conditions and take 12+ RX’s daily, I believe I am going to stay with BCBS standard. The generic meds through the Mail Order Pharmacy, which I use most, are a little less, and the potential for me to run into a non-network provider is probably greater, although I agree BCBS is widely accepted.

My Medicare Part B is deducted from Social Security. Do you know how BCBS basic would reimburse me for such payments? Presumably, I would have to find out who to contact and where to send proof the payments are deducted from Social Security. I have been looking at the difference between the increased RX costs of BCBS basis versus the $134.00 monthly cost of Medicare Part B. The basic still comes out ahead by a little. But, since I have had Medicare Part B starting in July of this year, I have not had to pay any medical expenses, and generic RX’s have been reduced to $10.00 from the Mail Order Pharmacy. I also like getting RX’s delivered to my home because I do not care to run around a lot.

So, I am still skittish, but leaning toward staying with BCBS standard. Let me know what you finally decide to do.

postalwave  
#5 Posted : Monday, November 6, 2017 2:42:15 PM(UTC)
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Originally Posted by: Twiggy Go to Quoted Post


My Medicare Part B is deducted from Social Security. Do you know how BCBS basic would reimburse me for such payments? Presumably, I would have to find out who to contact and where to send proof the payments are deducted from Social Security.


BCBS will not reimburse you for your Part B cost. ( I think that is what you are asking)

I will post back when I decide, I think I will take another look in a couple of days.

>>>>>>>>>>>>>>>>>
I don't know how that came out that way: BCBS will reimburse you for your Part B cost.

Edited by user Monday, December 11, 2017 6:37:03 PM(UTC)  | Reason: deleted "not"

TheRealOrange  
#6 Posted : Tuesday, November 7, 2017 4:06:25 AM(UTC)
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Originally Posted by: postalwave Go to Quoted Post
Originally Posted by: Twiggy Go to Quoted Post


My Medicare Part B is deducted from Social Security. Do you know how BCBS basic would reimburse me for such payments? Presumably, I would have to find out who to contact and where to send proof the payments are deducted from Social Security.


BCBS will not reimburse you for your Part B cost. ( I think that is what you are asking)

I will post back when I decide, I think I will take another look in a couple of days.

You may want to double check that for 2018 depending on your BC/BS plan. A recent article on FedSmith indicates:

BlueCross Blue Shield PPO – Basic Option – Limited HRA [Health Reimbursement Arrangement] is provided to any member enrolled in Medicare Part A and Part B; reimbursement is to be used exclusively to pay Medicare Part B premiums – $600 annually. (New)

So, it may be worth another check if the $600 annual amount makes a difference.

https://www.fedsmith.com...edicare-part-b-premiums/
postalwave  
#7 Posted : Tuesday, November 7, 2017 10:19:37 AM(UTC)
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Thanks for the link TheRealOrange
As I am going on Medicare Part B the $600 would be cash back in my pocket. However trying to find out info from BCBS has proven problematic so far. I spent an hour on the phone with national # was told they did not have any info but had a number I could call.. After Jan 1 2018. They next day I called my local plan and was offered the same # after much rambling. I will try again maybe after the open season actually starts.
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#8 Posted : Tuesday, November 7, 2017 10:57:26 AM(UTC)

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I can't find it readily, but I recall someone posting here recently the $600 is really $300 per person or $600 for a self + 1 when both have Parts A and B. That would be be consistent with the brochure language which says 'up to' $600.

If you really want to get into the details especially the financial details of making a decision selecting a plan or option, spend $8 for an on line subscription to Checkbook's Open Season Guide for Federal Employees. It will provide you with cost estimates for all the plans and options consisting of premiums plus out of pocket expenses plan by plan. If you are still working, your personnel office may have it available at work.

https://www.checkbook.org/newhig2/hig.cfm
GO4IT!  
#9 Posted : Tuesday, November 7, 2017 11:14:18 AM(UTC)
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I really appreciate all the additional information, thanks to everyone. Based on my cursory reviews, it appears the BCBS Basic Option reimbursement for Medicare Part B is, “Up to $600.00.” Whether this includes both single and single plus 1, I am not sure. Even if the, “Up to $600.00” applies to single individuals, that is only a little over 5 months reimbursement for Medicare Part B premiums. Thus, the lower cost of Mail Order generic RX’s, given the number I use regularly, would not substantially advantage me financially to switch to BCBS Basic over my current BCBS Standard Option. Absent some other information we may discover, I am pretty certain I am sticking with the BCBS Standard Option.

Postalwave, and others, let us know what you decide to do. If you elect to change options, let us know how it works out for you.
postalwave  
#10 Posted : Wednesday, November 8, 2017 8:52:05 AM(UTC)
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the 600 is per person

if you have medicare a and b you get the mail order w/ basic

still awaiting bcbs to have the info available with their customer service reps..
postalwave  
#11 Posted : Monday, December 11, 2017 6:42:44 PM(UTC)
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As of the 11th of Dec no new info available re: HRA . Bravo BCBS
I took a leap and changed to Basic. We will see.
GO4IT!  
#12 Posted : Tuesday, December 12, 2017 10:48:38 AM(UTC)
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Postalwave,

Please keep us informed how reimbursement for your Medicare Part B works out; whether it is a hassle, and do you have to request reimbursement every month, (I believe you do); and just how much do they reimburse your Medicare Part B payments, i.e., 6 months to entire year. As I previously indicated, I elected to stay with BCBS standard.
postalwave  
#13 Posted : Tuesday, March 20, 2018 9:27:35 AM(UTC)
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From
Madmax18

Posted: 19 minutes ago

Postalwave, I'm new to this site so apologies if I'm doing something wrong by emailing you directly. I just today set up a FedSoup user account and I guess there's a few days delay until I can actually post anything. I'm reaching out to you because the comments you posted several months ago about pairing Medicare and BCBS Basic were directly related to my current set of circumstances. Only difference is that I will pay more for Medicare because I'm subject to the Income Related Monthly Adj Amount. Nonetheless, I've pretty much decided to opt for Medicare so am now struggling with the decision on what federal plan to pair with it. I've been researching this since last fall and have read or listened to every piece of literature or webinar I could find. And across the board, the experts all say to move from Standard to another lower cost but equally adequate plan such as Aetna Direct, BCBS Basic or NALC. I've read on Fed Soup the forum on Aetna Direct and think I'll take a pass on it. Too many issues with it. So given my long standing good experience with BCBS Standard, I'm close to selecting BCBS Basic. My only real concern is its coverage of only providers in the plan(has never been a problem for me in the DC area). But you articulated exactly my thinking that between Medicare participants and BCBS participants, I ought to have a lot of coverage.

So that's a long way of asking if over the past few months, you opted to go with Basic and if you have any other pearls of wisdom to share? I've done so much research that I'm concerned I'm not seeing the forest for the trees.

Thanks in advance.
Madmax18

And my answer:
Sorry nothing yet. Not yet on Medicare, still unsure about the reimbursement part as well. Keeping fingers crossed




postalwave  
#14 Posted : Wednesday, June 27, 2018 1:56:26 PM(UTC)
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I have received 2 checks that covers the 600 bucks.
FYI the link is https://www.fepblue.org/...y&utm_content=online

which in turn links to https://media.fepblue.or...y_Me_Back_Claim_Form.pdf
for a form that can be FAXed to WageWorks the company doing the check mailing. They have an online way of doing this that I would not touch w/ a 10 " pole.
Down side of this is you get no verification that the fax was processed until the check arrives. Looks like this should only be required once a year if you wait until you have paid in more than 600 to medicare for the year.

PS sorry I took so long to get back here.
RetVAFed  
#15 Posted : Friday, August 17, 2018 3:10:44 PM(UTC)
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I don't post much to the forum but view it frequently. I am a retired federal employee on Medicare (A&B) with FEP Blue Cross Standard for me and my wife. My wife will turn 65 in early March; she is not a federal employee. My plan is for her to sign up for Medicare A&B in early December, three months before her birthday. Since it will be open season I also plan to change coverage from Blue Cross Standard to Basic, providing the reimbursement is still offered. If not, I'll look at Aetna or some other plan. Does this sound like a good choice?
postalwave  
#16 Posted : Saturday, August 18, 2018 5:54:59 AM(UTC)
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I can only say the Basic option with Medicare A&B still seems like a good choice for me. I know nothing about Aetena. Everyone medical situation and likely region of the country will effect there decision.
GO4IT!  
#17 Posted : Monday, November 12, 2018 9:51:38 AM(UTC)
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BCBS Standard v. Basic when you also have Medicare A & B for 2019 Open Season.

I am curious how things worked out for those of you who went with BCBS Basic, and received the $600.00 reimbursement for Medicare?

I stayed with BCBS Standard, and I have not had to pay any medical costs. I had a number of in office procedures and doctor visits. Of course, I had no Medicare reimbursement.

I guess my concern again this year primarily has to do with coverage for non-Network physicians with Basic.

For those of you who went with BCBS Basic with Medicare A & B, how did things work out for you?
postalwave  
#18 Posted : Monday, November 12, 2018 12:44:40 PM(UTC)
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So far so good.

My dental option is still up for grabs...
GoHuskers  
#19 Posted : Monday, November 12, 2018 1:02:02 PM(UTC)

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I made the switch a couple of years ago and things have worked out fine. The prescription co-pays are more with Basic but the lower premium more than made up for the difference and the Part B reimbursement that started last year makes it an even better deal. I live in a fairly large metro area so there has been no problem staying in network. Haven't paid a dime out of pocket for anything other than prescriptions and dental since making the switch. I believe there are a few things that Standard covers that Basic doesn't but none of them were in areas that I expect to be an issue for me or my wife.
thanks 1 user thanked for this useful post.
DebraD on 1/27/2019(UTC)
GO4IT!  
#20 Posted : Wednesday, November 14, 2018 10:29:29 AM(UTC)
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I sincerely appreciate all of your responses. After spending several hours comparing BCBS Standard v Basic, I concluded I would come out about $1100.00 per year to my benefit with Basic, given the additional cost of my regular RX’s, difference in monthly premiums, and Medicare reimbursement, absent any need for Specialty drugs, or non-Network provider’s. Many physicians in my region are in Network Providers, and all my regular medications are generic. So, I believe I am going to take the Basic over the Standard Option this year.

Did any of you encounter any problems with the transition at the first of the year?
thanks 1 user thanked GO4IT! for this useful post.
EDM on 11/14/2018(UTC)
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