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Sante123  
#1 Posted : Sunday, November 15, 2020 10:18:14 AM(UTC)
Sante123

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This somewhat confusing under-the-radar plan for Medicare A+B enrollees was new for 2020 but has been substantially improved for 2021. It now features a Medicare premium rebate of up to $1800 ($900 for Self Only) that gets automatically added to your Social Security check at a rate of $75 per month. No need to file reimbursement claims. No deductibles, coinsurance or copays except for drugs, and Rx copays are really low. The plan works the same for any provider who accepts Medicare, whether in or out of network. It’s a nationwide plan that also pays benefits for overseas urgent and emergency care. It’s both a FEHB plan AND a Medicare Advantage Plan. No need to suspend FEHB to enroll. It has all the extra freebies that Advantage plans have but Original Medicare doesn’t. What’s more, it protects you against the “donut hole” shift in RX prices that regular Advantage plans suffer from. There is only one payer, this plan, which means that you use only one insurance card (the plan’s) and get only only one claim statement (the plan’s). No need to show providers your Medicare card and no waiting for both an MSN and an EOB. The plan premiums are also amazingly low, even better than Aetna Direct.

So, what’s the catch? No catch really, but some things are not what you’d expect. First, sign up is a two-step process. Step one is you sign up as usual for the ordinary Aetna Advantage FEHB plan. Step two is you wait 7-10 business days and then for each adult enrollee you provide Aetna with the respective Medicare Part A+B ID number(s) and initial date(s) of Medicare coverage. Afterwards, you get a special Aetna Medicare Advantage card which replaces the generic Advantage Plan card that they first send you after step one is completed. What else? Well, the Aetna Advantage plan is very different (in a bad way) if you (and any covered spouse/partner) are not enrolled in Medicare Parts A+B or have not completed step two above. The official brochure has only one set of enrollment codes regardless of your Medicare status. But very importantly, It is the completion of step two that transforms the plan from a so-so FEHB plan into a supercharged hybrid FEHB/Medicare Advantage plan. Most of the official brochure is devoted to explaining the coverage and benefits for non-Medicare enrollees. Only a few pages are devoted to what happens if you have Parts A+B and complete step two of the sign up process. To get more specific details about the Medicare Advantage option under this plan, you need to consult a separate Aetna document that lays it all out. To make things easy, I am attaching links to the generic plan brochure, the Aetna Medicare Advantage plan guide, and Aetna’s plan overview page. In my opinion, this plan is well worth checking out.

2021 Plan Brochure
Aetna Medicare Advantage Plan Guide
Aetna Plans Overview for Medicare Enrollees
FlowerGirl  
#2 Posted : Monday, November 16, 2020 9:36:40 AM(UTC)

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I’ve been researching this plan all weekend. I spoke with Aetna today in order to resolve some concerns I had. Everything was answered to my satisfaction. I asked the agent what the differences are between this plan and Aetna Direct, which I currently have. I was told there are two differences: with Aetna Advantage Aetna is the primary payer; with the Direct plan Medicare is the primary. The other difference is the prescription benefits.

In order to get the $75 a month benefit to help pay for Medicare Part B, their brochure states on page 92 that your Social Security check will be credited each month for $75. That doesn’t help me since I don’t have Social Security benefits. My payments for Part B come out of my annuity check from OPM. I inquired about that and the agent seemed to think it works the same way; my annuity check will be credited. I’m going to call again later this afternoon to see what the next agent has to say about this.

Well, I’ve been on the phone most of the day to get an answer to the $75 reimbursement conundrum. I talked to OPM, per Aetna; Aetna per OPM; Medicare per Aetna. The fourth and last agent at Aetna really did try her best. Her suggestion was that perhaps I should call back at the end of the week when, maybe, they will have an answer. Maybe.

Edited by user Monday, November 16, 2020 2:27:01 PM(UTC)  | Reason: Not specified

Sante123  
#3 Posted : Tuesday, November 17, 2020 12:51:44 PM(UTC)
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With its latest update issued today, the Checkbook Guide for FEHB health plans now lists this Aetna Medicare Advantage plan as the top rated plan in the country for Medicare A&B enrollees, everywhere except Washington, DC and its suburbs. In that area, Aetna Medicare Advantage is #2. So there you have it. I guess from now on it will no longer be the best plan that no one has ever heard of.
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FlowerGirl on 11/18/2020(UTC)
FlowerGirl  
#4 Posted : Tuesday, November 17, 2020 5:58:29 PM(UTC)

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So, which plan is rated #1 in Washington, DC, and its suburbs?
fedspouse  
#5 Posted : Tuesday, November 17, 2020 7:15:06 PM(UTC)

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We have had Aetna Direct for the past few years. This plan sounds better but am trying to figure out why it is less expensive. What is missing that Aetna Direct covers? Can you go to any doctor who accepts Medicare?

I too want to know what is rated #1!
Sante123  
#6 Posted : Tuesday, November 17, 2020 7:25:49 PM(UTC)
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Originally Posted by: FlowerGirl Go to Quoted Post
So, which plan is rated #1 in Washington, DC, and its suburbs?


Your question forced me to log in to the Checkbook Guide one more time for a look see. The last time I did was earlier today. At that time, the Aetna Medicare Advantage plan was #2 in the greater DC area and #1 pretty much everywhere else. Its placement at that time reflected an update which the folks at Checkbook Guide undertook this morning to give a clearer picture re: the nuances of the Medicare Advantage plans. Well, to my surprise, it looks like they sharpened their pencils once again. Now, Aetna Medicare Advantage nationwide is #2 by a whisker behind the Medicare Advantage option under the United Advantage plan.

As for the greater DC area, the Guide now lists four plans ahead of the Aetna Medicare Advantage plan: United Choice Plus Advanced, United Choice Primary, United Choice Plus Primary, and United Advantage (in that order.) They are all the Medicare Advantage versions of those plans.

As I indicated in my earlier post, the Medicare Advantage option under FEHB plans that offer one shares the same plan code as the non-Medicare Advantage version of the same plan. That presents a challenge for most folks to understand what’s involved. I suppose many will get confused and move on to easier-to-understand choices. If so, that would be similar to what happened when high deductible plans were first introduced. However, then as now, it would be a mistake to skip over plans just because they are new and unfamiliar. It pays to do your homework. Especially this time around.

FWIW: The results mentioned above are based using a worst case profile of a retired Self + One couple with high expenses, where both have enrolled in Medicare Parts A+B.

Edited by user Tuesday, November 17, 2020 7:42:08 PM(UTC)  | Reason: assorted edits added for greater clarity

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FlowerGirl on 11/18/2020(UTC)
teeeeej  
#7 Posted : Tuesday, November 17, 2020 8:27:11 PM(UTC)
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The UHC Advantage is probably going to be competitive with the Aetna.

https://uhcvirtualretire...hbmvp/how-the-plan-works
Sante123  
#8 Posted : Wednesday, November 18, 2020 8:12:51 AM(UTC)
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Originally Posted by: fedspouse Go to Quoted Post
We have had Aetna Direct for the past few years. This plan sounds better but am trying to figure out why it is less expensive. What is missing that Aetna Direct covers? Can you go to any doctor who accepts Medicare?


Most of the Medicare Advantage options are new to the FEHB universe, so it’s difficult to figure out why they are less expensive. However, in the commercial market, advantage plans have proven to be cheaper than Original Medicare, while also offering extra benefits that Original Medicare does not.

The question is not what Aetna Medicare Advantage is missing, but what Aetna Direct is missing. The former seems to have better Rx benefits, better SNF benefits and better freebies like Silver Sneakers gym memberships, free transportation to/from doctor visits, free meals delivered after a hospital stay, etc., etc.

Yes, you can go to any provider that accepts Medicare assignment. Benefits are the same in or out of network (essentially zero cost for everything except drugs). In my area, none of the local hospital systems or their physicians were listed as being in their network. But when I called the providers, they all said they would accept Aetna Medicare Advantage. To them, the reimbursement rate is the same either way because everything is governed by Medicare rules.

If you’d like to hear things directly, the Aetna VP for federal plans was recently on the “For Your Benefit” show on Federal News Network. The way he talked about it, you get the impression that they believe Aetna Medicare Advantage is “new and improved” when compared to Aetna Direct. Here is the link :

Aetna VP Appearance on “For Your Benefit” program

Edited by user Wednesday, November 18, 2020 8:14:17 AM(UTC)  | Reason: fix a typo

fedspouse  
#9 Posted : Wednesday, November 18, 2020 12:59:03 PM(UTC)

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Santee123 - Thank you so much for your detailed reply. I just finished listening to the link you provided. He didn't go into detail the differences between Aetna Direct and the Aetna Advantage other than the way they are set up (one is a supplement to Medicare and the other is really an Advantage plan in that it replaces Medicare and has enhanced benefits and features.

I also listened to Mike Causey today who had Walton Francis on his show Your Turn. Not much new info. He will be back again next Wednesday. We are Narfe members so I went to their website and see that tomorrow afternoon Tammy Flanigan is doing a webinar about FEHB and Medicare Parts A & B. I signed up for that.

Most likely this research will be a head start for next year because we currently are in Aetna Direct and we still have $1086 in the health fund (I have another health fund through my former employer that I can only use for Part B premiums reimbursement so I have gone back and forth between them and Aetna. Sadly my other fund won't let me use it to reimburse the monthly FEHB premium because, even though it is self + 1, it is taken out of husband's annuity and not mine. I'm guessing, but will have to check, that Aetna won't transfer our remaining fund balance from Aetna Direct to Aetna Advantage.

Edited by user Wednesday, November 18, 2020 1:00:46 PM(UTC)  | Reason: Not specified

OUtside  
#10 Posted : Wednesday, November 18, 2020 4:02:32 PM(UTC)

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I'm sure no one, including me, wants to turn this thread into a 'Should I enroll in Part B?' discussion, but if the plan is paying a big chunk of the Part B premium, why are the Checkbook estimates way lower (self + 1, high expenses) for subscribers with Part A only?

Edited by user Wednesday, November 18, 2020 4:03:26 PM(UTC)  | Reason: Correct typo

Sante123  
#11 Posted : Wednesday, November 18, 2020 4:41:03 PM(UTC)
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@OUTside:

Because the folks at Checkbook Guide forgot that you can’t enroll in a Medicare Advantage plan at all unless you have signed up for both Parts A and B. So that comparison is inaccurate.
teeeeej  
#12 Posted : Wednesday, November 18, 2020 8:32:08 PM(UTC)
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Quote:

Most of the Medicare Advantage options are new to the FEHB universe, so it’s difficult to figure out why they are less expensive.


I think it is less liability for the insurance company. The Advantage plans pay nothing if Medicare assignment isn't accepted.
Sante123  
#13 Posted : Wednesday, November 18, 2020 9:17:55 PM(UTC)
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Originally Posted by: teeeeej Go to Quoted Post
Quote:

Most of the Medicare Advantage options are new to the FEHB universe, so it’s difficult to figure out why they are less expensive.


I think it is less liability for the insurance company. The Advantage plans pay nothing if Medicare assignment isn't accepted.


In all fairness, there is no way to know whether that will be much of a factor. First, most FEHB Medicare Advantage option plans are new for 2021. So they have never paid a claim yet and so are guesstimating what their cost profile will be. Second, over 90% of all providers accept Medicare assignment, and folks in such plans would logically avoid providers that don’t participate. Third, Blue Cross Basic is far more restrictive. It pays zero benefits both to non-participating providers and to participating providers who are not “preferred”. If your analysis were true, that should make their premiums cheap. Yet, BCBS Basic premiums are 50% higher than Aetna Medicare Advantage. That’s because folks who want to use non-preferred providers would be foolish to sign up for a plan that offers zero coverage for those who do. So, there are no material “savings” for that plan. And I’d bet the same is true for the Medicare Advantage plans.
teeeeej  
#14 Posted : Thursday, November 19, 2020 6:51:41 AM(UTC)
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Originally Posted by: Sante123 Go to Quoted Post
Originally Posted by: teeeeej Go to Quoted Post
Quote:

Most of the Medicare Advantage options are new to the FEHB universe, so it’s difficult to figure out why they are less expensive.


I think it is less liability for the insurance company. The Advantage plans pay nothing if Medicare assignment isn't accepted.


In all fairness, there is no way to know whether that will be much of a factor. First, most FEHB Medicare Advantage option plans are new for 2021. So they have never paid a claim yet and so are guesstimating what their cost profile will be. Second, over 90% of all providers accept Medicare assignment, and folks in such plans would logically avoid providers that don’t participate. Third, Blue Cross Basic is far more restrictive. It pays zero benefits both to non-participating providers and to participating providers who are not “preferred”. If your analysis were true, that should make their premiums cheap. Yet, BCBS Basic premiums are 50% higher than Aetna Medicare Advantage. That’s because folks who want to use non-preferred providers would be foolish to sign up for a plan that offers zero coverage for those who do. So, there are no material “savings” for that plan. And I’d bet the same is true for the Medicare Advantage plans.


That's why BCBS Basic is probably a poor choice for people on Medicare. Aetna Direct, GEHA Standard and GEHA High are better optinons as secondary insurance plans because they don't care about networks and they cover things that Medicare doesn't.

Medicare has three types of providers:

Participating providers: Accept Medicare and always take assignment. The provider must accept payments provided by Medicare and can only bill patients for Medicare defined deductibles, co-payments and co-insurance.
Non-participating providers: Accept Medicare but do not agree to take assignment in all cases. When they do not accept assignment they are limited to "excess charges" and not "balance" billing. Excess charges are limited to 15% of 95% of Medicare allowed charges. Some states limit this to 5% or even do not allow any excess charges. Whether the secondary insurance covers this or not probably depends on what it says in the brochure.
Opt-out providers: Do not accept Medicare and must require a signed private contract except for "emergency care services. You are responsible for the full amount of a private contract bill. Medicare will not pay anything and since Medicare will not pay anything, the Aetna Medicare Advantage will also not pay anything.
freeageless  
#15 Posted : Thursday, November 19, 2020 12:02:55 PM(UTC)
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I would not take Aetna Medicare Advantage Plan. I have Medicare Parts A and B as primary insurance and GEHA Standard as secondary insurance. GEHA pays more for certain procedures that Medicare does not cover. For example recently I had a physical exam with tests that cost about six hundred dollars. Medicare paid about 150 dollars and GEHA paid about 300 dollars. The internist is a participating provider with Medicare. GEHA paid far more than Medicare did. In addition, I have had to have numerous CT scans MRI's and Bypass surgery. I have never had to have pre-certification for any procedures. With Aetna I called them and they said I would have to have all of that pre-certified. I have been to Europe. On a couple times I have to go to the doctor. Medicare paid nothing-and GEHA, picked up most of the cost. Per Aetna if I had their Advantage plan, they would have paid nothing. I would not change or take the Medicare Advantage Plan. The devil is in the details-and there are plenty of devils in that Aetna Advantage Plan. I would advise people to consider the Aetna Direct Plan, GEHA or other plains where Medicare is primary.
Sante123  
#16 Posted : Friday, November 20, 2020 9:26:32 AM(UTC)
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Originally Posted by: freeageless Go to Quoted Post
I would not take Aetna Medicare Advantage Plan. I have Medicare Parts A and B as primary insurance and GEHA Standard as secondary insurance. GEHA pays more for certain procedures that Medicare does not cover. For example recently I had a physical exam with tests that cost about six hundred dollars. Medicare paid about 150 dollars and GEHA paid about 300 dollars. The internist is a participating provider with Medicare. GEHA paid far more than Medicare did. In addition, I have had to have numerous CT scans MRI's and Bypass surgery. I have never had to have pre-certification for any procedures. With Aetna I called them and they said I would have to have all of that pre-certified. I have been to Europe. On a couple times I have to go to the doctor. Medicare paid nothing-and GEHA, picked up most of the cost. Per Aetna if I had their Advantage plan, they would have paid nothing. I would not change or take the Medicare Advantage Plan. The devil is in the details-and there are plenty of devils in that Aetna Advantage Plan. I would advise people to consider the Aetna Direct Plan, GEHA or other plains where Medicare is primary.


As you may recall, I also had GEHA Standard for many years, and found it to be a very good and reliable plan, especially when it was coupled with Medicare Parts A+B. Like most plans, it requires pre-certification for all the things you mentioned, plus a lot more. But not when it is secondary to Medicare Parts A+B. Even still, when providers do the pre-cert contacts (whether out of habit or because they are required to), the patient often plays no role and may not even know the providers performed that function in the background. And yes, its wrap-around feature and secondary status allows GEHA to often pay whatever portion of the Medicare allowed charge that Medicare does not. This Aetna plan is primary for all medical claims, so it requires pre-certification for a number of services, just like GEHA does when it is primary. One has to consider the whole mix of pluses/minuses and make your own value decision.

But beware of making straight comparisons between Original Medicare and the FEHB Medicare Advantage plans. First, all Medicare Advantage plans, even the commercial ones, pay for things that Original Medicare does not. Second, the FEHB versions of the Medicare Advantage plans are government subsidized and enjoy higher combined premiums (Part B + total FEHB premiums) than the commercial plans, so they can be more generous in their coverage, e.g. their enhanced donut hole Rx coverage. Third, Aetna Medicare Advantage pays (via reimbursement) for both urgent and emergency overseas care at zero cost regardless of network. But not routine care. Original Medicare offers no overseas benefits at all. If an Aetna rep told you that this plan does not pay for overseas charges, they were mistaken. It’s right in their plan description, which I provided in my first post. However, if your overseas procedures were neither emergency nor urgent care, then it is correct that they would not have been covered.

There are lots of choices in the FEHB. To each his/her own.
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freeageless on 11/20/2020(UTC)
freeageless  
#17 Posted : Friday, November 20, 2020 10:48:45 AM(UTC)
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Sante,
Thank you for your very well thought out response. If you don't mind me asking: if you are a federal retiree, which one have you chosen, or which one you choose?
Thanks
Sante123  
#18 Posted : Friday, November 20, 2020 12:54:28 PM(UTC)
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Originally Posted by: freeageless Go to Quoted Post
Sante,
Thank you for your very well thought out response. If you don't mind me asking: if you are a federal retiree, which one have you chosen, or which one you choose?
Thanks


I chose Aetna Medicare Advantage, and have already completed both steps for enrollment.
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freeageless on 11/20/2020(UTC), FlowerGirl on 11/20/2020(UTC)
jagfan  
#19 Posted : Saturday, November 21, 2020 10:59:32 AM(UTC)

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The Aetna Medicare Advantage plan sounds interesting. In my situation, however, I'm not sure it would be a good fit. I use Mayo Clinic in Florida for all medical care, primary and specialty. Upon reviewing the types of insurance accepted at the clinic, Medicare Advantage plans are mentioned but it is unclear whether any are currently under contract. Their list of contracted plans does not include any Medicare Advantage plans, however, the list is always being updated and a phone call could be made to confirm. I don't want to take any chances, so I will stay with Aetna Direct.
teeeeej  
#20 Posted : Saturday, November 21, 2020 11:35:22 AM(UTC)
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The nice part about the FEHB Medicare Advantage plans is you can always change the next open season if it is not working out. So, if you feel you need more robust coverage than what the Advantage provides, there's not much hassle to change.

If you did not have retiree health insurance and picked a private medicare advantage plan, you would not be able to switch to the more robust Medicare supplement (medigap) plans without underwriting.
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