Why should FEHB members buy Medicare Part B?

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VictoriaF
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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Mon Mar 18, 2019 9:16 am

VictoriaF wrote:
Mon Mar 18, 2019 9:10 am
Those who have both Medicare Part B and FEHB, what FEHB plan do you use?

Right now, I am quite happy with the GEHA High-Deductible Health Plan (HDHP). But it does not integrate well with Medicare. At the yesterday's meeting of the D.C. Bogleheads, one person has suggested that Blue Cross Blue Shield (BCBS) is the best FEHB plan. Grabiner has further noted that BCBS Basic is more appropriate than BCBS Standard, but that the key is how a plan integrates with Medicare.

When the time comes, I will read plan materials, but for now, I want to get a sanity check from the readers of this thread:
1. Is BCBS-Basic a preferred option for integrating with Medicare Part B?
2. Does BCBS-Basic provide coverage when one travels internationally?
3. What BCBS-Basic features to pay attention to? Pharmaceutical coverage? Doctors and hospitals in network? Something else?

Victoria
Also:
4. What would be reasons NOT to select BCBS-Basic?

Victoria
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HueyLD
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Re: Why should FEHB members buy Medicare Part B?

Post by HueyLD » Mon Mar 18, 2019 10:19 am

(1). Yes, as far as I know.

(2). Yes and the details can be found on pages 135 -137 of the 2019 plan brochure.

(3). Prescription drug coverage is quite comprehensive. See page 173 for the summary and pages 113 -125 for details.

Remember the Basic plan is an EPO plan, meaning that you must receive services from preferred providers in order to get coverage. If you live in an area where virtually all providers accept FEHB BCBS, you are good to go. However, if very few providers accept FEHB BCBS in your area, then it is not a good one for you.

(4). See above

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VictoriaF
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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Mon Mar 18, 2019 10:23 am

HueyLD wrote:
Mon Mar 18, 2019 10:19 am
...

(4). See above
Thank you, HueyLD, this is very helpful,

Victoria
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tj
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Re: Why should FEHB members buy Medicare Part B?

Post by tj » Mon Mar 18, 2019 2:32 pm

I thought Aetna direct was the top choice for Medicare b folks.

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Re: Why should FEHB members buy Medicare Part B?

Post by retiredjg » Mon Mar 18, 2019 3:05 pm

VictoriaF wrote:
Mon Mar 18, 2019 9:10 am
Those who have both Medicare Part B and FEHB, what FEHB plan do you use?

Right now, I am quite happy with the GEHA High-Deductible Health Plan (HDHP). But it does not integrate well with Medicare. At the yesterday's meeting of the D.C. Bogleheads, one person has suggested that Blue Cross Blue Shield (BCBS) is the best FEHB plan. Grabiner has further noted that BCBS Basic is more appropriate than BCBS Standard, but that the key is how a plan integrates with Medicare.

When the time comes, I will read plan materials, but for now, I want to get a sanity check from the readers of this thread:
1. Is BCBS-Basic a preferred option for integrating with Medicare Part B?
2. Does BCBS-Basic provide coverage when one travels internationally?
3. What BCBS-Basic features to pay attention to? Pharmaceutical coverage? Doctors and hospitals in network? Something else?
4. What would be reasons NOT to select BCBS-Basic?

Victoria
Victoria, I switched to BCBS Basic a couple of years ago (from the more expensive version) when I learned from posts here that the Standard option was not offering anything extra once on Medicare. I pay $159.74 per month (single) this year but I get back $600 a year in my BCBS premiums.

I also have Medicare Part B at the lowest rate.

They integrate perfectly with each other. Medicare pays it's part then sends the rest to BCBS and I get paperwork saying I don't owe anything. All happens in a timely manner and no mistakes that I'm aware of (however, I never see the actual bills, so I would not know about mistakes there).

I do not pay any medical bills except prescription co-pays. I don't pay co-pays at the doctor, or for lab work, or tests, or x-rays, or anything. I am very satisfied and will not change unless something better comes along.

I believe it covers international travel, but not positive. As I'm sure you know, Medicare does not.

No problems with doctors and hospitals in network. Don't have to use a primary care system etc. Doctor just has to accept Medicare assignments (and most here do).

I was previously happy with GEHA (I think before medicare) but left them because they pushed the CVS pharmacy so hard - our local CVS is crowded, slow, and has made several mistakes and I just got tired of dealing with them.

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Re: Why should FEHB members buy Medicare Part B?

Post by retiredjg » Mon Mar 18, 2019 3:15 pm

HueyLD wrote:
Mon Mar 18, 2019 10:19 am
Remember the Basic plan is an EPO plan, meaning that you must receive services from preferred providers in order to get coverage. If you live in an area where virtually all providers accept FEHB BCBS, you are good to go. However, if very few providers accept FEHB BCBS in your area, then it is not a good one for you.
I believe this is true when BCBS is primary (for example if you are still working). I do not believe it is true once Medicare becomes the primary provider. The doctor just has to accept Medicare assignment.

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Re: Why should FEHB members buy Medicare Part B?

Post by HueyLD » Mon Mar 18, 2019 3:28 pm

retiredjg wrote:
Mon Mar 18, 2019 3:15 pm
HueyLD wrote:
Mon Mar 18, 2019 10:19 am
Remember the Basic plan is an EPO plan, meaning that you must receive services from preferred providers in order to get coverage. If you live in an area where virtually all providers accept FEHB BCBS, you are good to go. However, if very few providers accept FEHB BCBS in your area, then it is not a good one for you.
I believe this is true when BCBS is primary (for example if you are still working). I do not believe it is true once Medicare becomes the primary provider. The doctor just has to accept Medicare assignment.
Jg,

You misunderstood what I wrote. Yes, the EPO limitations don't change with Medicare. But federal employee BCBS may not be widely accepted in some parts of the country and going to a provider who accepts Medicare but not a preferred BCBS provider will result in the 20% not being paid by the BCBS. Of course there are exceptions for true emergencies.

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Re: Why should FEHB members buy Medicare Part B?

Post by Swansea » Mon Mar 18, 2019 3:28 pm

BCBS standard is also more generous with PT visits, which is a factor for me.
I dropped Medicare B a couple of years ago, ran the numbers, and I've come out ahead. Of course, if one has many issues, Medicare B can make sense.

4nwestsaylng
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Re: Why should FEHB members buy Medicare Part B?

Post by 4nwestsaylng » Mon Mar 18, 2019 3:36 pm

VictoriaF wrote:
Mon Mar 18, 2019 9:10 am
Those who have both Medicare Part B and FEHB, what FEHB plan do you use?

Right now, I am quite happy with the GEHA High-Deductible Health Plan (HDHP). But it does not integrate well with Medicare. At the yesterday's meeting of the D.C. Bogleheads, one person has suggested that Blue Cross Blue Shield (BCBS) is the best FEHB plan. Grabiner has further noted that BCBS Basic is more appropriate than BCBS Standard, but that the key is how a plan integrates with Medicare.

When the time comes, I will read plan materials, but for now, I want to get a sanity check from the readers of this thread:
1. Is BCBS-Basic a preferred option for integrating with Medicare Part B?
2. Does BCBS-Basic provide coverage when one travels internationally?
3. What BCBS-Basic features to pay attention to? Pharmaceutical coverage? Doctors and hospitals in network? Something else?
4. What would be reasons NOT to select BCBS-Basic?

Victoria
I had the GEHA High Deductible HP while working, but made the mistake of signing up for Medicare Part A when I turned 65, thinking I "had to",but kept working for three more years, keeping the HDHP. That is not allowed, and I had to remove excess HSA contributions and pay tax and a minimal penalty.
That's when I transferred to GEHA Standard. It is unfortunate that it does not help with the Part B Medicare premium, but I have been happy with GEHA and have not looked at BCBS or other alternatives. Is BCBS more accepted by doctors? I get a checkup annually at one of the top medical schools in the country, and have had no problem with GEHA being accepted, along with Medicare.

Since the FEHB plans include younger people, I suspect that it is more likely that more doctors over time may actually drop or limit taking on new Medicare patients, instead of limiting BCBS or GEHA or Aetna patients. In the FEHB plans, they can't selectively drop older people in the plans, but in Medicare, many practices are now not taking on new Medicare patients due to fee limits. They need to keep a patient mix of all ages to stay financially viable. With the FEHB plans, you stay in that diversfied patient mix as a retiree.

I can see that people who are able to keep income at or below $85 k in retirement, can have a reasonable premium with Part B, but over time, $85K is not what it used to be, and the IRMAA tiers are not only not inflation adjusted, but as I pointed out, were arbitrarily bumped up last year, and this could happen again. Also note that anyone paying IRMAA does not receive the COLA protection that Medicare rates cannot exceed the SS COLA; Medicare can raise the IRMAA rates any amount they want, there is no COLA restriction.

So if you are going to have a RMD of $30k, SS in the 30's and some dividend/interest income, you are going to be in an IRMAA bracket,probably indefinitely, even without doing Roth conversions. And if you don't do any Roth conversions, your tax deferred accounts are going to grow, the RMD will grow over time, and current federal marginal tax rates are due to "sunset" in 2025.

I am not betting that after 2025 they will be renewed. I am reading David McKnight's small book, "The Power of Zero". It overstates the opportunity to reduce your taxes, but it does make a strong case that current federal marginal tax rates constitute a temporary "sale" that should be taken advantage of
to do Roth conversions.

I think if I want to do more Roth conversions, I will have to drop Part B. I may look at BCBS or Aetna FEHB. Apart from some help with Medicare B premium, do you see any advantages of these two over GEHA Standard?

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VictoriaF
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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Tue Mar 19, 2019 5:08 pm

retiredjg wrote:
Mon Mar 18, 2019 3:05 pm

Victoria, I switched to BCBS Basic a couple of years ago (from the more expensive version) when I learned from posts here that the Standard option was not offering anything extra once on Medicare. I pay $159.74 per month (single) this year but I get back $600 a year in my BCBS premiums.

I also have Medicare Part B at the lowest rate.

They integrate perfectly with each other. Medicare pays it's part then sends the rest to BCBS and I get paperwork saying I don't owe anything. All happens in a timely manner and no mistakes that I'm aware of (however, I never see the actual bills, so I would not know about mistakes there).

I do not pay any medical bills except prescription co-pays. I don't pay co-pays at the doctor, or for lab work, or tests, or x-rays, or anything. I am very satisfied and will not change unless something better comes along.

I believe it covers international travel, but not positive. As I'm sure you know, Medicare does not.

No problems with doctors and hospitals in network. Don't have to use a primary care system etc. Doctor just has to accept Medicare assignments (and most here do).

I was previously happy with GEHA (I think before medicare) but left them because they pushed the CVS pharmacy so hard - our local CVS is crowded, slow, and has made several mistakes and I just got tired of dealing with them.
retiredjg,

Thank you very much for sharing your experience!

I spent the past two days reading about Medicare and combining it with either Blue Cross Blue Shield or GEHA. Based on my reading, apart from your personal experience, BCBS-Basic comes out better than GEHA-Standard. GEHA is a little cheaper per month, but BCBS's $600 more than compensate for it.

One reason I like GEHA is that it's not for profit. It turns out that CareFirst, a BCBS provider in the Mid-Atlantic region, is also not for profit.

Medical expenses outside the U.S. are covered by both BCBS and GEHA. BCBS has interesting provisions:
- they recommend Overseas Assistance Center (provided by GMMI, Inc) to help coordinating healthcare abroad, and
- if one receives medical services at a military installation the expenses are handled as in the U.S.
From the brochure: "For inpatient facility care you receive overseas, we provide benefits at the Preferred level under both Standard and Basic Options, without member cost-share, for admissions to a DoD facility, or when the Overseas Assistance Center (provided by GMMI, Inc.) has arranged direct billing or acceptance of a guarantee of benefits with the facility."

One question I have not been able to resolve is as follows:
In the BCBS brochure they make distinction between "preferred" providers and "participating" providers. Those with BCBS-Standard may go to "participating" providers that are not "preferred," at reduced coverage. But those with BCBS-Basic are not covered for participating providers at all. When I searched the BCBS database of providers, I did not see any distinction between "preferred" and "participating." If the database contains only preferred providers, I am curious where "participating but not preferred" providers are listed. Most likely, this is a non-issue. But I am well aware that the most reasonable assumptions sometimes backfire.

BCBS offers a curious benefit: DIY Docs:
"Members also have the opportunity to purchase a Do-It-Yourself Documents (DIY Docs) package for a low annual subscription rate. DIY Docs members receive online access to over 350 interactive, state-specific legal documents that can be customized by the member. These documents are authored and reviewed by attorneys for accuracy and to ensure they are legally valid in all 50 states. Available DIY Docs include a will, powers of attorney, bill of sale, contract, residential lease, and much more."

I don't know that the "low annual subscription rate" is, but doing one's own will and powers of attorney is a significant financial benefit.

Thanks again,
Victoria
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mrc
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Re: Why should FEHB members buy Medicare Part B?

Post by mrc » Tue Mar 19, 2019 5:27 pm

VictoriaF wrote:
Tue Mar 19, 2019 5:08 pm

One question I have not been able to resolve is as follows:
In the BCBS brochure they make distinction between "preferred" providers and "participating" providers. Those with BCBS-Standard may go to "participating" providers that are not "preferred," at reduced coverage. But those with BCBS-Basic are not covered for participating providers at all. When I searched the BCBS database of providers, I did not see any distinction between "preferred" and "participating." If the database contains only preferred providers, I am curious where "participating but not preferred" providers are listed. Most likely, this is a non-issue. But I am well aware that the most reasonable assumptions sometimes backfire.
I have wrestled with this too. It seems to be a distinction without a difference for the members in the Basic plan. In the PPO, you do not want to see a participating provider, but a preferred provider. The first P is preferred, not participating. It's their terminology, but they do not define well what a preferred provider is. When you call a new office be sure they are Preferred.

https://custserv.fepblue.org/eservice/glossary.html
PROVIDER TYPE

Each local Blue Cross and Blue Shield Plan can contract with providers in its service area. There are two types of professional contracting providers, Preferred and Participating and two types of contracting facilities, Preferred or Member. If providers do not contract with the Plan, they are considered to be non-participating or non-member.
The 2019 Brochure (p. 13)

Non-preferred providers. This is a PPO-only contract. There are no benefits for care performed by Non-preferred providers (Participating/Non-participating) or Non-preferred facilities (Member/Non-member). Y ou must use Preferred providers in order to receive benefits. See page 18 for the exceptions to this requirement.
If I didn't know better, I would say this obfuscation was deliberate. Just remember, the title of the plan (on the cover of the brochure: A Fee-For-Service Plan (Standard and Basic Option) with a Preferred Provider Organization
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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Tue Mar 19, 2019 5:29 pm

4nwestsaylng wrote:
Mon Mar 18, 2019 3:36 pm
That's when I transferred to GEHA Standard. It is unfortunate that it does not help with the Part B Medicare premium, but I have been happy with GEHA and have not looked at BCBS or other alternatives. Is BCBS more accepted by doctors? I get a checkup annually at one of the top medical schools in the country, and have had no problem with GEHA being accepted, along with Medicare.
I live in the Washington D.C. metro area. I found all my doctors in the BCBS network. I also checked some hospitals in case I need some special care in the future. BCBS covers:
• George Wash Univ, Washington, DC - Blue Distinction Center, Blue Distinction Center+
• Georgetown Univ, Washington, DC - Blue Distinction Center
• Virginia Hospital Center, Arlington, VA - Blue Distinction Center, Blue Distinction Center+
• Johns Hopkins Hospital, Baltimore, MD - Blue Distinction Center
• Mayo Clinic, Rochester, MN – yes
• Memorial Sloan Kettering Cancer Center, NY, NY - Blue Distinction Center
• New York Presbyterian Hosp, NY, NY - Blue Distinction Center
• Cleveland Clinic, Cleveland, OH - Blue Distinction Center, Blue Distinction Center

4nwestsaylng wrote:
Mon Mar 18, 2019 3:36 pm
Since the FEHB plans include younger people, I suspect that it is more likely that more doctors over time may actually drop or limit taking on new Medicare patients, instead of limiting BCBS or GEHA or Aetna patients. In the FEHB plans, they can't selectively drop older people in the plans, but in Medicare, many practices are now not taking on new Medicare patients due to fee limits. They need to keep a patient mix of all ages to stay financially viable. With the FEHB plans, you stay in that diversfied patient mix as a retiree.
Good point. Note however, that if you have both Medicare Part B and FEHB, you should go to doctors that accept Medicare, or your coverage will be lower.
4nwestsaylng wrote:
Mon Mar 18, 2019 3:36 pm
I can see that people who are able to keep income at or below $85 k in retirement, can have a reasonable premium with Part B, but over time, $85K is not what it used to be, and the IRMAA tiers are not only not inflation adjusted, but as I pointed out, were arbitrarily bumped up last year, and this could happen again. Also note that anyone paying IRMAA does not receive the COLA protection that Medicare rates cannot exceed the SS COLA; Medicare can raise the IRMAA rates any amount they want, there is no COLA restriction.

So if you are going to have a RMD of $30k, SS in the 30's and some dividend/interest income, you are going to be in an IRMAA bracket,probably indefinitely, even without doing Roth conversions. And if you don't do any Roth conversions, your tax deferred accounts are going to grow, the RMD will grow over time, and current federal marginal tax rates are due to "sunset" in 2025.

I am not betting that after 2025 they will be renewed. I am reading David McKnight's small book, "The Power of Zero". It overstates the opportunity to reduce your taxes, but it does make a strong case that current federal marginal tax rates constitute a temporary "sale" that should be taken advantage of to do Roth conversions.
I am aggressively converting to Roth. I started large conversions as soon as I retired and I plan to complete them by the time I am 70. I won't have RMDs and will stay in the lowest Medicare Part B band, except the first year on Medicare.

4nwestsaylng wrote:
Mon Mar 18, 2019 3:36 pm
I think if I want to do more Roth conversions, I will have to drop Part B. I may look at BCBS or Aetna FEHB. Apart from some help with Medicare B premium, do you see any advantages of these two over GEHA Standard?
I reviewed BCBS and GEHA brochures, but not Aetna. I paid attention to certain things, but I did not conduct a detailed comparative analysis. Based on my high-level review, it seems that BCBS has a more flexible international coverage and a better pharmacy coverage. The annual out-of-pocket maximum is $5,500 for BCBS-Basic and $6,500 for GEHA-Standard. OPM provides a plan comparison tool at https://www.opm.gov/healthcare-insuranc ... are-plans/ , and the thing that stood out was that BCBS has an excellent customer service.

Victoria
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Re: Why should FEHB members buy Medicare Part B?

Post by HueyLD » Tue Mar 19, 2019 5:32 pm

On the fepblue.org site, the "Find a Preferred Provider" means just that. Preferred, not anything else.

https://www.fepblue.org/find-a-Doctor

Also make sure the provider accepts Medicare assignment.

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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Tue Mar 19, 2019 5:41 pm

mrc wrote:
Tue Mar 19, 2019 5:27 pm
If I didn't know better, I would say this obfuscation was deliberate. Just remember, the title of the plan (on the cover of the brochure: A Fee-For-Service Plan (Standard and Basic Option) with a Preferred Provider Organization
Interesting references. Thanks!

Right now I have GEHA-HDHP, and my first question was if my current healthcare providers would be covered under BCBS-Basic. The brochure tells you to use BC/BS National Doctor & Hospital Finder at www.fepblue.org/provider/ . The link redirects you to https://www.fepblue.org/find-a-doctor?u ... ium=vanity where you have several options, one of which is “Find a preferred provider.” When you click on it, you get to https://provider.fepblue.org/app/public ... ProductId=

Once you are in the provider search area, there is no indication of whether the provider is preferred or merely participating. However, I am hoping that since I have clicked on "Find a preferred provider", everyone listed here is indeed preferred.

Victoria
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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Tue Mar 19, 2019 5:47 pm

HueyLD wrote:
Tue Mar 19, 2019 5:32 pm
On the fepblue.org site, the "Find a Preferred Provider" means just that. Preferred, not anything else.

https://www.fepblue.org/find-a-Doctor

Also make sure the provider accepts Medicare assignment.
I used a slightly different link but came to the same conclusions. Thank you.

By the way, both BCBS and GEHA warn you against doctors offering to sign a private contract. From the BCBS brochure:
"NOTE ABOUT PRIVATE CONTRACTS
A provider may ask you to sign a contract asking you to agree to them billing you directly for services usually covered by Medicare. We do not recommend you sign a contract like this. If you do, Medicare will not cover your service. We’ll only pay the amount we would’ve paid had Medicare paid their portion. You’ll have to pay the additional charges."

Victoria
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Re: Why should FEHB members buy Medicare Part B?

Post by HueyLD » Tue Mar 19, 2019 5:51 pm

I have been helping a family member transitioning into Medicare and FEHB BCBS-Basic and have lots of experience with the system.

The very important steps to follow are:

(1) Get on the fepblue.org site to check the preferred status of a provider.

(2) Call the provider's office and ask two questions:

....(A). Does the provider accept Medicare assignment?

....(B). Is the provider a preferred provider for federal employee BCBS?

That's all.

P.s. Have never been asked to sign any private contract. Just say no.

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Re: Why should FEHB members buy Medicare Part B?

Post by 4nwestsaylng » Tue Mar 19, 2019 10:35 pm

VictoriaF wrote:
Tue Mar 19, 2019 5:47 pm
HueyLD wrote:
Tue Mar 19, 2019 5:32 pm
On the fepblue.org site, the "Find a Preferred Provider" means just that. Preferred, not anything else.

https://www.fepblue.org/find-a-Doctor

Also make sure the provider accepts Medicare assignment.
I used a slightly different link but came to the same conclusions. Thank you.

By the way, both BCBS and GEHA warn you against doctors offering to sign a private contract. From the BCBS brochure:
"NOTE ABOUT PRIVATE CONTRACTS
A provider may ask you to sign a contract asking you to agree to them billing you directly for services usually covered by Medicare. We do not recommend you sign a contract like this. If you do, Medicare will not cover your service. We’ll only pay the amount we would’ve paid had Medicare paid their portion. You’ll have to pay the additional charges."

Victoria
However, if you had only the FEHB plan and no Medicare to get in the way, I suspect that the plan would pay its usual amount, and you would come up with the copay plus any additional charge. Thus in this situation having Part B lets the FEHB plan largely off the hook.

Private contracts may not be that common in many areas, but increasingly in expensive urban areas such as Silicon Valley,some top doctors have gone "boutique" in mid-career or, increasingly in their 30's after burn-out with a local hospital controlled PPO or HMO. I would not personally choose a private contract unless the alternatives were not good,but again it may be that Medicare is more restrictive than FEHB alone.

Or, what if I wanted to move to Canada or live there for six months a year? Medicare pays nothing, whereas the FEHB plans will still provide coverage.

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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Wed Mar 20, 2019 9:07 am

4nwestsaylng wrote:
Tue Mar 19, 2019 10:35 pm
However, if you had only the FEHB plan and no Medicare to get in the way, I suspect that the plan would pay its usual amount, and you would come up with the copay plus any additional charge. Thus in this situation having Part B lets the FEHB plan largely off the hook.

Private contracts may not be that common in many areas, but increasingly in expensive urban areas such as Silicon Valley,some top doctors have gone "boutique" in mid-career or, increasingly in their 30's after burn-out with a local hospital controlled PPO or HMO. I would not personally choose a private contract unless the alternatives were not good,but again it may be that Medicare is more restrictive than FEHB alone.

Or, what if I wanted to move to Canada or live there for six months a year? Medicare pays nothing, whereas the FEHB plans will still provide coverage.
Good points.

My approach to healthcare is as follows:
1. my health is my highest priority
2. I will pay what I can afford
3. I will save where savings do not have health impacts, and
4. I will avoid catastrophic expenses.

By carrying both FEHB and Medicare Part B, I will pay what I can afford (2), and avoid catastrophic expenses (4). By analyzing BCBS and GEHA plans, I will chose a slightly cheaper option (3), without consequences to my health (1), or incurring catastrophic expenses (4).

If I find a doctor or a treatment that has a good chance to improve my health (1), I'll pay out of pocket what I can afford (2), without incurring catastrophic expenses (4).

It's conceivable that I may overpay for boutique doctors and treatments because I will have Medicare Part B.
It's also conceivable that I will avoid catastrophic expenses if I get emergency treatment at a non-participating facility.

Victoria
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Re: Why should FEHB members buy Medicare Part B?

Post by 4nwestsaylng » Wed Mar 20, 2019 3:47 pm

VictoriaF wrote:
Wed Mar 20, 2019 9:07 am
4nwestsaylng wrote:
Tue Mar 19, 2019 10:35 pm
However, if you had only the FEHB plan and no Medicare to get in the way, I suspect that the plan would pay its usual amount, and you would come up with the copay plus any additional charge. Thus in this situation having Part B lets the FEHB plan largely off the hook.

Private contracts may not be that common in many areas, but increasingly in expensive urban areas such as Silicon Valley,some top doctors have gone "boutique" in mid-career or, increasingly in their 30's after burn-out with a local hospital controlled PPO or HMO. I would not personally choose a private contract unless the alternatives were not good,but again it may be that Medicare is more restrictive than FEHB alone.

Or, what if I wanted to move to Canada or live there for six months a year? Medicare pays nothing, whereas the FEHB plans will still provide coverage.
Good points.

My approach to healthcare is as follows:
1. my health is my highest priority
2. I will pay what I can afford
3. I will save where savings do not have health impacts, and
4. I will avoid catastrophic expenses.

By carrying both FEHB and Medicare Part B, I will pay what I can afford (2), and avoid catastrophic expenses (4). By analyzing BCBS and GEHA plans, I will chose a slightly cheaper option (3), without consequences to my health (1), or incurring catastrophic expenses (4).

If I find a doctor or a treatment that has a good chance to improve my health (1), I'll pay out of pocket what I can afford (2), without incurring catastrophic expenses (4).

It's conceivable that I may overpay for boutique doctors and treatments because I will have Medicare Part B.
It's also conceivable that I will avoid catastrophic expenses if I get emergency treatment at a non-participating facility.

Victoria
Victoria, I totally agree. I know that if I just had GEHA Standard, my current maximal out of pocket for the year is $7500, but in a few years it could be $10,000, who knows? So there is more uncertainty, and I can see that there is more peace of mind just paying for FEHB and Part B, and if at some point in the future, Part B just becomes onerous and restrictive, there is always the option to drop it and stay with FEHB. I think if we just pay these premiums on auto pay from our accounts, we are covered, and the rest of our budget works around that for everything else :D

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Re: Why should FEHB members buy Medicare Part B?

Post by delamer » Wed Mar 20, 2019 7:10 pm

4nwestsaylng wrote:
Wed Mar 20, 2019 3:47 pm
VictoriaF wrote:
Wed Mar 20, 2019 9:07 am
4nwestsaylng wrote:
Tue Mar 19, 2019 10:35 pm
However, if you had only the FEHB plan and no Medicare to get in the way, I suspect that the plan would pay its usual amount, and you would come up with the copay plus any additional charge. Thus in this situation having Part B lets the FEHB plan largely off the hook.

Private contracts may not be that common in many areas, but increasingly in expensive urban areas such as Silicon Valley,some top doctors have gone "boutique" in mid-career or, increasingly in their 30's after burn-out with a local hospital controlled PPO or HMO. I would not personally choose a private contract unless the alternatives were not good,but again it may be that Medicare is more restrictive than FEHB alone.

Or, what if I wanted to move to Canada or live there for six months a year? Medicare pays nothing, whereas the FEHB plans will still provide coverage.
Good points.

My approach to healthcare is as follows:
1. my health is my highest priority
2. I will pay what I can afford
3. I will save where savings do not have health impacts, and
4. I will avoid catastrophic expenses.

By carrying both FEHB and Medicare Part B, I will pay what I can afford (2), and avoid catastrophic expenses (4). By analyzing BCBS and GEHA plans, I will chose a slightly cheaper option (3), without consequences to my health (1), or incurring catastrophic expenses (4).

If I find a doctor or a treatment that has a good chance to improve my health (1), I'll pay out of pocket what I can afford (2), without incurring catastrophic expenses (4).

It's conceivable that I may overpay for boutique doctors and treatments because I will have Medicare Part B.
It's also conceivable that I will avoid catastrophic expenses if I get emergency treatment at a non-participating facility.

Victoria
Victoria, I totally agree. I know that if I just had GEHA Standard, my current maximal out of pocket for the year is $7500, but in a few years it could be $10,000, who knows? So there is more uncertainty, and I can see that there is more peace of mind just paying for FEHB and Part B, and if at some point in the future, Part B just becomes onerous and restrictive, there is always the option to drop it and stay with FEHB. I think if we just pay these premiums on auto pay from our accounts, we are covered, and the rest of our budget works around that for everything else :D
My thought was just the opposite — save the premium cost now and purchase Medicare Part B in the future if needed, when our health is more likely to have deteriorated.

With a couple, I wonder if there would be any issue with one opting for Part B and the other not, if one spouse had significantly worse health? I don’t see why it should be...

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Re: Why should FEHB members buy Medicare Part B?

Post by TimeRunner » Wed Mar 20, 2019 7:26 pm

Health deterioration can also be cognitive. One advantage of having Medicare Part B along with FEHB is that Medicare B is primary and will bill your FEHB plan, which, if you select one, will pick up the rest of the bill (prescription drugs and other exclusions apply). Without Part B, you or your personal finance manager (heh) will be responsible for tracking insurance billings and reimbursements, paying providers the remainder, etc. Easy to do now, perhaps not so easy down the road.
One cannot enlighten the unconscious.

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Re: Why should FEHB members buy Medicare Part B?

Post by ChrisC » Wed Mar 20, 2019 9:22 pm

TimeRunner wrote:
Wed Mar 20, 2019 7:26 pm
Health deterioration can also be cognitive. One advantage of having Medicare Part B along with FEHB is that Medicare B is primary and will bill your FEHB plan, which, if you select one, will pick up the rest of the bill (prescription drugs and other exclusions apply). Without Part B, you or your personal finance manager (heh) will be responsible for tracking insurance billings and reimbursements, paying providers the remainder, etc. Easy to do now, perhaps not so easy down the road.
I've managed Federal retiree health care coverage for my MIL and BIL the last few years. (My wife and I have FEHB coverage as well, with one of us opting into Medicare Part B and the other declining Part B, for reasons I discussed earlier.) With my MIL and BIL both of them became single after a spouse departed, one by leaving the earth, the other by leaving the marriage.

My MIL had a very expensive FEHB Plan (high option APWU) along with Medicare Parts A and B. She was very old school -- just stuck with the same FEHB plan she had when she retired in 1980 until she passed in 2017 at 98. Her medical care became quite expensive her last few years; she was of sound mind till the end, and with her overlapping health insurance coverage, there were still major gaps in some coverage; for example, emergency ambulance costs, which became frequent her last few years, weren't always covered by Medicare and FEHB. We still had to review EOB and Medicare Summaries. So, it just wasn't as "easy" as you appear to think it would be. And of course, medical insurance simply did not cover her slide into home care and later into an assisted living.

We took my BIL, who has MS, off his expensive high option plan (MD IPA) and steered him into BCBS-Basic a few years ago when they offered the $600 reumbursement for Medicare A & B enrollment. Under both FEHB and Medicare coverage, we still have some gaps, including some mobility transportation costs and some rehabilitative servcies. He also needed some durable medical equipment, and it became a pain to search and find Medicare providers and go thru the hurdles associated with getting approval for some equipment. Moreover, we have one provider for some of his therapies that continues to file Medicare appeal claims whenever BCBS appears to be late with paying the Medicare co=payments, Nonetheless, he paid no out-of-pocket for his expensive MS infusions and two knee replacement surgeries -- the $42K in annual assisted living costs is another story, however, and when he progresses to skilled nursing care, the $8K in monthly charges ($96K annually) for skilled nursing care will be met by his pension, Social Secruity retirement benefits and our savings.

The idea that with FEHB and Medicare B that this is a cake walk through paying providers or dealing with claims might be true for those with little medical or health care issues. I think when the health care becomes more difficult to manage, so does the health care insurance coverage, whether you have FEHB plans and Medicare Part B, or simply a good FEHB plan with OOP limits.

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Re: Why should FEHB members buy Medicare Part B?

Post by TimeRunner » Wed Mar 20, 2019 9:33 pm

ChrisC, thanks for sharing your experiences. FEHB seems to be s l o w l y improving FEHB plan coordination with Medicare. Let's hope that progress continues.
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Re: Why should FEHB members buy Medicare Part B?

Post by Yooper16 » Wed Mar 20, 2019 9:59 pm

A bit of pen to paper doodlings, has it costing us about $100 per month combined when we take Part B and keep FEHB. Only a tad more than what our car insurance and liablilty umbrella is for the year. Hope we never have to use the car insurance, pretty sure we will be using Mdicare and FEHB.

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Re: Why should FEHB members buy Medicare Part B?

Post by ChrisC » Wed Mar 20, 2019 10:25 pm

Yooper16 wrote:
Wed Mar 20, 2019 9:59 pm
A bit of pen to paper doodlings, has it costing us about $100 per month combined when we take Part B and keep FEHB. Only a tad more than what our car insurance and liablilty umbrella is for the year. Hope we never have to use the car insurance, pretty sure we will be using Mdicare and FEHB.
How do you figure that? Part B, basic premium is now $135.40 per month. My wife now pays $270.90; she would have paid $352 per month but for harvesting some tax losses. It can get very expensive for two -- this isn't rocket science in calculating premium costs. https://www.medicare.gov/your-medicare- ... rt-b-costs

I do think having Part B and FEHB might make some sense if you're paying just the basic premium for Part B. But if you're in high IRMAA land, it strikes me that paying $352 or $433 per month in Part B premiums (tiers IV and V) could be considered by many as flushing money down the drain given the fact that the FEHB is very good stand-alone coverage -- it's the coverage we all basically had when we were employed. I get the idea that as we get older, we're likely to use our coverage more. However, FEHB plans do have catastrophic or OOP limits!

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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Thu Mar 21, 2019 8:12 am

ChrisC wrote:
Wed Mar 20, 2019 9:22 pm
We took my BIL, who has MS, off his expensive high option plan (MD IPA) and steered him into BCBS-Basic a few years ago when they offered the $600 reimbursement for Medicare A & B enrollment.
Chris,

Thank you very much for real-life scenarios. When you were changing your BIL's insurance, was the $600 the determining factor? Have you considered, and rejected, BCBS-Standard?

I am wondering why BCBS is not providing any incentives for BCBS-Standard in combination with Medicare Part B.

Victoria
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Re: Why should FEHB members buy Medicare Part B?

Post by Yooper16 » Thu Mar 21, 2019 9:19 am

ChrisC wrote:
Wed Mar 20, 2019 10:25 pm
Yooper16 wrote:
Wed Mar 20, 2019 9:59 pm
A bit of pen to paper doodlings, has it costing us about $100 per month combined when we take Part B and keep FEHB. Only a tad more than what our car insurance and liablilty umbrella is for the year. Hope we never have to use the car insurance, pretty sure we will be using Mdicare and FEHB.
How do you figure that? Part B, basic premium is now $135.40 per month. My wife now pays $270.90; she would have paid $352 per month but for harvesting some tax losses. It can get very expensive for two -- this isn't rocket science in calculating premium costs. https://www.medicare.gov/your-medicare- ... rt-b-costs

I do think having Part B and FEHB might make some sense if you're paying just the basic premium for Part B. But if you're in high IRMAA land, it strikes me that paying $352 or $433 per month in Part B premiums (tiers IV and V) could be considered by many as flushing money down the drain given the fact that the FEHB is very good stand-alone coverage -- it's the coverage we all basically had when we were employed. I get the idea that as we get older, we're likely to use our coverage more. However, FEHB plans do have catastrophic or OOP limits!

OOPs I subtracted the wrong the wrong premium--- subtracted our present FEHB rather than the Part B.

We won't be paying IRMAA as our combined income in retirement is going to be around 90k(using 4% SWR) at present, which is 30k more than we really need other than we are remodeling this old house. Includes CSRS pension, 1 SS and 1 private pension if I start them next year at 65.5 to 66

New Math

Aetna Direct plus Medicare B === 575 per month x 12 = 6900 minus HRA paid by Aetna 1800 === 5100
removing Medicare B for both is 270 per month yearly is - 3240

Remaining difference is about 1860 per year or approx. 150 per month less in premiums if we don't take part B. We can be reimbursed for part B premiums from HRA

But our present FEHB, Aetna Direct and surely others waive all deductibles, copays(except RX) when you have part B and using Medicare assignement providers.

Yep, I agree that the higher B premiums would put a different spin on things.

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Re: Why should FEHB members buy Medicare Part B?

Post by ChrisC » Thu Mar 21, 2019 3:39 pm

VictoriaF wrote:
Thu Mar 21, 2019 8:12 am
ChrisC wrote:
Wed Mar 20, 2019 9:22 pm
We took my BIL, who has MS, off his expensive high option plan (MD IPA) and steered him into BCBS-Basic a few years ago when they offered the $600 reimbursement for Medicare A & B enrollment.
Chris,

Thank you very much for real-life scenarios. When you were changing your BIL's insurance, was the $600 the determining factor? Have you considered, and rejected, BCBS-Standard?

I am wondering why BCBS is not providing any incentives for BCBS-Standard in combination with Medicare Part B.

Victoria
We changed to BCBS-Basic primarily because we (1) had a good track record with them several years ago before my wife and I went to a HDHP; (2) didn't really consider standard because in the past, standard was always more expensive than basic which served our needs; (3) the $600 was helpful but not determinative -- Aetna Direct provides a $900 incentive but we didn't go with them because we had some prior issues with them, as the prior Plan Administrator, Coventry, treated some procedures as experimental and not fully covered. For BIL, we needed network providers recognized both in Virginia and North Carolina, where my BIL currently resides after a move down here. BCBS has a wide array of providers.

I think BCBS-Basic is competing directly with the Aetna Direct product, which is the trend setter in this area. It might be the case that the other insurance plans don't have a major Medicare patient base and thus do not have to offer incentives. Who knows?

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Re: Why should FEHB members buy Medicare Part B?

Post by MichDad » Fri Mar 22, 2019 6:22 am

This is a very important thread and I thank all who have shared their experiences and thoughts. I'm 63 years old so I'll need to make this decision in the not-too-distant future.

At present, my wife and I live and travel abroad more than eight months each year. Medicare does not cover medical expenses incurred outside the USA. In addition, I believe if we opted for Medicare Part B coverage, our monthly premiums would be high. Given this, my present inclination is to not opt into Medicare Part B. For what it's worth, we're enrolled in GEHA's HDHP and we like it very much.

I'll continue to monitor this thread and will reevaluate this next year.

MichDad

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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Fri Mar 22, 2019 7:52 am

ChrisC wrote:
Thu Mar 21, 2019 3:39 pm
We changed to BCBS-Basic primarily because we (1) had a good track record with them several years ago before my wife and I went to a HDHP; (2) didn't really consider standard because in the past, standard was always more expensive than basic which served our needs; (3) the $600 was helpful but not determinative -- Aetna Direct provides a $900 incentive but we didn't go with them because we had some prior issues with them, as the prior Plan Administrator, Coventry, treated some procedures as experimental and not fully covered. For BIL, we needed network providers recognized both in Virginia and North Carolina, where my BIL currently resides after a move down here. BCBS has a wide array of providers.

I think BCBS-Basic is competing directly with the Aetna Direct product, which is the trend setter in this area. It might be the case that the other insurance plans don't have a major Medicare patient base and thus do not have to offer incentives. Who knows?
Thank you, Chris,

As I wrote earlier, I am looking for an FEHB plan on the border between foolish economizing and unnecessary overspending. It seems that BCBS-Basic is a good fit (in conjunction with Medicare Part B).

Victoria
WINNER of the 2015 Boglehead Contest. | Every joke has a bit of a joke. ... The rest is the truth. (Marat F)

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Re: Why should FEHB members buy Medicare Part B?

Post by cleosdad » Fri Mar 22, 2019 10:08 am

MichDad wrote:
Fri Mar 22, 2019 6:22 am
This is a very important thread and I thank all who have shared their experiences and thoughts. I'm 63 years old so I'll need to make this decision in the not-too-distant future.

At present, my wife and I live and travel abroad more than eight months each year. Medicare does not cover medical expenses incurred outside the USA. In addition, I believe if we opted for Medicare Part B coverage, our monthly premiums would be high. Given this, my present inclination is to not opt into Medicare Part B. For what it's worth, we're enrolled in GEHA's HDHP and we like it very much.

I'll continue to monitor this thread and will reevaluate this next year.

MichDad
Hi Victoria, I have used GEHA basic and Medicare A/B for a number of years andhave been very happy and never pay out of pocket.

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Re: Why should FEHB members buy Medicare Part B?

Post by delamer » Fri Mar 22, 2019 10:31 am

cleosdad wrote:
Fri Mar 22, 2019 10:08 am
MichDad wrote:
Fri Mar 22, 2019 6:22 am
This is a very important thread and I thank all who have shared their experiences and thoughts. I'm 63 years old so I'll need to make this decision in the not-too-distant future.

At present, my wife and I live and travel abroad more than eight months each year. Medicare does not cover medical expenses incurred outside the USA. In addition, I believe if we opted for Medicare Part B coverage, our monthly premiums would be high. Given this, my present inclination is to not opt into Medicare Part B. For what it's worth, we're enrolled in GEHA's HDHP and we like it very much.

I'll continue to monitor this thread and will reevaluate this next year.

MichDad
Hi Victoria, I have used GEHA basic and Medicare A/B for a number of years andhave been very happy and never pay out of pocket.
Several people have mentioned the “never pay out of pocket” angle.

But if you pay an additional $1600 in premiums a year for Part B to avoid $1000 in co-pays — for example —that is a pretty high price.

I understand that there are good reasons to take Part B and FEHB, but not paying anything out-of-pocket isn’t necessarily going to be one of them.

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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Fri Mar 22, 2019 11:09 am

cleosdad wrote:
Fri Mar 22, 2019 10:08 am
Hi Victoria, I have used GEHA basic and Medicare A/B for a number of years and have been very happy and never pay out of pocket.
Hi Cleosdad,

Thank you for the data point,

Victoria
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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Fri Mar 22, 2019 11:21 am

delamer wrote:
Fri Mar 22, 2019 10:31 am

But if you pay an additional $1600 in premiums a year for Part B to avoid $1000 in co-pays — for example —that is a pretty high price.

I understand that there are good reasons to take Part B and FEHB, but not paying anything out-of-pocket isn’t necessarily going to be one of them.
I agree that not having to pay out-of-packet is not a requirement for selecting health insurance plans. My requirements include the following:

1. Health insurance must have a cap on the maximum annual expenses.
2. The insurance should enable you to continue using your current medical providers.
3. If your needs change, the insurance must allow you using premier medical centers such as Johns Hopkins or Mayo Clinic.
4. Reasonable coverage outside the U.S.
5. Reasonable coverage of pharmaceutical drugs.
6. If you have an emergency, and an ambulance delivers you to an out-of-network center, you should not have to pay tens of thousands of dollars in out-of-network costs.
7. You should anticipate future changes in health insurance, both in FEHB and Medicare.

Items 1 through 6 can be evaluated today.
Item 7 requires assessment of future risks. My preference is to get somewhat overlapping coverage and pay a little more now as a risk mitigation measure.

Victoria
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Re: Why should FEHB members buy Medicare Part B?

Post by mrc » Fri Mar 22, 2019 2:31 pm

delamer wrote:
Fri Mar 22, 2019 10:31 am

Several people have mentioned the “never pay out of pocket” angle.

But if you pay an additional $1600 in premiums a year for Part B to avoid $1000 in co-pays — for example —that is a pretty high price.

I understand that there are good reasons to take Part B and FEHB, but not paying anything out-of-pocket isn’t necessarily going to be one of them.
That idea works out well for the early years. But if a major health issue arises, having both plans becomes cost effective. Waiting until you are older/sicker won't work well with Medicare b/c of the delayed sign up penalty.

For cash flow purposes, even as relatively healthy light users at present, the $1600 level payment every year is more predictable (easier to budget for), and is the same whether there is one primary care visit in a year, or two major surgeries.

In our case, the cost of Selt+1 BCBS Basic plus one Part B (no IRMAA) is $2200 less than the cost of Self+1 Standard without Medicare. That is before the Part B $600 rebate. This is a no-brainier in some cases.
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Re: Why should FEHB members buy Medicare Part B?

Post by delamer » Fri Mar 22, 2019 2:38 pm

mrc wrote:
Fri Mar 22, 2019 2:31 pm
delamer wrote:
Fri Mar 22, 2019 10:31 am

Several people have mentioned the “never pay out of pocket” angle.

But if you pay an additional $1600 in premiums a year for Part B to avoid $1000 in co-pays — for example —that is a pretty high price.

I understand that there are good reasons to take Part B and FEHB, but not paying anything out-of-pocket isn’t necessarily going to be one of them.
That idea works out well for the early years. But if a major health issue arises, having both plans becomes cost effective. Waiting until you are older/sicker won't work well with Medicare b/c of the delayed sign up penalty.

For cash flow purposes, even as relatively healthy light users at present, the $1600 level payment every year is more predictable (easier to budget for), and is the same whether there is one primary care visit in a year, or two major surgeries.

In our case, the cost of Selt+1 BCBS Basic plus one Part B (no IRMAA) is $2200 less than the cost of Self+1 Standard without Medicare. That is before the Part B $600 rebate. This is a no-brainier in some cases.
Of course the decision will vary based on individual (or family) circumstances.

But my point was that some people are very happy to not have co-pays and deductibles but don’t acknowledge that there is a significant premium cost paid to not have those fees.

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Re: Why should FEHB members buy Medicare Part B?

Post by Yooper16 » Fri Mar 22, 2019 3:15 pm

The idea of not doing Part B was very much on the table.

Our self plus 1 of National Rural Letter Carriers is 335/mo well below most all other FEHB policies. It is consistently rated as one of the top 1 or 2 FEHB plans by Consumer Checkpoint for cost and benefit.

Ended up deciding that getting in at 2019 ground level $ for Medicare B was worth the shortterm additional cost for possible/probably longterm asset protection.

We retired---shouldn't have to think so hard! :sharebeer

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Re: Why should FEHB members buy Medicare Part B?

Post by 4nwestsaylng » Fri Mar 22, 2019 3:44 pm

I am going to stay with Part B for now, precisely because of Victoria's point of overlapping security, but if I stay in high IRMMA brackets I may reconsider in the future, since I did save $55k in my HSA when I had the GEHA HDHP. Now that the HSA is with Fidelity, I need to look at the investment choices, it is currently sitting in Fidelity Cash Reserves.

Hope to see some choices other BHds have made with this new Fidelity HSA.

I was happy with GEHA HDHP< and am in GEHA Standard now. My premium is $127 a month. They don't give any rebate to help with Medicare Part B, whereas I think BCBS Basic pays $600. But if the BCBS premium is $30 a month higher, the real BCBS subsidy is more like $240 net. If I see any problem with GEHA being accepted, then I would reconsider, but with Medicare B accepted with most providers, I have not had a problem.

I think it is very important that one have Original Medicare, so that you can directly go to a specialist if you want.That is a big deal when you need it.

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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Fri Mar 22, 2019 5:47 pm

4nwestsaylng wrote:
Fri Mar 22, 2019 3:44 pm
I am going to stay with Part B for now, precisely because of Victoria's point of overlapping security, but if I stay in high IRMMA brackets I may reconsider in the future, since I did save $55k in my HSA when I had the GEHA HDHP. Now that the HSA is with Fidelity, I need to look at the investment choices, it is currently sitting in Fidelity Cash Reserves.

Hope to see some choices other BHds have made with this new Fidelity HSA.

I was happy with GEHA HDHP< and am in GEHA Standard now. My premium is $127 a month. They don't give any rebate to help with Medicare Part B, whereas I think BCBS Basic pays $600. But if the BCBS premium is $30 a month higher, the real BCBS subsidy is more like $240 net. If I see any problem with GEHA being accepted, then I would reconsider, but with Medicare B accepted with most providers, I have not had a problem.

I think it is very important that one have Original Medicare, so that you can directly go to a specialist if you want.That is a big deal when you need it.
For a single person:
GEHA-Standard = $127.36/month x 12 = $1,528.32/year
BCBS-Basic = $159.74/month x 12 = $1,916.88/year - $600 = $1,319.88/year
A single person is saving $208.44/year in premiums with BCBS-Basic.

Annual maximum:
GEHA-Standard = $6,500
BCBS-Basic = $5,500
Thus, there is a potential saving of $1,000/year in the worst years.

Pharmaceutical and international coverage are comparable, but one should check his or her specific prescriptions.

Potential issue:
GEHA-Standard - compensates for non-preferred providers (less than preferred)
BCBS-Basic - does not compensate for non-preferred providers
Most providers I've checked are "preferred" by BCBS-Basic.

NOTE that you can use your HSA funds to pay for Medicare and FEHB premiums.

Victoria
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Re: Why should FEHB members buy Medicare Part B?

Post by hale2 » Fri Mar 22, 2019 8:53 pm

VictoriaF wrote:
Fri Mar 22, 2019 5:47 pm
4nwestsaylng wrote:
Fri Mar 22, 2019 3:44 pm
I am going to stay with Part B for now, precisely because of Victoria's point of overlapping security, but if I stay in high IRMMA brackets I may reconsider in the future, since I did save $55k in my HSA when I had the GEHA HDHP. Now that the HSA is with Fidelity, I need to look at the investment choices, it is currently sitting in Fidelity Cash Reserves.

Hope to see some choices other BHds have made with this new Fidelity HSA.

I was happy with GEHA HDHP< and am in GEHA Standard now. My premium is $127 a month. They don't give any rebate to help with Medicare Part B, whereas I think BCBS Basic pays $600. But if the BCBS premium is $30 a month higher, the real BCBS subsidy is more like $240 net. If I see any problem with GEHA being accepted, then I would reconsider, but with Medicare B accepted with most providers, I have not had a problem.

I think it is very important that one have Original Medicare, so that you can directly go to a specialist if you want.That is a big deal when you need it.
For a single person:
GEHA-Standard = $127.36/month x 12 = $1,528.32/year
BCBS-Basic = $159.74/month x 12 = $1,916.88/year - $600 = $1,319.88/year
A single person is saving $208.44/year in premiums with BCBS-Basic.

Annual maximum:
GEHA-Standard = $6,500
BCBS-Basic = $5,500
Thus, there is a potential saving of $1,000/year in the worst years.

Pharmaceutical and international coverage are comparable, but one should check his or her specific prescriptions.

Potential issue:
GEHA-Standard - compensates for non-preferred providers (less than preferred)
BCBS-Basic - does not compensate for non-preferred providers
Most providers I've checked are "preferred" by BCBS-Basic.

NOTE that you can use your HSA funds to pay for Medicare and FEHB premiums.

Victoria
I spent several years in the DC area and had BCBS basic, as did many friends and relatives (some of whom were retired). I don't recall a situation when anyone complained that a provider (including specialists) they wanted was not a preferred provider. I know it's just one data point, but it seemed that it was a very popular plan in the area so there are a lot of providers there.

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Re: Why should FEHB members buy Medicare Part B?

Post by ChrisC » Fri Mar 22, 2019 10:33 pm

VictoriaF wrote:
Fri Mar 22, 2019 5:47 pm
4nwestsaylng wrote:
Fri Mar 22, 2019 3:44 pm
I am going to stay with Part B for now, precisely because of Victoria's point of overlapping security, but if I stay in high IRMMA brackets I may reconsider in the future, since I did save $55k in my HSA when I had the GEHA HDHP. Now that the HSA is with Fidelity, I need to look at the investment choices, it is currently sitting in Fidelity Cash Reserves.

Hope to see some choices other BHds have made with this new Fidelity HSA.

I was happy with GEHA HDHP< and am in GEHA Standard now. My premium is $127 a month. They don't give any rebate to help with Medicare Part B, whereas I think BCBS Basic pays $600. But if the BCBS premium is $30 a month higher, the real BCBS subsidy is more like $240 net. If I see any problem with GEHA being accepted, then I would reconsider, but with Medicare B accepted with most providers, I have not had a problem.

I think it is very important that one have Original Medicare, so that you can directly go to a specialist if you want.That is a big deal when you need it.
For a single person:
GEHA-Standard = $127.36/month x 12 = $1,528.32/year
BCBS-Basic = $159.74/month x 12 = $1,916.88/year - $600 = $1,319.88/year
A single person is saving $208.44/year in premiums with BCBS-Basic.

Annual maximum:
GEHA-Standard = $6,500
BCBS-Basic = $5,500
Thus, there is a potential saving of $1,000/year in the worst years.

Pharmaceutical and international coverage are comparable, but one should check his or her specific prescriptions.

Potential issue:
GEHA-Standard - compensates for non-preferred providers (less than preferred)
BCBS-Basic - does not compensate for non-preferred providers
Most providers I've checked are "preferred" by BCBS-Basic.

NOTE that you can use your HSA funds to pay for Medicare and FEHB premiums.

Victoria
If you're making comparisons from one plan to another, I wouldn't consider the annual maximum to be a major point, as both GEHA standard and BCBS-Basic operate as secondary insurance plans to Medicare B, and the likelihood that you'll bump against that maximum would appear very remote, as I believe the secondary insurance plans don't count Medicare deductibles or copays as part of the annual maximum/catastrophic limit. Undoubtedly, the maximum limit is important for stand-alone FEHB coverage, and when you're comparing worse case scenarios for not taking Part B coverage as against potential exposure under the stand-alone FEHB coverage.

I think you have to look around the fringes of policy coverage to discern meaningful differences. For instance, how does one plan treat dental coverage for routine check ups or do they have some coverage for oral, dental surgery; how are hearing aids covered (at one time BCBS had a major difference in its favor but I think GEHA might have caught up); do they have discounts for fitness centers or vision care; which has the better customer service ratings (personally, I find some GEHA reps to be uninformed and sometimes you're best tactic is HUCA); and then there's always network provider issues.

If you've decided to enroll in Part B, I'm not sure a yearly difference of $208 between GEHA standard and BCBS-Basic is significant.

See, generally, https://ask.fedweek.com/medicare/fehb-medicare/ for overlap of coverage between FEHB and Medicare.

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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Sat Mar 23, 2019 6:57 am

hale2 wrote:
Fri Mar 22, 2019 8:53 pm
I spent several years in the DC area and had BCBS basic, as did many friends and relatives (some of whom were retired). I don't recall a situation when anyone complained that a provider (including specialists) they wanted was not a preferred provider. I know it's just one data point, but it seemed that it was a very popular plan in the area so there are a lot of providers there.
Thank you, hale2,

It seems that you have more than one data point if you include your friends and relatives.

Victoria
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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Sat Mar 23, 2019 7:16 am

ChrisC wrote:
Fri Mar 22, 2019 10:33 pm
If you're making comparisons from one plan to another, I wouldn't consider the annual maximum to be a major point, as both GEHA standard and BCBS-Basic operate as secondary insurance plans to Medicare B, and the likelihood that you'll bump against that maximum would appear very remote, as I believe the secondary insurance plans don't count Medicare deductibles or copays as part of the annual maximum/catastrophic limit. Undoubtedly, the maximum limit is important for stand-alone FEHB coverage, and when you're comparing worse case scenarios for not taking Part B coverage as against potential exposure under the stand-alone FEHB coverage.
Both BCBS-Basic and GEHA-Standard wave deductibles, copays, and coinsurance for those with Medicare Part B. But the worst case scenarios do happen. I cannot predict in advance what form they may take, but it's comforting to have them capped.

Having said that, in really bad cases, a $1,000 difference between maximum out-of-packet expenses is relatively trivial.
ChrisC wrote:
Fri Mar 22, 2019 10:33 pm
I think you have to look around the fringes of policy coverage to discern meaningful differences. For instance, how does one plan treat dental coverage for routine check ups or do they have some coverage for oral, dental surgery; how are hearing aids covered (at one time BCBS had a major difference in its favor but I think GEHA might have caught up); do they have discounts for fitness centers or vision care; which has the better customer service ratings (personally, I find some GEHA reps to be uninformed and sometimes you're best tactic is HUCA); and then there's always network provider issues.
I agree that many meaningful differences are in the fringes. But that's where the choice becomes highly individual. For example, I always purchase a dental insurance, and thus FEHB dental coverage is not important for me. I have access to much less expensive gyms than those subsidized by BCBS. But I was intrigued by BCBS's DIY Docs that would enable me to update my will and powers of attorney.
ChrisC wrote:
Fri Mar 22, 2019 10:33 pm
If you've decided to enroll in Part B, I'm not sure a yearly difference of $208 between GEHA standard and BCBS-Basic is significant.

See, generally, https://ask.fedweek.com/medicare/fehb-medicare/ for overlap of coverage between FEHB and Medicare.
I agree that $208 is insignificant for making the insurance decision. I did these calculations in response to another poster, so that instead of speaking in general about GEHA vs. BCBS prices and the BCBS $600 discount, we could see the actual numbers.

Victoria
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Re: Why should FEHB members buy Medicare Part B?

Post by Deb6425 » Sun Mar 31, 2019 5:40 pm

I was also hoping to hear from any fed retirees who did not take Part B! Please chime in!!

I turn 65 this year. My intention is to opt out of Part B since I would have to pay the IRMAA ($433 per mo for 2019 for 4 months, and $370 per mo for 2020; not sure about the level of IRMAA for the remaining years before 70). When I hit 70, my RMDs will put me in a higher IRMAA category again. I currently have BCBS-Basic under FEHB. The wrap around of $600 and payment of co-pays still doesn't make it viable for me. I don't go the doctor often enough to make it worthwhile. I plan on self insuring for long term health care with the savings (hopefully). My brother and an acquaintance, both fed retirees, opted out of Part B. Neither of them regret it so far, but it is early days for them.

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Re: Why should FEHB members buy Medicare Part B?

Post by delamer » Sun Mar 31, 2019 6:03 pm

Deb6425 wrote:
Sun Mar 31, 2019 5:40 pm
I was also hoping to hear from any fed retirees who did not take Part B! Please chime in!!

I turn 65 this year. My intention is to opt out of Part B since I would have to pay the IRMAA ($433 per mo for 2019 for 4 months, and $370 per mo for 2020; not sure about the level of IRMAA for the remaining years before 70). When I hit 70, my RMDs will put me in a higher IRMAA category again. I currently have BCBS-Basic under FEHB. The wrap around of $600 and payment of co-pays still doesn't make it viable for me. I don't go the doctor often enough to make it worthwhile. I plan on self insuring for long term health care with the savings (hopefully). My brother and an acquaintance, both fed retirees, opted out of Part B. Neither of them regret it so far, but it is early days for them.
I didn’t take Part B but I am only a month into Medicare, so I don’t have much insight.

The IRMAA hit plus the ability to buy in later (albeit at a higher cost) were big factors in our decision.

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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Sun Mar 31, 2019 6:18 pm

Deb6425 wrote:
Sun Mar 31, 2019 5:40 pm
I was also hoping to hear from any fed retirees who did not take Part B! Please chime in!!

I turn 65 this year. My intention is to opt out of Part B since I would have to pay the IRMAA ($433 per mo for 2019 for 4 months, and $370 per mo for 2020; not sure about the level of IRMAA for the remaining years before 70). When I hit 70, my RMDs will put me in a higher IRMAA category again. I currently have BCBS-Basic under FEHB. The wrap around of $600 and payment of co-pays still doesn't make it viable for me. I don't go the doctor often enough to make it worthwhile. I plan on self insuring for long term health care with the savings (hopefully). My brother and an acquaintance, both fed retirees, opted out of Part B. Neither of them regret it so far, but it is early days for them.
Your reasoning and reasoning of your brother and an acquaintance are an example of the problem of induction. If you have a concept in mind, it does not matter how many times it has held true; it takes a single counter-event to completely destroy your concept. It does not matter for how many years you and people you know did not have much use for health insurance. A single disease: cardio-vascular, neurological, cognitive, or something like that can wreck havoc in your medical needs.

However, you are not proposing to go without insurance. You just want to continue using FEHB and forego Medicare Part B. There is less risk in this. Your worst case scenario is that you will decide to get Medicare Part B several years from now and will pay penalties for late enrollment, which you should be able to afford.

In my opinion, you should base your decision not on other people's experiences but on risk calculations. For example, assume that you will need to get Medicare Part B 15 years from now and will live for 15 years after that. Calculate how much you would be saving by not having Part B for 15 years and how much extra you would be paying for a late enrollment 15 years from now. If the difference is favorable or negligible, not enrolling in Part B now might make sense.

Good luck,

Victoria
WINNER of the 2015 Boglehead Contest. | Every joke has a bit of a joke. ... The rest is the truth. (Marat F)

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Re: Why should FEHB members buy Medicare Part B?

Post by ChrisC » Sun Mar 31, 2019 6:54 pm

VictoriaF wrote:
Sun Mar 31, 2019 6:18 pm

In my opinion, you should base your decision not on other people's experiences but on risk calculations. For example, assume that you will need to get Medicare Part B 15 years from now and will live for 15 years after that. Calculate how much you would be saving by not having Part B for 15 years and how much extra you would be paying for a late enrollment 15 years from now. If the difference is favorable or negligible, not enrolling in Part B now might make sense.

Good luck,

Victoria

I think most, including me, who forego Medicare Part B make the calculation of never enrolling in Medicare Part B and how much risk exposure we have by simply relying on FEHB insurance. We make the calculation that the risk exposure is always capped with FEHB (whether $6 or 7K) annually -- caps we may never reach in any given year and that the cost of Medicare Part B premiums for those who will always be in Tiers 3 or 4 in IRMAA is not worth the bang for the buck you get with both FEHB and Medicare Part B.

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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Sun Mar 31, 2019 7:04 pm

ChrisC wrote:
Sun Mar 31, 2019 6:54 pm
VictoriaF wrote:
Sun Mar 31, 2019 6:18 pm

In my opinion, you should base your decision not on other people's experiences but on risk calculations. For example, assume that you will need to get Medicare Part B 15 years from now and will live for 15 years after that. Calculate how much you would be saving by not having Part B for 15 years and how much extra you would be paying for a late enrollment 15 years from now. If the difference is favorable or negligible, not enrolling in Part B now might make sense.

Good luck,

Victoria

I think most, including me, who forego Medicare Part B make the calculation of never enrolling in Medicare Part B and how much risk exposure we have by simply relying on FEHB insurance. We make the calculation that the risk exposure is always capped with FEHB (whether $6 or 7K) annually -- caps we may never reach in any given year and that the cost of Medicare Part B premiums for those who will always be in Tiers 3 or 4 in IRMAA is not worth the bang for the buck you get with both FEHB and Medicare Part B.
FEHB could go away, or become more expensive, or lose much of its appeal. It is within the realm of possibilities.

The coordination between FEHB and Part B may change in the ways that would make having both more prudent than either one. This could be for medical coverage, pharmaceutical, or both.

Out of network doctors and emergency room personnel may aggressively charge out-of-network prices for those who are not on Medicare.

IRMAA may get repealed.

My point is not that you are making a wrong decision, but that the things may change in a variety of ways. You should apply your subjective estimates of probability that you may change your mind about Part B in future years. In my opinion, it's a better decision making approach than anchoring on the people you know.

Victoria
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Re: Why should FEHB members buy Medicare Part B?

Post by ChrisC » Sun Mar 31, 2019 10:07 pm

VictoriaF wrote:
Sun Mar 31, 2019 7:04 pm

FEHB could go away, or become more expensive, or lose much of its appeal. It is within the realm of possibilities.

Yes, those are all possibilites though they appear to be quite remote and on the same scale of possibilites as the Congress and the President enacting legislation to take away or diminish CSRS or FERS pensions for those already retired as annuitants. As this is just peer speculation, I would speculate that it is more likely for Medicare Part B to get more expensive (for those paying permiums in Tiers II-V) and eventually for it to be means tested completely.

The coordination between FEHB and Part B may change in the ways that would make having both more prudent than either one. This could be for medical coverage, pharmaceutical, or both.

There is already well-versed coordination and rules governing FEHB and Medicare, even for those who don't enroll in Medicare; for instance, providers under FEHB are required to be paid at Medicare rates even if the FEHB patient is not enrolled in Medicare; we might not like the way coordination rules operate currrently, but this has been around for decades.

Out of network doctors and emergency room personnel may aggressively charge out-of-network prices for those who are not on Medicare.

I'm not sure this is possible under current rules, unless these providers themselves don't accept Medicare assigned rates or Medicare patients, in which case it wouldn't matter if you had Medicare coverage.

IRMAA may get repealed.

Seriously. The trend is to have those who can afford to pay the full (or some of the) freight of the cost of Medicare insurance -- that's what IRMAA is designed to do with Part B and now Part D. Moreover, if Medicare is ever expanded to those under 65, I don't see how IRMAA would ever be eliminated -- it saves the Government money to have high income people to pay all or some of the Medicare subsidy associated with premium payment.

My point is not that you are making a wrong decision, but that the things may change in a variety of ways. You should apply your subjective estimates of probability that you may change your mind about Part B in future years. In my opinion, it's a better decision making approach than anchoring on the people you know.

Ok, I see your point but change can go in many different ways, including making Medicare much more expensive for those who already have adequate health insurance coverage. Though I doubt these changes would be made without grandfathering or providing safe harbors fo existing Medicare beneficiaries or those covered by existing health coverage, it is something to think about in your calculations.

Victoria

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Re: Why should FEHB members buy Medicare Part B?

Post by VictoriaF » Sun Mar 31, 2019 10:29 pm

ChrisC wrote:
Sun Mar 31, 2019 10:07 pm
VictoriaF wrote:
Sun Mar 31, 2019 7:04 pm

FEHB could go away, or become more expensive, or lose much of its appeal. It is within the realm of possibilities.

Yes, those are all possibilites though they appear to be quite remote and on the same scale of possibilites as the Congress and the President enacting legislation to take away or diminish CSRS or FERS pensions for those already retired as annuitants. As this is just peer speculation, I would speculate that it is more likely for Medicare Part B to get more expensive (for those paying permiums in Tiers II-V) and eventually for it to be means tested completely.

The coordination between FEHB and Part B may change in the ways that would make having both more prudent than either one. This could be for medical coverage, pharmaceutical, or both.

There is already well-versed coordination and rules governing FEHB and Medicare, even for those who don't enroll in Medicare; for instance, providers under FEHB are required to be paid at Medicare rates even if the FEHB patient is not enrolled in Medicare; we might not like the way coordination rules operate currrently, but this has been around for decades.

Out of network doctors and emergency room personnel may aggressively charge out-of-network prices for those who are not on Medicare.

I'm not sure this is possible under current rules, unless these providers themselves don't accept Medicare assigned rates or Medicare patients, in which case it wouldn't matter if you had Medicare coverage.

IRMAA may get repealed.

Seriously. The trend is to have those who can afford to pay the full (or some of the) freight of the cost of Medicare insurance -- that's what IRMAA is designed to do with Part B and now Part D. Moreover, if Medicare is ever expanded to those under 65, I don't see how IRMAA would ever be eliminated -- it saves the Government money to have high income people to pay all or some of the Medicare subsidy associated with premium payment.

My point is not that you are making a wrong decision, but that the things may change in a variety of ways. You should apply your subjective estimates of probability that you may change your mind about Part B in future years. In my opinion, it's a better decision making approach than anchoring on the people you know.

Ok, I see your point but change can go in many different ways, including making Medicare much more expensive for those who already have adequate health insurance coverage. Though I doubt these changes would be made without grandfathering or providing safe harbors fo existing Medicare beneficiaries or those covered by existing health coverage, it is something to think about in your calculations.

Victoria
I find it difficult to respond to color coded responses, and so here is a summary response:
1. It's much more difficult to reduce or eliminate pensions of current recipients than to change insurance or increase its cost. In the realm of possibilities, our pensions should outlive our insurance.
2. I did not know that providers must charge Medicare rates even those not enrolled in Medicare. This is good.
3. As I understand it, if an ambulance delivers an unconscious patient to an emergency room, and an emergency room physician is out of network, he or she can't charge Medicare patients more than 115% of the Medicare rate. Billing is different for those who are not on Medicare. I recall an NPR program about people getting tens of thousands dollars in charges from emergency rooms. Perhaps, FEHB alone protects from such eventualities, but I was under impression that Medicare is the main defense.
4. I agree that the trend is towards higher payments. But IRMAA could be replaced by something that's not tied to Medicare, for example, an income tax on high income regardless of whether you receive Medicare (similar to a tax that helps to fund ACA).
5. I have pretty much made my mind to have both FEHB and Part B when I will become eligible for Medicare. For now, I am participating in this discussion to prepare for when it comes. I like to consider key decisions well ahead of time.

Thank you for a good discussion,
Victoria
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