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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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sport  
#1 Posted : Wednesday, April 8, 2020 3:50:59 PM(UTC)

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30 days away from 65. Retired from Feds in 2011. Kept FEBP with BCBS Basic. So...should I sign up for Part B and keep FEBP, or not get Part B since I have FEBP. Or drop FEBP and get Part B. Has anyone analyzed this? Pros cons? Thanks.
HoosierDaddy  
#2 Posted : Wednesday, April 8, 2020 6:33:53 PM(UTC)

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If I was in your situation I would keep FEHB and get part b. With Medicare as your primary insurance and BCBS basic secondary and you stay in network your only out of pocket costs would be RX co-pays and you can lower those because you would have access to the mail order pharmacy. Also with BCBS basic you can sign up for a medicare reimbursement account and get reimbursed for $800 a year of your part b premiums. Also I believe that if you don't sign up for part b when you are first eligible you pay a penalty if you decide sign up later.
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sport  
#3 Posted : Thursday, April 9, 2020 7:55:27 AM(UTC)

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Thanks much.
teeeeej  
#4 Posted : Tuesday, May 26, 2020 8:31:05 PM(UTC)
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My understanding is that Aetna Direct is the most lucrative FEHB option to have with Medicare.

The HalfBreed  
#5 Posted : Monday, August 31, 2020 9:14:39 AM(UTC)

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Please take note that HoosierDaddy said "BCBS BASIC". I kept the BCBS Standard for my own personal reasons.

I just applied for Medicare and took pt B. There's a 7 month window to apply. Your birth month, Plus or Minus 3 months.
If you're still working at that time, you'd have to ask medicare folks. 1-800-MEDICARE (1-800-633-4227) I don't think you'll be required, but double check.
For every 12 months you delay pt B if you can get it at age 65, there's a PERMANENT 10% penalty that will never go away. 24 months = 20%, etc.
Currently, pt B is ~ $144/month but there's IRMAA which forces higher paid retirees to pay more. I was pushed up to $202.40 per month, and I'm single.

I'd keep BCBS, or whatever you chose. It's technically not a "Supplement" (think AARP plan) like many many being sold on the secondary market, but it's more like Secondary Ins.
If Medicare does not pay for XYZ services, you're BCBS will pay for it as they have during your working career as I'm told. You also get the benefit of prescription drugs.
You'd have to sign up for pt D and pay for it if you want prescription drug insurance.

There are others who use AETNA, etc that also get the reimbursement from pt B, according to them.
Also note that, there are certain pitfalls to be aware of, in that BCBS Basic may not cover you're Dr if they're not in the BCBS type listing.
Some have also said it's not usable outside of the USA, but I don't know about that personally.

Edited by user Monday, August 31, 2020 9:17:01 AM(UTC)  | Reason: IRMAA info

RETIRED CSRS 12/19/2012 @ age 57 w/39 years.
Good Bye Tension...Hello Pension !
GSBS  
#6 Posted : Wednesday, September 2, 2020 2:25:57 PM(UTC)
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Originally Posted by: HoosierDaddy Go to Quoted Post
If I was in your situation I would keep FEHB and get part b. With Medicare as your primary insurance and BCBS basic secondary and you stay in network your only out of pocket costs would be RX co-pays and you can lower those because you would have access to the mail order pharmacy. Also with BCBS basic you can sign up for a medicare reimbursement account and get reimbursed for $800 a year of your part b premiums. Also I believe that if you don't sign up for part b when you are first eligible you pay a penalty if you decide sign up later.


I see much lower Prescription prices at a Retail store then I would by mail? Why do I maintain the 'Cadillac' of BCBS Plans, why would I want duplicate coverage at a higher overall price? BCBS suggests everyone to take Medicare when eligible to keep Plan costs low, lower for whom? I've read the FEHB plan can be worth it's weight in Gold in retirement. Reg Jones, former OPM Benefits Director says this if I'm reading it correctly:

"So, what are you to do? The consensus of opinion among the experts is that most Medicare-eligible federal retirees only need their FEHB enrollment and premium-free Part A. That’s because this combination of coverage will give them the greatest protection for the least amount of money. Only those with specific needs covered by Part B need to enroll in that. And even fewer need Part D."

https://www.fedweek.com/...need-fehb-in-retirement/



https://www.opm.gov/heal...stfacts/fehbmedicare.pdf

Edited by user Wednesday, September 2, 2020 2:28:39 PM(UTC)  | Reason: .

OUtside  
#7 Posted : Thursday, September 3, 2020 8:51:56 PM(UTC)

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Plan costs kept low when fehb retiree has Part B, why? The answer is Medicare pays about 80% of medical care for Part B services, leaving the plan to pay only 20%. Without Part B, the Plan likely pays much higher than 20% for the same services (bc Medicare is not paying anything).

In the recent thread which asked has the cost of Part B been worth it to you?, Walt Francis is quoted saying having both insurances overall is extra costly (to the entire healthcare system) as likely having to cover 'unnecessary care.' I think the point here is, if the retiree is not required to pay a copay, he/she is more apt to obtain services, so the person possibly consumes more. If, on occasion, services aren't required or are counterproductive, for example, if mistakes occur, the services are yet more expensive (for the entire healthcare system). If memory services, the amount of extra cost was estimated to be 2 billion a year or so, in that thread.

Edited by user Friday, September 4, 2020 4:29:37 PM(UTC)  | Reason: Clarification

ex-military  
#8 Posted : Wednesday, September 9, 2020 4:24:53 AM(UTC)
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Originally Posted by: GSBS Go to Quoted Post
Originally Posted by: HoosierDaddy Go to Quoted Post
If I was in your situation I would keep FEHB and get part b. With Medicare as your primary insurance and BCBS basic secondary and you stay in network your only out of pocket costs would be RX co-pays and you can lower those because you would have access to the mail order pharmacy. Also with BCBS basic you can sign up for a medicare reimbursement account and get reimbursed for $800 a year of your part b premiums. Also I believe that if you don't sign up for part b when you are first eligible you pay a penalty if you decide sign up later.


I see much lower Prescription prices at a Retail store then I would by mail? Why do I maintain the 'Cadillac' of BCBS Plans, why would I want duplicate coverage at a higher overall price? BCBS suggests everyone to take Medicare when eligible to keep Plan costs low, lower for whom? I've read the FEHB plan can be worth it's weight in Gold in retirement. Reg Jones, former OPM Benefits Director says this if I'm reading it correctly:


Those drug prices are entirely dependent on WHAT you are taking. My wife and I take numerous RXs daily. Some are a better deal to go retail. Others are leaps and bounds cheaper to go Mail Order. One RX in particular would set me back over $70 for a 30 day supply at the Retail , but I can get it through the Mail Pharmacy for $15 for 90 day supply. Not a tough choice.
Guts  
#9 Posted : Friday, October 16, 2020 1:09:41 PM(UTC)

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Originally Posted by: OUtside Go to Quoted Post
Plan costs kept low when fehb retiree has Part B, why? The answer is Medicare pays about 80% of medical care for Part B services, leaving the plan to pay only 20%. Without Part B, the Plan likely pays much higher than 20% for the same services (bc Medicare is not paying anything).

In the recent thread which asked has the cost of Part B been worth it to you?, Walt Francis is quoted saying having both insurances overall is extra costly (to the entire healthcare system) as likely having to cover 'unnecessary care.' I think the point here is, if the retiree is not required to pay a copay, he/she is more apt to obtain services, so the person possibly consumes more. If, on occasion, services aren't required or are counterproductive, for example, if mistakes occur, the services are yet more expensive (for the entire healthcare system). If memory services, the amount of extra cost was estimated to be 2 billion a year or so, in that thread.


Is there a future FEHB Medicare Advantage Plan in the works?
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kgkistari  
#10 Posted : Sunday, October 18, 2020 4:20:14 PM(UTC)
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We have Medicare A & B along with Blue Cross Blue Shield Basic. We've had zero out of pocket expenses except for medication copays. Considering both my husband and I have had unexpected medical situations come up, I'm very happy with them. Not to mention, the $800 rebate we each received.
brooker242  
#11 Posted : Wednesday, October 21, 2020 4:55:33 AM(UTC)
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Should Federal Annuitants Enroll in Medicare Part B after Age 65? Medicare Part B will rarely save you nearly as much money as you spend on the Part B premium. This is because the cost sharing for physician visits and tests in almost all FEHB plans is already so low. And as we discuss below, for those who pay more for Part B than the normal premium, it is almost always a bad buy in purely financial terms.

As a financial matter, however many years you elect to do without Part B, you will be money ahead for approximately the first five or six years after joining or rejoining (those who start out paying the higher income-tested premium well be much more money ahead). After that, the penalty will outweigh your earlier savings (except for those who were once above, but now fall below, the income-tested premium).


https://www.checkbook.or...care-part-b-after-age-65

Edited by user Wednesday, October 21, 2020 6:07:17 AM(UTC)  | Reason: Not specified

OUtside  
#12 Posted : Wednesday, October 21, 2020 1:53:16 PM(UTC)

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broker242's information above is somewhat dated, for a more up to date summary, see the thread at this web site entitled Has the Cost of Medicare Part B been worth it to you?
teeeeej  
#13 Posted : Friday, October 30, 2020 6:41:55 PM(UTC)
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The problem with using BCBS Basic with Medicare is that it covers nothing out of network. What if youare traveling and the local hospital isn't in network? Is it worth the risk?

GEHA Standard, GEHA High, and Aetna Direct provide the same coverage in and out of network which makes it more like a Medigap plan, but better because it covers some things that Medicare doesn't cover. BCBS Standard is probably overkill with Medicare unless you benefit from their formulary over the other options.
The HalfBreed  
#14 Posted : Friday, October 30, 2020 10:21:32 PM(UTC)

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I'm a member of the Face Book group of retired FAA employees, and this has been brought up many times in the last year.
(I retired in 2012 @ age 57, but just applied for Medicare back in Jan 2020, coz I turned 65 in April 2020)

I've seen good posts, and other posts where folks were happy with their decisions, until it proved fatal. Like one poster above mentioned.
A Few folks on FB went overseas and wound up with NO insurance, others negotiated lower prices because the Dr, Hospitals (over there AND Here) etc did not accept Medicare Pricing.

Others have had $750,000 PLUS medical expenses and wound up paying NOTHING, out of pocket.
Save a few hundred bucks....take your chance at the wheel of misfortune...Good Luck, as it's a personal choice and totally up to you.

I'm fortunate to have a great CSRS retirement and have no issue paying for A, B and FEHB. IRMAA kicked me (single, just turned 65) into the $202.40 / month Part B category.
But, that's OK.

My Motto ? It's better to have it and not need it, than to need it and not have it. Your mileage may vary.

Before I depart site, I'd also like to point out that FEHB is not "Supplementary" insurance as some may suggest. It's SECONDARY Insurance.

The key difference is that, if Medicare does not, or will not cover it....FEHB WILL....just like when you were working. Look it up.

Things that should make you go Hmmmmmmm. Good Luck,Stay Safe all.
RETIRED CSRS 12/19/2012 @ age 57 w/39 years.
Good Bye Tension...Hello Pension !
Hired 2015  
#15 Posted : Saturday, October 31, 2020 4:58:05 AM(UTC)
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My spouse turned 65, I am still working and we have FEHB BCBS basic. We did alot of research and elected not to take medicare part b because we will continue FEHB coverage.

There are many prescription discount plans in our area that are cheaper than FEHB BCBS prescription rates. One prescription we have is $18 under FEHB BCBS plan and is $3 with a local store discount card plan. Our durable medical equipment costs under the FEHB BCBS were just so high we were forced to look for other options. We are paying far less with a cash discount option now. The copays for doctors visits with FEHB BCBS are just too costly. We get nailed for a copay to have blood drawn that cost more than if we go with a hospital lab discount card program to pay cash.

We are finding we have to look at the costs to make choices when FEHB or other local programs result in lower prices. Due to Covid the pharmacy mail order options we found were more gimmick. In several cases the pharmacies never submitted the prescriptions to FEHB BCBS and we paid full price.

Its buyer beware in healthcare where you need to put in the time to research, ask about optional discount programs. For 2021 FEHB we are going to look at major medical coverage only to patch together other discount programs to get by until I retire. Frankly having FEHB we have run into providers that resent we are federal workers where we caught overbillings. We are far more cautious where we go for healthcare and less likely to use FEHB if we can avoid it.



OUtside  
#16 Posted : Saturday, October 31, 2020 3:23:42 PM(UTC)

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To teeeej's question, ' What if youare traveling and the local hospital isn't in network? Is it worth the risk?, it's true that BC Basic requires using preferred providers in almost all instances, but one of the exceptions is for emergency care. So if while travelling you require emergency hospital care, you should be ok. One reason I say that is, hospital bills are usually big bills, so I think if retired travelling feds with BC Basic got stuck with big expenses, we would have heard about it over the years sometime, like probably in these forum discussions.

It's true with BC Basic a subscriber has to keep the preferred provider point in mind. For example, we have heard discussions on this forum where the subscriber had lab specimen taken by his/her doctor who then sent the specimen to the lab. Subscriber asked dr (but not lab) is lab preferred provider? Doctor said yes but was incorrect. Subscriber got stuck with bill for going out of network.

To Hired 2015, it sounds as if at least some of your issues with BC Basic is you used providers who are not preferred providers. For example, the lab work you mentioned, if you had used a preferred provider, the plan would have required no copay (which would have certainly been less expensive than a hospital lab discount unless the discount was 100%). Also, if the pharmacy you used did not submit to to Blue Cross, how could a preferred pharmacy even think about doing that?, they would be under contract to do just the opposite.

Edited by user Sunday, November 1, 2020 9:44:18 AM(UTC)  | Reason: Not specified

Sante123  
#17 Posted : Monday, November 2, 2020 8:14:20 PM(UTC)
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Originally Posted by: Guts Go to Quoted Post

Is there a future FEHB Medicare Advantage Plan in the works?


Check out the upgraded Aetna Federal Medicare Advantage Plan for 2021. They’ve added up to $1800 in Medicare Part B premium rebates to a plan that has VERY low monthly premiums, low RX costs, and essentially no other copays, coinsurance or deductibles. It also manages to keep Rx copays from rising during the ““donut hole” stage of prescription benefits. And it has extra freebies common to other Medicare Advantage plans. Best yet, it’s part of FEHB, so you don’t have to suspend FEHB coverage prior to signing up. Last week, Aetna’s VP for federal health plans explained it all on Federal News Network’s “ For Your Benefit” show.

Edited by user Friday, November 6, 2020 9:11:18 PM(UTC)  | Reason: To replace “premiums” with “copays”.

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