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Bob Loblaw  
#61 Posted : Sunday, November 28, 2021 1:06:45 PM(UTC)
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Wyre, here’s the summary of benefits for the United Retiree Advantage plan. I’ve already signed up for it.
https://uhcvirtualretire...of%20Benefits%202022.pdf
fedspouse  
#62 Posted : Sunday, November 28, 2021 6:11:04 PM(UTC)

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I took advantage of the option to have someone call me. I asked this question and was told that yes there would be an uncharge of IRMAA if you are subject to it. Right now we are not but I do foresee that happening in a year once RMDs happen.
sandhill  
#63 Posted : Tuesday, November 30, 2021 1:29:21 PM(UTC)
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So all of this is giving me pause ... I signed up for Aetna MA but have found now that they do not cover the hypothyroid drug I have taken for years. I'm not thrilled with the idea of paying for it out of pocket, especially if I'm going to have to pay an upcharge via IRMMA.

I may need to switch back to my old plan (APWU/Cigna) and Medicare Part B.
sandhill  
#64 Posted : Wednesday, December 1, 2021 9:06:25 AM(UTC)
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So I've now made about 6 phone calls including being transferred between different parties and no one at Aetna seems to be able to tell me about coverage for the drugs I take. Anyone have any suggestions to find definitive answers? I found that even though my drugs are not on my existing plan's formulary (even for this year) they have been covered so I'm not sure what to think. But again, at this point, I'm figuring it's probably safer to stay with the plan I know, especially since I sometimes travel out of the country for several months at a time and would not want my coverage to be limited to only significant emergencies.
Sante123  
#65 Posted : Wednesday, December 1, 2021 10:13:31 AM(UTC)
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Originally Posted by: sandhill Go to Quoted Post
So I've now made about 6 phone calls including being transferred between different parties and no one at Aetna seems to be able to tell me about coverage for the drugs I take. Anyone have any suggestions to find definitive answers? I found that even though my drugs are not on my existing plan's formulary (even for this year) they have been covered so I'm not sure what to think. But again, at this point, I'm figuring it's probably safer to stay with the plan I know, especially since I sometimes travel out of the country for several months at a time and would not want my coverage to be limited to only significant emergencies.


Here is the 2022 drug list. Perhaps your Rx is included there.

https://www.aetnafeds.co...RMULARY_OPEN2_PLUS_5.pdf

Sante123  
#66 Posted : Wednesday, December 1, 2021 10:15:18 AM(UTC)
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And BTW, the plan covers both emergencies and urgent care overseas. Only routine care is excluded.
sandhill  
#67 Posted : Wednesday, December 1, 2021 11:47:25 AM(UTC)
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Thanks for the listing. It says the drug is Tier 4, non-preferred brand drug. Oh well ... I tried switching to a generic years ago and it didn't work.
fedspouse  
#68 Posted : Tuesday, December 14, 2021 5:26:17 AM(UTC)

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I know open season just ended. We stuck with Aetna Direct because we did have a few unanswered questions. I know with this plan you can go "out of network". Basically does that mean we can go to ANY doctor that accepts Medicare assignment? My PCP does not accept Medicare Advantage Plans that are not Johns Hopkins ones. What will happen when I go to the doctor? Will they refuse to see me because they don't accept my insurance? I tried calling the billing office yesterday morning while still open season but was on hold too long so gave up.
sandhill  
#69 Posted : Tuesday, December 14, 2021 5:46:30 AM(UTC)
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I ended up switching back to APWU’s high option plan. It’s worked well for me in the past, and they have a Medicare Advantage plan (via United Health Care) that I can opt into. The big plus is that I can opt into it at any time, and if it doesn’t work out I can go back to the regular high option plan. Also, my medical expenses overseas (not just emergency) will be covered. I will just need to submit the bills after the fact. I was afraid of getting stuck in a plan that didn’t work for me, so this is a win-win in my mind.
Sante123  
#70 Posted : Monday, January 31, 2022 7:34:26 AM(UTC)
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Originally Posted by: fedspouse Go to Quoted Post
I know with this plan you can go "out of network". Basically does that mean we can go to ANY doctor that accepts Medicare assignment?


Sorry for not getting back to you sooner. With this plan you can go to any provider that accepts Medicare and the plan. With respect to Medicare, that means that it doesn’t matter whether the provider accepts assignment or not. If they do accept assignment, then bills go directly from the provider to the plan. If they do not accept assignment (but they do accept Medicare), then you pay the fee upfront and get reimbursement from the plan. There is always the remote possibility that the provider simply may choose not to accept the plan at all. This is true of any plan as it pertains to out of network providers. But ALL providers are obliged to provide emergency services as needed. For providers that you will see often, it is always best to ask them (before you sign up) if they accept this plan. The same goes for any plan you’re interested in.

You mentioned a particular situation in which a provider decided to be very picky about which plans they would accept. However, in my experience, this has been a non-issue. Everyone that I have gone to, whether in or out of network, has accepted the plan without any questions asked.

It’s normal for folks who have never had an FEHB Medicare Advantage plan to be a little bit anxious about how things work. However, all I can say is that this has been the most effortless plan I’ve ever had. No hassles, no complications, no hours on the phone arguing with customer service reps. And it sure is nice getting all those EOB’s showing zero payment due from the patient.
fedspouse  
#71 Posted : Tuesday, February 1, 2022 1:15:02 PM(UTC)

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Originally Posted by: Sante123 Go to Quoted Post
Originally Posted by: fedspouse Go to Quoted Post
I know with this plan you can go "out of network". Basically does that mean we can go to ANY doctor that accepts Medicare assignment?


Sorry for not getting back to you sooner. With this plan you can go to any provider that accepts Medicare and the plan. With respect to Medicare, that means that it doesn’t matter whether the provider accepts assignment or not. If they do accept assignment, then bills go directly from the provider to the plan. If they do not accept assignment (but they do accept Medicare), then you pay the fee upfront and get reimbursement from the plan. There is always the remote possibility that the provider simply may choose not to accept the plan at all. This is true of any plan as it pertains to out of network providers. But ALL providers are obliged to provide emergency services as needed. For providers that you will see often, it is always best to ask them (before you sign up) if they accept this plan. The same goes for any plan you’re interested in.

You mentioned a particular situation in which a provider decided to be very picky about which plans they would accept. However, in my experience, this has been a non-issue. Everyone that I have gone to, whether in or out of network, has accepted the plan without any questions asked.

It’s normal for folks who have never had an FEHB Medicare Advantage plan to be a little bit anxious about how things work. However, all I can say is that this has been the most effortless plan I’ve ever had. No hassles, no complications, no hours on the phone arguing with customer service reps. And it sure is nice getting all those EOB’s showing zero payment due from the patient.


Thanks. What do you tell medical offices the name of the plan? If you say Aetna Medicare Advantage it could be a Part C plan on the open market and not the FEHB plan. One of my doctors in December told me that starting Jan 1,2022 they would be part of the Johns Hopkins Health plans and would only accept Johns Hopkins Medicare Advantage Plans. (they accept other insurance too but the only Medicare Advantage Plan accepted would be Johns Hopkins plans). My primary is Johns Hopkins but I was on hold too long when I called. I also sometimes go to a couple of other doctors who are also part of Johns Hopkins (they have been busy buying up medical practices around here)
Sante123  
#72 Posted : Thursday, February 10, 2022 5:13:02 PM(UTC)
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FEHBP-Aetna Advantage
PPO ESA Plan

Edited by user Thursday, February 10, 2022 5:19:16 PM(UTC)  | Reason: Not specified

fedspouse  
#73 Posted : Thursday, February 10, 2022 5:17:02 PM(UTC)

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Originally Posted by: Sante123 Go to Quoted Post
FEHBP-Aetna Advantage
PPO ESA Plan
PLAN# 200-EGS00000137


You give them all that info?
Sante123  
#74 Posted : Thursday, February 10, 2022 5:25:39 PM(UTC)
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Well, as you can see, I dropped off the the third line via an edit, but you beat me to it. The first of the two lines should suffice for them to locate the plan in their data tables. This is the info from the beginning of the card.

To be honest, for the first time around, I always spell out to providers that this is Aetna’s FEHB Medicare Advantage Plan. There is only one such animal.

Edited by user Thursday, February 10, 2022 5:32:18 PM(UTC)  | Reason: Not specified

fedspouse  
#75 Posted : Thursday, February 10, 2022 5:26:43 PM(UTC)

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Originally Posted by: Sante123 Go to Quoted Post
Well, as you can see, I dropped off the the third line via an edit, but you beat me to it. The first of the two lines should suffice for them to locate the plan in their data tables.


Thanks!
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