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Medicare and Health Care


*This is a non-medical board. This site shall not be used to seek professional, medical or legal consultation.

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.

To read today's top news stories on federal employee pay, benefits, retirement, job rights and other workplace issues visit FederalDaily.com.

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HoosierDaddy  
#21 Posted : Wednesday, July 31, 2019 7:28:38 PM(UTC)

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In your situation you won't be eligible for Medicare until you reach 65. If you sign up for social security at 62 then you will automatically be enrolled in Medicare when you reach 65 unless you opt out. Part A is free so you might as well get it. For part B you need to figure if it's cost effective for you. I believe BCBS standard waives some fees if Medicare is primary and you can sign up for their Medicare reimbursement account and get $600 every year toward your part B premiums. It might even be a good idea to switch to BCBS basic, between the $600 reimbursement and what you save in premiums it would be like getting part B for free. If you medical provider accepts Medicare your only out of pocket costs would be for RX's
GSBS  
#22 Posted : Wednesday, July 31, 2019 8:04:15 PM(UTC)
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Originally Posted by: HoosierDaddy Go to Quoted Post
In your situation you won't be eligible for Medicare until you reach 65. If you sign up for social security at 62 then you will automatically be enrolled in Medicare when you reach 65 unless you opt out. Part A is free so you might as well get it. For part B you need to figure if it's cost effective for you. I believe BCBS standard waives some fees if Medicare is primary and you can sign up for their Medicare reimbursement account and get $600 every year toward your part B premiums. It might even be a good idea to switch to BCBS basic, between the $600 reimbursement and what you save in premiums it would be like getting part B for free. If you medical provider accepts Medicare your only out of pocket costs would be for RX's
Most of that makes complete sense to me and thank you. I'm good with signing up as you say at 62 for coverage for age 65 as long as no premiums would be taken out. Most importantly I was interested in what I had previously read about the $600 premium offset and how that works. I'm still trying to understand why I would require Medicare if I was planning on staying on my FEHB plan for as long as possible? So far the only difference I see would be possible co-pay assistance with certain providers & all that Durable Medical Equipment available to Medicare members. Is their a solid argument why you need both coverages in Retirement, aside from the possible penalties which shouldn't apply to me at this time. Again great answers and I see this is asked quite a bit. I will be reading the 'Medicare & You' PDF in full to further educate myself

TheRealOrange  
#23 Posted : Thursday, August 1, 2019 2:58:02 AM(UTC)
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Originally Posted by: GSBS Go to Quoted Post
Originally Posted by: HoosierDaddy Go to Quoted Post
In your situation you won't be eligible for Medicare until you reach 65. If you sign up for social security at 62 then you will automatically be enrolled in Medicare when you reach 65 unless you opt out. Part A is free so you might as well get it. For part B you need to figure if it's cost effective for you. I believe BCBS standard waives some fees if Medicare is primary and you can sign up for their Medicare reimbursement account and get $600 every year toward your part B premiums. It might even be a good idea to switch to BCBS basic, between the $600 reimbursement and what you save in premiums it would be like getting part B for free. If you medical provider accepts Medicare your only out of pocket costs would be for RX's
Most of that makes complete sense to me and thank you. I'm good with signing up as you say at 62 for coverage for age 65 as long as no premiums would be taken out. Most importantly I was interested in what I had previously read about the $600 premium offset and how that works. I'm still trying to understand why I would require Medicare if I was planning on staying on my FEHB plan for as long as possible? So far the only difference I see would be possible co-pay assistance with certain providers & all that Durable Medical Equipment available to Medicare members. Is their a solid argument why you need both coverages in Retirement, aside from the possible penalties which shouldn't apply to me at this time. Again great answers and I see this is asked quite a bit. I will be reading the 'Medicare & You' PDF in full to further educate myself.

As already mentioned, since you will be signing up for Social Security benefits at age 62, you will be automatically enrolled in Medicare when you reach age 65, unless you opt out. My understanding is that you cannot opt out of Medicare Part A if you are receiving either Social Security retirement or disability benefits, and since it is free, that shouldn't be an issue. For you and most everyone else, the decision about whether to opt out of Part B to save the premiums will be a personal decision based on your unique circumstances. Many plans now offer incentives to stay in Part B, such as the BCBS Basic Option for members enrolled in Medicare Parts A and B. They are eligible to be reimbursed up to $600 per calendar year for their Medicare Part B premium payments. Assuming the standard Part B premium amount of $135.50 per month, the reimbursement essentially reduces the premium amount to $85.50 per month. If the Part B benefits received are worth that much or more, then staying in Part B would make sense. If not, then opting out would make sense. It is also my understanding that Medicare is the primary payer even if you have FEHB when you are an annuitant and you have Medicare.
teeeeej  
#24 Posted : Thursday, August 1, 2019 6:15:15 PM(UTC)
teeeeej

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Originally Posted by: TheRealOrange Go to Quoted Post
Originally Posted by: GSBS Go to Quoted Post
Originally Posted by: HoosierDaddy Go to Quoted Post
In your situation you won't be eligible for Medicare until you reach 65. If you sign up for social security at 62 then you will automatically be enrolled in Medicare when you reach 65 unless you opt out. Part A is free so you might as well get it. For part B you need to figure if it's cost effective for you. I believe BCBS standard waives some fees if Medicare is primary and you can sign up for their Medicare reimbursement account and get $600 every year toward your part B premiums. It might even be a good idea to switch to BCBS basic, between the $600 reimbursement and what you save in premiums it would be like getting part B for free. If you medical provider accepts Medicare your only out of pocket costs would be for RX's
Most of that makes complete sense to me and thank you. I'm good with signing up as you say at 62 for coverage for age 65 as long as no premiums would be taken out. Most importantly I was interested in what I had previously read about the $600 premium offset and how that works. I'm still trying to understand why I would require Medicare if I was planning on staying on my FEHB plan for as long as possible? So far the only difference I see would be possible co-pay assistance with certain providers & all that Durable Medical Equipment available to Medicare members. Is their a solid argument why you need both coverages in Retirement, aside from the possible penalties which shouldn't apply to me at this time. Again great answers and I see this is asked quite a bit. I will be reading the 'Medicare & You' PDF in full to further educate myself.

As already mentioned, since you will be signing up for Social Security benefits at age 62, you will be automatically enrolled in Medicare when you reach age 65, unless you opt out. My understanding is that you cannot opt out of Medicare Part A if you are receiving either Social Security retirement or disability benefits, and since it is free, that shouldn't be an issue. For you and most everyone else, the decision about whether to opt out of Part B to save the premiums will be a personal decision based on your unique circumstances. Many plans now offer incentives to stay in Part B, such as the BCBS Basic Option for members enrolled in Medicare Parts A and B. They are eligible to be reimbursed up to $600 per calendar year for their Medicare Part B premium payments. Assuming the standard Part B premium amount of $135.50 per month, the reimbursement essentially reduces the premium amount to $85.50 per month. If the Part B benefits received are worth that much or more, then staying in Part B would make sense. If not, then opting out would make sense. It is also my understanding that Medicare is the primary payer even if you have FEHB when you are an annuitant and you have Medicare.


Don't forget about Aetna Direct and MHBP Consumer Option. They also waive Medicare co-pays, coinsurance and deductibles. Aetna Direct gives you $900 per year that you can use towards part B premiums and MHBP gives you $1200....
GSBS  
#25 Posted : Friday, August 2, 2019 6:30:30 PM(UTC)
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Originally Posted by: TheRealOrange Go to Quoted Post
For you and most everyone else, the decision about whether to opt out of Part B to save the premiums will be a personal decision based on your unique circumstances. Many plans now offer incentives to stay in Part B, such as the BCBS Basic Option for members enrolled in Medicare Parts A and B. They are eligible to be reimbursed up to $600 per calendar year for their Medicare Part B premium payments. Assuming the standard Part B premium amount of $135.50 per month, the reimbursement essentially reduces the premium amount to $85.50 per month. If the Part B benefits received are worth that much or more, then staying in Part B would make sense. If not, then opting out would make sense. It is also my understanding that Medicare is the primary payer even if you have FEHB when you are an annuitant and you have Medicare.
Great answer, would BCBS Standard also offer this $600. I found this on the Federal News Network and it really seemed to answer the question presented in an easy to read format. Any thoughts on this?
===============================================================================================
"Medicare and FEHB – Do you need both?
By Stephen Zelcer
January 2, 2018
Federal employees age 65 and up are eligible to enroll in Medicare. Most feds are happy with their Federal Employee Health Benefits (FEHB) coverage and don’t feel any natural interest in Medicare. Medicare, however, demands enrollment and threatens non-subscribers with penalties. This forces feds into a position of having to choose whether they will enroll in Medicare just to spare themselves the penalty.

Let’s investigate these Medicare penalties to see if there truly is a penalty to be scared of.

Medicare penalties do not apply if you are still covered by “active employment coverage.” FEHB is considered active employment coverage while you are still employed with the federal government. (When you retire, FEHB is no longer “active employment coverage” but rather “annuitant coverage.”)

This point has a couple important ramifications:

Feds who are age 65, still at work and covered by FEHB will not be penalized for not taking Medicare. Medicare simply can’t threaten while covered by active employment coverage.
Even people who are retired, but still covered under FEHB (or an employer plan) through their working spouse are considered covered by active employment coverage, and are not penalized for not taking Medicare.
Medicare Part A does not have a late penalty. For most Americans Part A is free. Even if you enroll late, there is no penalty.


If Part A is free, why wouldn’t someone enroll in Part A immediately? What could possibly be wrong with FREE? As wonderful as FREE sounds, there is a drawback.

Part A will preclude enrollees from contributing to a Health Savings Account. HSA functions much like a flexible spending account, only offers more robust benefits, such as:

Higher contributions limits: $3,450 for those enrolled in a self-only health plan; $6,900 for those enrolled in Self Plus One or Family Plans (2018 limits);
$1,000 additional “catch-up” contribution is allowed for anyone over age 55;
No “use or lose;”
No account limits;
Account can be invested;
HSA money can be used to pay for a broader range of qualified expenses (including long term care insurance premiums, Medicare Part B premiums, non-prescription drugs and services); and
Access HSA money in retirement.
These benefits of an HSA cannot be overstated. They translate into thousands of dollars of savings on an annual basis. Because enrollment in Medicare (Part A or B) precludes participation in HSA, we shouldn’t necessarily rush to enroll in the free Part A coverage. Remember, late enrollment in Part A has no penalty.

Medicare penalties are only for LATE enrollment. Late enrollment, as opposed to NON-enrollment. If you NEVER enroll then you won’t need to pay the penalty!

This is the heart of the dilemma — will you ever enroll in Medicare B if you’re covered by FEHB?

Do you need both?

There are a couple of ways to answer this question:

Answer #1 —You don’t need both. Obviously every insurance plan is nuanced. Just as we find differences between each plan in FEHB, we will find some differences between FEHB and Medicare. However, to quote OPM “generally, plans under the FEHB program help pay for the same kinds of expenses as Medicare.”

In many cases FEHB proves to be more comprehensive, often including emergency care outside the U.S., as well as dental and vision, which Medicare does not cover. In fact, because FEHB offers a menu of plans, should you ever find your current coverage is inadequate, you will be able to switch to a more robust plan during an open season, even in retirement.

Since FEHB and Medicare coverage is generally the same, why should you pay for both?

Answer #2 —There’s a benefit to having both. While the above answer suggests that you don’t need both, there is a benefit to having both. Many FEHB plans have a special “coordination of benefits” with Medicare, where the FEHB plans pick up the secondary tab right away and waive their deductibles, co-pays and co-insurance. This coordination can result in no out-of-pocket costs to you.

So it turns out that an FEHB enrollee who pays for Medicare is essentially paying to have no out-of-pocket exposure.

Is that a smart thing to do? What would be your out-of-pocket exposure if you didn’t have Medicare?
Ultimately, the decision whether to have both FEHB and Medicare boils down to a comparison between the cost of Medicare and the out-of-pocket exposure you would have without Medicare.

Here are a couple of examples:

Example #1: A FEHB Self-Plus-One Plan has an out-of-pocket maximum exposure of $6,500. Medicare Part B premiums for a couple (based on their joint income) happens to cost just about $6,500. Is it worth spending $6,500 in Part B premiums just to avoid a potential $6,500 loss if a catastrophic event occurred? Most likely not.

Example #2: An FEHB Self-Plus-One-Plan has an out-of-pocket maximum exposure of $12,000. Medicare Part B premiums for a couple (based on their joint income) happens to cost about $3,000. Is it worth spending $3,000 in Part B premiums just to avoid a potential $12,000 loss if a catastrophic event occurred? This example highlights how each person may feel different about assuming the risk of their out-pocket-exposure. Some may not feel comfortable with such exposures, while others may reason that is they don’t have a catastrophic event for 4 years, they will have saved $12,000 of Part B premiums ($3,000 x 4 years = $12,000).

If we consider all the above points, we may discover that our FEHB coverage not only provides protection from the cost of illness, but also protects us from Medicare threats, too!"


https://federalnewsnetwo...d-fehb-do-you-need-both/



TheRealOrange  
#26 Posted : Monday, August 5, 2019 2:38:48 AM(UTC)
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Originally Posted by: GSBS Go to Quoted Post
Originally Posted by: TheRealOrange Go to Quoted Post
For you and most everyone else, the decision about whether to opt out of Part B to save the premiums will be a personal decision based on your unique circumstances. Many plans now offer incentives to stay in Part B, such as the BCBS Basic Option for members enrolled in Medicare Parts A and B. They are eligible to be reimbursed up to $600 per calendar year for their Medicare Part B premium payments. Assuming the standard Part B premium amount of $135.50 per month, the reimbursement essentially reduces the premium amount to $85.50 per month. If the Part B benefits received are worth that much or more, then staying in Part B would make sense. If not, then opting out would make sense. It is also my understanding that Medicare is the primary payer even if you have FEHB when you are an annuitant and you have Medicare.
Great answer, would BCBS Standard also offer this $600.

I don't think BCBS Standard qualifies for the $600 reimbursement for Medicare Part B:

HOWEVER, IF YOU DECIDE TO COMBINE YOUR COVERAGE WITH MEDICARE PART A AND B, YOU GET SOME GREAT ADDITIONAL BENEFITS, SUCH AS:

• We’ll waive your copays, coinsurance and deductibles for covered services for all three plans
• Basic Option members get access to the Mail Service Pharmacy and can get a $600 reimbursement for paying Medicare Part B premiums
• Standard and Basic Option members get reduced copays for certain prescription drug tiers

2019 MEDICARE AND BLUE
Blue Cross and Blue Shield Service Benefit Plan Summary
https://media.fepblue.or...s/2019_Medicare_Book.pdf
thanks 1 user thanked TheRealOrange for this useful post.
GSBS on 8/6/2019(UTC)
GSBS  
#27 Posted : Tuesday, August 6, 2019 10:02:01 AM(UTC)
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@TheRealOrange

That was really helpful, in fact, the most helpful thing I've read. Thank you!
TheRealOrange  
#28 Posted : Tuesday, August 6, 2019 10:18:34 AM(UTC)
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Originally Posted by: GSBS Go to Quoted Post
@TheRealOrange

That was really helpful, in fact, the most helpful thing I've read. Thank you!

You're very welcome and thanks for the kind note. I'm glad you found the information helpful.
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