Federal Retirees and Medicare vis a vis FEHB?

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MrWasabi65
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Federal Retirees and Medicare vis a vis FEHB?

Post by MrWasabi65 »

I'm doing some medium and long term financial planning as a recent federal retiree.

I am learning about the implications of IRMMA, although I am using my FEHB until I get closer to Medicare age (61 now)

For those farther down the road, how did Medicare play into the federal retiree health benefits you were already receiving?

Do you use both health care insurance programs? How do they replace or compliment each other? thanks
quietseas
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by quietseas »

I'd start here with a site search for "FEHB medicare"? Lots of information already here.

https://www.google.com/search?sitesearc ... b+medicare
ModifiedDuration
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by ModifiedDuration »

There have been a lot of threads on this, such as:

viewtopic.php?t=379460&hilit=Fehb

viewtopic.php?t=192832&hilit=Fehb

Just do a search on FEHB in this Forum.
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retiredjg
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by retiredjg »

I use both. FEHB BCBS basic option and Medicare Part B.

The BCBS reimburses me $800 for my Medicare payments so Medicare costs very little. Since essentially all providers near me are preferred providers, I never pay any bills other than Rx co-pays. No doctor co-pays, no deductible, no labs, nada.

I don't mind paying for two coverages when it means no bills no matter what (almost).

What makes this work for me is that I keep my income under IRMAA and I am single. So there is just one Medicare premium, much of which is reimbursed to me by BCBS Basic (but not by Standard).

For people who are going to be in IRMAA territory for sure and/or when there are two people you have to pay IRMAA for...I think the better choice is often to skip Part B and rely on the annual catastrophic limit to protect you from enormous bills.

As with everything, it depends on your situation. Many threads on this. Do take advantage of them.
delamer
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by delamer »

Review the Consumer Checkbook recommendations on FEHB for retirees.

It is an excellent resource.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
Swansea
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by Swansea »

retiredjg wrote: Thu Jun 23, 2022 9:49 am I use both. FEHB BCBS basic option and Medicare Part B.

The BCBS reimburses me $800 for my Medicare payments so Medicare costs very little. Since essentially all providers near me are preferred providers, I never pay any bills other than Rx co-pays. No doctor co-pays, no deductible, no labs, nada.

I don't mind paying for two coverages when it means no bills no matter what (almost).

What makes this work for me is that I keep my income under IRMAA and I am single. So there is just one Medicare premium, much of which is reimbursed to me by BCBS Basic (but not by Standard).

For people who are going to be in IRMAA territory for sure and/or when there are two people you have to pay IRMAA for...I think the better choice is often to skip Part B and rely on the annual catastrophic limit to protect you from enormous bills.

As with everything, it depends on your situation. Many threads on this. Do take advantage of them.
I agree with your IRMAA recommendation.
tj
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by tj »

retiredjg wrote: Thu Jun 23, 2022 9:49 am I use both. FEHB BCBS basic option and Medicare Part B.

The BCBS reimburses me $800 for my Medicare payments so Medicare costs very little. Since essentially all providers near me are preferred providers, I never pay any bills other than Rx co-pays. No doctor co-pays, no deductible, no labs, nada.

I don't mind paying for two coverages when it means no bills no matter what (almost).

What makes this work for me is that I keep my income under IRMAA and I am single. So there is just one Medicare premium, much of which is reimbursed to me by BCBS Basic (but not by Standard).

For people who are going to be in IRMAA territory for sure and/or when there are two people you have to pay IRMAA for...I think the better choice is often to skip Part B and rely on the annual catastrophic limit to protect you from enormous bills.

As with everything, it depends on your situation. Many threads on this. Do take advantage of them.
The risk of BCBS basic with Medicare is that it does not pay the Medicare coinsurance if you go outside of BCBS network, this seems like an unnecessary risk when there are alternatives available. For that reason, Aetna Direct, GEHA standard and geha High seem like superior choice's for those with Medicare part b. Possibly others, I am nowhere near Medicare age so am not following closely.
Ricola
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by Ricola »

retiredjg wrote: Thu Jun 23, 2022 9:49 am I use both. FEHB BCBS basic option and Medicare Part B.

The BCBS reimburses me $800 for my Medicare payments so Medicare costs very little. Since essentially all providers near me are preferred providers, I never pay any bills other than Rx co-pays. No doctor co-pays, no deductible, no labs, nada.

I don't mind paying for two coverages when it means no bills no matter what (almost).

What makes this work for me is that I keep my income under IRMAA and I am single. So there is just one Medicare premium, much of which is reimbursed to me by BCBS Basic (but not by Standard).

For people who are going to be in IRMAA territory for sure and/or when there are two people you have to pay IRMAA for...I think the better choice is often to skip Part B and rely on the annual catastrophic limit to protect you from enormous bills.

As with everything, it depends on your situation. Many threads on this. Do take advantage of them.
So Medicare is your primary and FEHB secondary. Do you show both insurance cards when using services and need to explain this? and does FEHB provide record-keeping or does Medicare?
Swansea
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by Swansea »

Ricola wrote: Sun Jun 26, 2022 12:09 pm
retiredjg wrote: Thu Jun 23, 2022 9:49 am I use both. FEHB BCBS basic option and Medicare Part B.

The BCBS reimburses me $800 for my Medicare payments so Medicare costs very little. Since essentially all providers near me are preferred providers, I never pay any bills other than Rx co-pays. No doctor co-pays, no deductible, no labs, nada.

I don't mind paying for two coverages when it means no bills no matter what (almost).

What makes this work for me is that I keep my income under IRMAA and I am single. So there is just one Medicare premium, much of which is reimbursed to me by BCBS Basic (but not by Standard).

For people who are going to be in IRMAA territory for sure and/or when there are two people you have to pay IRMAA for...I think the better choice is often to skip Part B and rely on the annual catastrophic limit to protect you from enormous bills.

As with everything, it depends on your situation. Many threads on this. Do take advantage of them.
So Medicare is your primary and FEHB secondary. Do you show both insurance cards when using services and need to explain this? and does FEHB provide record-keeping or does Medicare?
Yes, both cards should be shown and on record. EOBs come from both agencies. I've never had to explain the sequential order, but lots of retired feds in my state.
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retiredjg
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by retiredjg »

Ricola wrote: Sun Jun 26, 2022 12:09 pm
retiredjg wrote: Thu Jun 23, 2022 9:49 am I use both. FEHB BCBS basic option and Medicare Part B.

The BCBS reimburses me $800 for my Medicare payments so Medicare costs very little. Since essentially all providers near me are preferred providers, I never pay any bills other than Rx co-pays. No doctor co-pays, no deductible, no labs, nada.

I don't mind paying for two coverages when it means no bills no matter what (almost).

What makes this work for me is that I keep my income under IRMAA and I am single. So there is just one Medicare premium, much of which is reimbursed to me by BCBS Basic (but not by Standard).

For people who are going to be in IRMAA territory for sure and/or when there are two people you have to pay IRMAA for...I think the better choice is often to skip Part B and rely on the annual catastrophic limit to protect you from enormous bills.

As with everything, it depends on your situation. Many threads on this. Do take advantage of them.
So Medicare is your primary and FEHB secondary. Do you show both insurance cards when using services and need to explain this? and does FEHB provide record-keeping or does Medicare?
Providers want both cards. This is never an issue. For a new provider, I am careful to tell them which is primary.

I get an EOB from BCBS for each service (same as before Medicare). These come in a few weeks. I get quarterly EOBs from Medicare. I am not meticulous with it, but I do cross check them and never found a mistake yet. The combination of the two is enlightening.
chalet
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by chalet »

retiredjg wrote: Sun Jun 26, 2022 1:26 pm The combination of the two is enlightening.

what sort of things get past both insurances?
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retiredjg
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by retiredjg »

chalet wrote: Sun Jun 26, 2022 3:03 pm
retiredjg wrote: Sun Jun 26, 2022 1:26 pm The combination of the two is enlightening.
what sort of things get past both insurances?
I don't understand the question. Try again?
chalet
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by chalet »

do you end up paying for anything?

what are some things you have to pay for?
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AnnetteLouisan
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by AnnetteLouisan »

tj wrote: Sun Jun 26, 2022 10:56 am
retiredjg wrote: Thu Jun 23, 2022 9:49 am I use both. FEHB BCBS basic option and Medicare Part B.

The BCBS reimburses me $800 for my Medicare payments so Medicare costs very little. Since essentially all providers near me are preferred providers, I never pay any bills other than Rx co-pays. No doctor co-pays, no deductible, no labs, nada.

I don't mind paying for two coverages when it means no bills no matter what (almost).

What makes this work for me is that I keep my income under IRMAA and I am single. So there is just one Medicare premium, much of which is reimbursed to me by BCBS Basic (but not by Standard).

For people who are going to be in IRMAA territory for sure and/or when there are two people you have to pay IRMAA for...I think the better choice is often to skip Part B and rely on the annual catastrophic limit to protect you from enormous bills.

As with everything, it depends on your situation. Many threads on this. Do take advantage of them.
The risk of BCBS basic with Medicare is that it does not pay the Medicare coinsurance if you go outside of BCBS network, this seems like an unnecessary risk when there are alternatives available. For that reason, Aetna Direct, GEHA standard and geha High seem like superior choice's for those with Medicare part b. Possibly others, I am nowhere near Medicare age so am not following closely.
Would BCBS standard (the PPO) with Medicare Part B address the concern about going out of network?
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pahkcah
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by pahkcah »

AnnetteLouisan wrote: Sun Jun 26, 2022 5:27 pm Would BCBS standard (the PPO) with Medicare Part B address the concern about going out of network?
Yes, it would. You just would not get the $800 payment toward Medicare Part B premiums that BCBS Basic provides.
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retiredjg
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by retiredjg »

chalet wrote: Sun Jun 26, 2022 5:20 pm do you end up paying for anything?

what are some things you have to pay for?
See my post above. I've paid for nothing other than prescription co-pays (which are only covered by BCBS, but not Medicare Part B).
Naismith
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by Naismith »

chalet wrote: Sun Jun 26, 2022 3:03 pm what sort of things get past both insurances?
My husband had increasingly huge prisms in his glasses, and the optometrist suggested that at age 67 he consider having eye muscle surgery to align his eyes better. The insurances paid for the surgery, but not for some of the necessary tests, because those are the same tests most often given to youngsters with strabismus. BCBS would not pay for patients under age 18.

We are using BCBS Basic as our drug plan, and if also enrolled in Medicare we have access to the mail order pharmacy. Statin drugs are free, but others are $20 for a 3-month supply. However, there is a formulary and one needed drug is NOT in the BCBS formulary. The Amazon Prime Pharmacy came through for us at a reasonable price.

But yes, just about everything else has a final $0 price tag after both insurances are filed.
tj
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by tj »

AnnetteLouisan wrote: Sun Jun 26, 2022 5:27 pm
tj wrote: Sun Jun 26, 2022 10:56 am
retiredjg wrote: Thu Jun 23, 2022 9:49 am I use both. FEHB BCBS basic option and Medicare Part B.

The BCBS reimburses me $800 for my Medicare payments so Medicare costs very little. Since essentially all providers near me are preferred providers, I never pay any bills other than Rx co-pays. No doctor co-pays, no deductible, no labs, nada.

I don't mind paying for two coverages when it means no bills no matter what (almost).

What makes this work for me is that I keep my income under IRMAA and I am single. So there is just one Medicare premium, much of which is reimbursed to me by BCBS Basic (but not by Standard).

For people who are going to be in IRMAA territory for sure and/or when there are two people you have to pay IRMAA for...I think the better choice is often to skip Part B and rely on the annual catastrophic limit to protect you from enormous bills.

As with everything, it depends on your situation. Many threads on this. Do take advantage of them.
The risk of BCBS basic with Medicare is that it does not pay the Medicare coinsurance if you go outside of BCBS network, this seems like an unnecessary risk when there are alternatives available. For that reason, Aetna Direct, GEHA standard and geha High seem like superior choice's for those with Medicare part b. Possibly others, I am nowhere near Medicare age so am not following closely.
Would BCBS standard (the PPO) with Medicare Part B address the concern about going out of network?
BCBS standard has no in network restrictions, it just seems unnecessarily expensive for what is essentially a medigap unless their prescription plan is drastically better for you than the alternatives.
chalet
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by chalet »

tj wrote: Sun Jun 26, 2022 8:31 pm BCBS standard has no in network restrictions, it just seems unnecessarily expensive for what is essentially a medigap unless their prescription plan is drastically better for you than the alternatives.

for my location at age 65, basic plus a high deductible medigap G would be cheaper than standard.
tj
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by tj »

chalet wrote: Sun Jun 26, 2022 9:17 pm
tj wrote: Sun Jun 26, 2022 8:31 pm BCBS standard has no in network restrictions, it just seems unnecessarily expensive for what is essentially a medigap unless their prescription plan is drastically better for you than the alternatives.

for my location at age 65, basic plus a high deductible medigap G would be cheaper than standard.
I've never heard of someone having fehb and a medigap
HeelaMonster
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by HeelaMonster »

Today I applied for Medicare, Parts A and B. After much reading on BH and elsewhere, I elected to enroll in Part B as well as continue FEHB (FepBlue, BCBS Basic option). The online application process was smooth. In fact, so smooth that it made me wonder: I was somewhat surprised that the Medicare did not want to know about my other coverage. When I initially answered yes to the question about existing Group Health Plan, it corrected me that this applied only to CURRENT employment, and not to retiree coverage. Two questions for those who have been through the enrollment process:

1. At what point do they (Medicare) figure out that you have supplemental coverage, so they can coordinate benefits?

2. Presumably I need to notify BCBS (FepBlue) that I am enrolled in Medicare?
tj
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by tj »

HeelaMonster wrote: Sat Jul 02, 2022 5:27 pm Today I applied for Medicare, Parts A and B. After much reading on BH and elsewhere, I elected to enroll in Part B as well as continue FEHB (FepBlue, BCBS Basic option). The online application process was smooth. In fact, so smooth that it made me wonder: I was somewhat surprised that the Medicare did not want to know about my other coverage. When I initially answered yes to the question about existing Group Health Plan, it corrected me that this applied only to CURRENT employment, and not to retiree coverage. Two questions for those who have been through the enrollment process:

1. At what point do they (Medicare) figure out that you have supplemental coverage, so they can coordinate benefits?

2. Presumably I need to notify BCBS (FepBlue) that I am enrolled in Medicare?

You don't care about the network limitations of BCBS basic?
delamer
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by delamer »

HeelaMonster wrote: Sat Jul 02, 2022 5:27 pm Today I applied for Medicare, Parts A and B. After much reading on BH and elsewhere, I elected to enroll in Part B as well as continue FEHB (FepBlue, BCBS Basic option). The online application process was smooth. In fact, so smooth that it made me wonder: I was somewhat surprised that the Medicare did not want to know about my other coverage. When I initially answered yes to the question about existing Group Health Plan, it corrected me that this applied only to CURRENT employment, and not to retiree coverage. Two questions for those who have been through the enrollment process:

1. At what point do they (Medicare) figure out that you have supplemental coverage, so they can coordinate benefits?

2. Presumably I need to notify BCBS (FepBlue) that I am enrolled in Medicare?
My understanding is that Medicare is primary, so it doesn’t need to coordinate.

It pays out and then the secondary insurer steps in.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
HeelaMonster
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by HeelaMonster »

tj wrote: Sat Jul 02, 2022 5:37 pm You don't care about the network limitations of BCBS basic?
Nope. The choice (for me) was between Basic + Part B, or forgoing Part B altogether. In my area, at least, many feds were on Basic while we were working. And those that weren't have "downsized" to Basic, in combination with Medicare B.
delamer
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by delamer »

HeelaMonster wrote: Sat Jul 02, 2022 6:13 pm
tj wrote: Sat Jul 02, 2022 5:37 pm You don't care about the network limitations of BCBS basic?
Nope. The choice (for me) was between Basic + Part B, or forgoing Part B altogether. In my area, at least, many feds were on Basic while we were working. And those that weren't have "downsized" to Basic, in combination with Medicare B.
Just a FYI that GEHA Standard has significantly lower premiums. Provider network is United Healthcare.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
tj
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by tj »

delamer wrote: Sat Jul 02, 2022 8:26 pm
HeelaMonster wrote: Sat Jul 02, 2022 6:13 pm
tj wrote: Sat Jul 02, 2022 5:37 pm You don't care about the network limitations of BCBS basic?
Nope. The choice (for me) was between Basic + Part B, or forgoing Part B altogether. In my area, at least, many feds were on Basic while we were working. And those that weren't have "downsized" to Basic, in combination with Medicare B.
Just a FYI that GEHA Standard has significantly lower premiums. Provider network is United Healthcare.

Geha has no network limitations for those on Medicare.
delamer
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by delamer »

tj wrote: Sun Jul 03, 2022 10:03 am
delamer wrote: Sat Jul 02, 2022 8:26 pm
HeelaMonster wrote: Sat Jul 02, 2022 6:13 pm
tj wrote: Sat Jul 02, 2022 5:37 pm You don't care about the network limitations of BCBS basic?
Nope. The choice (for me) was between Basic + Part B, or forgoing Part B altogether. In my area, at least, many feds were on Basic while we were working. And those that weren't have "downsized" to Basic, in combination with Medicare B.
Just a FYI that GEHA Standard has significantly lower premiums. Provider network is United Healthcare.

Geha has no network limitations for those on Medicare.
Interesting. We don’t have Part B, so I was not aware of that.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
Bullhead5829
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by Bullhead5829 »

OP, for your second question, you can just call the customer service number on your BCBS plan and tell them that you have Medicare now as primary, as I did when I enrolled in Medicare.
tj
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by tj »

delamer wrote: Sun Jul 03, 2022 10:56 am
tj wrote: Sun Jul 03, 2022 10:03 am
delamer wrote: Sat Jul 02, 2022 8:26 pm
HeelaMonster wrote: Sat Jul 02, 2022 6:13 pm
tj wrote: Sat Jul 02, 2022 5:37 pm You don't care about the network limitations of BCBS basic?
Nope. The choice (for me) was between Basic + Part B, or forgoing Part B altogether. In my area, at least, many feds were on Basic while we were working. And those that weren't have "downsized" to Basic, in combination with Medicare B.
Just a FYI that GEHA Standard has significantly lower premiums. Provider network is United Healthcare.

Geha has no network limitations for those on Medicare.
Interesting. We don’t have Part B, so I was not aware of that.
I mean, the network still matters for stuff that Medicare doesn't cover, but not for Medicare covered procedures
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by Golf maniac »

I have NALC High and will not take Part B at 55. I am comfortable self insuring up to catastrophic limit each year. It all depends on your risk tolerance and financial capacity.
quietseas
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by quietseas »

tj wrote: Sat Jul 02, 2022 5:37 pm
You don't care about the network limitations of BCBS basic?
There are parts of the US where basically every provider within 100 miles is under BCBS Basic because there are only a handful of networks, all with BCBS contracts, and only a few physicians who are not in one of those networks. May not be the case in other places though.
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by UpperNwGuy »

I have Medicare Parts A and B along with FEHB. I pay a few reasonable co-pays for prescription medications, and that's it.
tj
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by tj »

quietseas wrote: Sun Jul 03, 2022 5:29 pm
tj wrote: Sat Jul 02, 2022 5:37 pm
You don't care about the network limitations of BCBS basic?
There are parts of the US where basically every provider within 100 miles is under BCBS Basic because there are only a handful of networks, all with BCBS contracts, and only a few physicians who are not in one of those networks. May not be the case in other places though.
What about emergency room doctors that aren't in any network?
tallguy3891
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by tallguy3891 »

tj wrote: Sun Jul 03, 2022 6:00 pm
quietseas wrote: Sun Jul 03, 2022 5:29 pm
tj wrote: Sat Jul 02, 2022 5:37 pm
You don't care about the network limitations of BCBS basic?
There are parts of the US where basically every provider within 100 miles is under BCBS Basic because there are only a handful of networks, all with BCBS contracts, and only a few physicians who are not in one of those networks. May not be the case in other places though.
What about emergency room doctors that aren't in any network?
I believe FEHB now also falls under the regulations of the No Surprises Act effective 1/01/2022 which addresses this issue?
tj
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by tj »

tallguy3891 wrote: Sun Jul 03, 2022 6:43 pm
tj wrote: Sun Jul 03, 2022 6:00 pm
quietseas wrote: Sun Jul 03, 2022 5:29 pm
tj wrote: Sat Jul 02, 2022 5:37 pm
You don't care about the network limitations of BCBS basic?
There are parts of the US where basically every provider within 100 miles is under BCBS Basic because there are only a handful of networks, all with BCBS contracts, and only a few physicians who are not in one of those networks. May not be the case in other places though.
What about emergency room doctors that aren't in any network?
I believe FEHB now also falls under the regulations of the No Surprises Act effective 1/01/2022 which addresses this issue?
I wouldn't think that override the BCBS policy to only cover what's in it's network for basic

Anyway, we'll see if what you say is correct as I have some ER claims with geha being processed soon
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pahkcah
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by pahkcah »

tj wrote: Sun Jul 03, 2022 7:29 pm
tallguy3891 wrote: Sun Jul 03, 2022 6:43 pm
tj wrote: Sun Jul 03, 2022 6:00 pm
quietseas wrote: Sun Jul 03, 2022 5:29 pm
tj wrote: Sat Jul 02, 2022 5:37 pm
You don't care about the network limitations of BCBS basic?
There are parts of the US where basically every provider within 100 miles is under BCBS Basic because there are only a handful of networks, all with BCBS contracts, and only a few physicians who are not in one of those networks. May not be the case in other places though.
What about emergency room doctors that aren't in any network?
I believe FEHB now also falls under the regulations of the No Surprises Act effective 1/01/2022 which addresses this issue?
I wouldn't think that override the BCBS policy to only cover what's in it's network for basic

Anyway, we'll see if what you say is correct as I have some ER claims with geha being processed soon
If Medicare Part A and Part B are primary, BCBS says ER care is covered (for both Basic and Standard). For anyone interested, here's a link to what is covered when Medicare is primary, and combined with BCBS: https://www.fepblue.org/our-plans/Medicare
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retiredjg
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by retiredjg »

BCBS Basic has some exceptions for services that are not in the preferred network. This was in effect before any recent legislation. For example,

-Emergency care when you end up in a facility that is not preferred.

-Professional care provided at a preferred facility by people who are not preferred providers (ER doctor is specifically mentioned).

These things are not well explained and I imagine there are a number of qualifications and loopholes. For example, I would guess you have to show that you ended up in a non-covered ER for a reason rather than by choice.

This information is found in Section 3 of the BCBS Service Benefit Plan pamphlet (page 20 in the 2021 version). Look for "exceptions".
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by tj »

pahkcah wrote: Sun Jul 03, 2022 7:43 pm
tj wrote: Sun Jul 03, 2022 7:29 pm
tallguy3891 wrote: Sun Jul 03, 2022 6:43 pm
tj wrote: Sun Jul 03, 2022 6:00 pm
quietseas wrote: Sun Jul 03, 2022 5:29 pm

There are parts of the US where basically every provider within 100 miles is under BCBS Basic because there are only a handful of networks, all with BCBS contracts, and only a few physicians who are not in one of those networks. May not be the case in other places though.
What about emergency room doctors that aren't in any network?
I believe FEHB now also falls under the regulations of the No Surprises Act effective 1/01/2022 which addresses this issue?
I wouldn't think that override the BCBS policy to only cover what's in it's network for basic

Anyway, we'll see if what you say is correct as I have some ER claims with geha being processed soon
If Medicare Part A and Part B are primary, BCBS says ER care is covered (for both Basic and Standard). For anyone interested, here's a link to what is covered when Medicare is primary, and combined with BCBS: https://www.fepblue.org/our-plans/Medicare
Maybe they got rid of that limitation
tallguy3891
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by tallguy3891 »

tj wrote: Sun Jul 03, 2022 7:29 pm
tallguy3891 wrote: Sun Jul 03, 2022 6:43 pm
tj wrote: Sun Jul 03, 2022 6:00 pm
quietseas wrote: Sun Jul 03, 2022 5:29 pm
tj wrote: Sat Jul 02, 2022 5:37 pm
You don't care about the network limitations of BCBS basic?
There are parts of the US where basically every provider within 100 miles is under BCBS Basic because there are only a handful of networks, all with BCBS contracts, and only a few physicians who are not in one of those networks. May not be the case in other places though.
What about emergency room doctors that aren't in any network?
I believe FEHB now also falls under the regulations of the No Surprises Act effective 1/01/2022 which addresses this issue?
I wouldn't think that override the BCBS policy to only cover what's in it's network for basic

Anyway, we'll see if what you say is correct as I have some ER claims with geha being processed soon
It looks like all of the geha brochures have a section on the No Surprise Act for reference.
Osprey
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by Osprey »

https://www.fepblue.org/our-plans/Medic ... e-benefits


Section on choosing a provider when covered by blue cross federal and Medicare says under basic plan must choose in network provider, standard can go out of network.

Finding a Provider

Medicare has its own network of Participating providers who accept Medicare’s assignment or payment. When you visit a provider (regardless of if they accept Medicare’s assignment), we’ll pay the difference between what Medicare pays and what you owe the provider.* You can see which providers are in Medicare’s network at medicare.gov.

*Note: Basic Option and FEP Blue Focus members must see a Preferred provider in our network. Standard Option members can see providers outside of our network.
OpenMinded1
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by OpenMinded1 »

AnnetteLouisan wrote: Sun Jun 26, 2022 5:27 pm
tj wrote: Sun Jun 26, 2022 10:56 am
retiredjg wrote: Thu Jun 23, 2022 9:49 am I use both. FEHB BCBS basic option and Medicare Part B.

The BCBS reimburses me $800 for my Medicare payments so Medicare costs very little. Since essentially all providers near me are preferred providers, I never pay any bills other than Rx co-pays. No doctor co-pays, no deductible, no labs, nada.

I don't mind paying for two coverages when it means no bills no matter what (almost).

What makes this work for me is that I keep my income under IRMAA and I am single. So there is just one Medicare premium, much of which is reimbursed to me by BCBS Basic (but not by Standard).

For people who are going to be in IRMAA territory for sure and/or when there are two people you have to pay IRMAA for...I think the better choice is often to skip Part B and rely on the annual catastrophic limit to protect you from enormous bills.

As with everything, it depends on your situation. Many threads on this. Do take advantage of them.
The risk of BCBS basic with Medicare is that it does not pay the Medicare coinsurance if you go outside of BCBS network, this seems like an unnecessary risk when there are alternatives available. For that reason, Aetna Direct, GEHA standard and geha High seem like superior choice's for those with Medicare part b. Possibly others, I am nowhere near Medicare age so am not following closely.
Would BCBS standard (the PPO) with Medicare Part B address the concern about going out of network?
Has anybody with BCBS Basic had a problem finding providers that are in-network? I've had BCBS Basic for a while, and my impression is that a vast majority of providers in the US are in-network. Maybe the Standard option would be better if you travel out of the country a lot? Of course, it might only take one accidental trip to an out-of-network provider to incur a huge bill. I'll have to read my policy, but I wonder if the requirement to be in-network is waived in the case of an emergency. In that instance, the insured might not be able to ask whether a provider is in network before accepting care.

My problem with BCBS Basic is that prescription benefits are okay, but not great. I wonder if some of the other FEHB plans typically recommended on this forum like GEHA have better prescription benefits.

I have secondary non-FEHB BCBS thru my wife. On a recent trip to the pharmacy, my bill would have been about $200 using BCBS Basic. I used the insurance I have thru her to get them for $50.
1grl1by
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by 1grl1by »

Golf maniac wrote: Sun Jul 03, 2022 5:21 pm I have NALC High and will not take Part B at 55. I am comfortable self insuring up to catastrophic limit each year. It all depends on your risk tolerance and financial capacity.
This is basically the same decision we made for my husband this year. Right now his health costs are very low (doctor once a year, eye drops are his only medication). If he follows the previous 3 generations of his family, he won't develop any health issues until his late 90s. When I turn 65 in 2 years our calculations will be different, I have a chronic and fairly expensive medical condition that involve lots of specialist visits and additional costs for treatments.
tj
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by tj »

OpenMinded1 wrote: Mon Jul 04, 2022 6:48 am
AnnetteLouisan wrote: Sun Jun 26, 2022 5:27 pm
tj wrote: Sun Jun 26, 2022 10:56 am
retiredjg wrote: Thu Jun 23, 2022 9:49 am I use both. FEHB BCBS basic option and Medicare Part B.

The BCBS reimburses me $800 for my Medicare payments so Medicare costs very little. Since essentially all providers near me are preferred providers, I never pay any bills other than Rx co-pays. No doctor co-pays, no deductible, no labs, nada.

I don't mind paying for two coverages when it means no bills no matter what (almost).

What makes this work for me is that I keep my income under IRMAA and I am single. So there is just one Medicare premium, much of which is reimbursed to me by BCBS Basic (but not by Standard).

For people who are going to be in IRMAA territory for sure and/or when there are two people you have to pay IRMAA for...I think the better choice is often to skip Part B and rely on the annual catastrophic limit to protect you from enormous bills.

As with everything, it depends on your situation. Many threads on this. Do take advantage of them.
The risk of BCBS basic with Medicare is that it does not pay the Medicare coinsurance if you go outside of BCBS network, this seems like an unnecessary risk when there are alternatives available. For that reason, Aetna Direct, GEHA standard and geha High seem like superior choice's for those with Medicare part b. Possibly others, I am nowhere near Medicare age so am not following closely.
Would BCBS standard (the PPO) with Medicare Part B address the concern about going out of network?
Has anybody with BCBS Basic had a problem finding providers that are in-network? I've had BCBS Basic for a while, and my impression is that a vast majority of providers in the US are in-network. Maybe the Standard option would be better if you travel out of the country a lot? Of course, it might only take one accidental trip to an out-of-network provider to incur a huge bill. I'll have to read my policy, but I wonder if the requirement to be in-network is waived in the case of an emergency. In that instance, the insured might not be able to ask whether a provider is in network before accepting care.

My problem with BCBS Basic is that prescription benefits are okay, but not great. I wonder if some of the other FEHB plans typically recommended on this forum like GEHA have better prescription benefits.

I have secondary non-FEHB BCBS thru my wife. On a recent trip to the pharmacy, my bill would have been about $200 using BCBS Basic. I used the insurance I have thru her to get them for $50.
I would be surprised if GEHA had superior prescription benefits to BCBS. Also the "in network" requirement probably doesn't apply to overseas
ChrisC
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by ChrisC »

1grl1by wrote: Mon Jul 04, 2022 8:44 am
Golf maniac wrote: Sun Jul 03, 2022 5:21 pm I have NALC High and will not take Part B at 55. I am comfortable self insuring up to catastrophic limit each year. It all depends on your risk tolerance and financial capacity.
This is basically the same decision we made for my husband this year. Right now his health costs are very low (doctor once a year, eye drops are his only medication). If he follows the previous 3 generations of his family, he won't develop any health issues until his late 90s. When I turn 65 in 2 years our calculations will be different, I have a chronic and fairly expensive medical condition that involve lots of specialist visits and additional costs for treatments.
For us, this seems to be largely driven by IRMAA considerations. If you’re not subject to IRMAA, it’s relatively an easier decision to enroll in Part B and keep a decent FEHB plan that coordinates well and might also reimburse you for some or all Part B premiums. So, BIL with expensive drug therapies of 2X $116k annually is completely covered by Medicare Part B and BCBS-Basic. He’s only paying the basic Medicare Part B premium of $170 monthly.

But, if you’re subject to IRMAA levels, and some hit these levels because of Roth conversions, then paying high Part B premium levels like $442 monthly for my wife might not be the most financially optimal decision. This is $5300 in annual premiums for Part B! I’m not enrolled in Part B and each year we think about disenrolling my wife in Part B; after all, we have GEHA standard plus 1 with a catastrophic limit of $6500 per person.
chalet
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by chalet »

OpenMinded1 wrote: Mon Jul 04, 2022 6:48 am I have secondary non-FEHB BCBS thru my wife. On a recent trip to the pharmacy, my bill would have been about $200 using BCBS Basic. I used the insurance I have thru her to get them for $50.
did you submit the $50 payment to your bcbs for payment?


also, if you had a different FEHB plan (non-bcbs), you would have two different formularies.
OpenMinded1
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by OpenMinded1 »

delete
HIinvestor
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by HIinvestor »

We have a FEHB BCBS plan plus Medicare A&B. We have the BCBS plan that is local and most familiar to our providers, all of who are participating & preferred. We had briefly considered switching to national BCBS and may investigate it again during open season but we have been pretty satisfied with the local insurer so willlikely stick with them, even tho they don’t refund us any portion of our Medicare B premiums. (This is the 1st month I’ve been enrolled in Medicare B.)
HeelaMonster
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by HeelaMonster »

HIinvestor wrote: Tue Jul 05, 2022 2:42 am We have a FEHB BCBS plan plus Medicare A&B. We have the BCBS plan that is local and most familiar to our providers, all of who are participating & preferred. We had briefly considered switching to national BCBS and may investigate it again during open season but we have been pretty satisfied with the local insurer so willlikely stick with them, even tho they don’t refund us any portion of our Medicare B premiums. (This is the 1st month I’ve been enrolled in Medicare B.)
Interesting. I didn't realize there was such a thing as a "local" plan, while still being part of FEHB(?).
tj
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by tj »

HeelaMonster wrote: Tue Jul 05, 2022 5:59 am
HIinvestor wrote: Tue Jul 05, 2022 2:42 am We have a FEHB BCBS plan plus Medicare A&B. We have the BCBS plan that is local and most familiar to our providers, all of who are participating & preferred. We had briefly considered switching to national BCBS and may investigate it again during open season but we have been pretty satisfied with the local insurer so willlikely stick with them, even tho they don’t refund us any portion of our Medicare B premiums. (This is the 1st month I’ve been enrolled in Medicare B.)
Interesting. I didn't realize there was such a thing as a "local" plan, while still being part of FEHB(?).
There are tons of local fehb options.
OpenMinded1
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Re: Federal Retirees and Medicare vis a vis FEHB?

Post by OpenMinded1 »

chalet wrote: Mon Jul 04, 2022 11:33 am
OpenMinded1 wrote: Mon Jul 04, 2022 6:48 am I have secondary non-FEHB BCBS thru my wife. On a recent trip to the pharmacy, my bill would have been about $200 using BCBS Basic. I used the insurance I have thru her to get them for $50.
did you submit the $50 payment to your bcbs for payment?

No. Maybe I misunderstood, but pretty sure I have been told by each of my two insurers that for prescriptions one insurance doesn't serve as secondary to the other. They said I should just go with the insurance that results in the smallest bill for a particular prescription. If I had told the pharmacy to use my FEHB BCBS Basic, it would have cost close to $200. Using the other (free) insurance that I have thru my wife's employer it cost about $50. Are you saying that I should now submit my receipt for $50 to FEHB BCBS? Seems like that would be using both insurances for prescriptions.


also, if you had a different FEHB plan (non-bcbs), you would have two different formularies.

Are you just saying that if I switch to something like FEHB GEHA, the prescription benefits will be different?
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