Why should FEHB members buy Medicare Part B?

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JohnS33031
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Re: Why should FEHB members buy Medicare Part B?

Post by JohnS33031 » Tue Apr 23, 2019 12:03 pm

We opted to take Part B and use Federal plan as supplemental . Never had a problem seeing any specialist or primary doc in Pennsylvania. Now we are moving to NYC and are having issues about the many docs who will not take Medicare patients.
If fees charged to medicare eligible pts with or without part B are limited anyway (is that correct?)why are these docs refusing medicare patients ? If we dropped B and used Federal as primary would this issue be solved?

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

Post by mrc » Tue Apr 23, 2019 12:18 pm

JohnS33031 wrote:
Tue Apr 23, 2019 12:03 pm
We opted to take Part B and use Federal plan as supplemental . Never had a problem seeing any specialist or primary doc in Pennsylvania. Now we are moving to NYC and are having issues about the many docs who will not take Medicare patients.
If fees charged to medicare eligible pts with or without part B are limited anyway (is that correct?)why are these docs refusing medicare patients ? If we dropped B and used Federal as primary would this issue be solved?
It may depend on the particular FEHB plan you choose. For us, BCBS Basic, without Medicare coverage we must be very careful seeing a provider that does not participate in Medicare and/or is not a preferred provider. Read your plan's "Coordinating Benefits with Medicare or Other Coverage" (section 9 in our plan brochure) with great care.
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dm200
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Re: Why should FEHB members buy Medicare Part B?

Post by dm200 » Tue Apr 23, 2019 3:04 pm

No firsthand knowledge or research, but a longtime friend and federal retiree (under CSRS) researches everything - to the ultimate. You ask him what time it is - and he will tell you how to make a watch!

His very extensive research led him to NOT get (and pay for) Medicare Part B. He told me that one important factor for him was that his wife used and depended upon his health/medical insurance. His wife has also chosen to NOT get )and pay for) Medicare part B either. They, especially his wife, probably have above average use of medical services - for their ages.

JohnS33031
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Re: Why should FEHB members buy Medicare Part B?

Post by JohnS33031 » Tue Apr 23, 2019 9:24 pm

mrc, you mentioned you have basic bc/bs without medicare coverage? If that is case , why would one need to find out if doc takes medicare? I was hoping if we drop part b. And just have federal as primary CIGNA plan, let's say, then could go to anyone on CIGNA panel ?

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

Post by mrc » Wed Apr 24, 2019 5:16 am

JohnS33031 wrote:
Tue Apr 23, 2019 9:24 pm
mrc, you mentioned you have basic bc/bs without medicare coverage? If that is case , why would one need to find out if doc takes medicare? I was hoping if we drop part b. And just have federal as primary CIGNA plan, let's say, then could go to anyone on CIGNA panel ?
I'm sorry, my phrasing was poor. We have BCBS Basic, and DW elected Medicare Part B (I'm not eligible yet). For folks in that plan WITHOUT Medicare part B, you must be careful who you see. You can be on the hook for balance billing amounts if your provider doesn't accept Medicare, or the entire amount, if your provider doesn't participate with BCBS.

We were all set to forego Medicare and stick with the same FEHB/BCBS Basic insurance we'd had all along (and avoid the hassle of finding docs that accept Medicare). That was, until we read the fine print on the retiree coverage limit rules. FEHB will only pay Medicare rates, and so choosing a doctor that doesn't accept Medicare subjects us to possible high OOP costs. Because we really should use providers that participate in Medicare (and for sure accept BCBS), DW elected Part B. And so will I when it's time.

When reading the plan brochure, remember you are an annuitant (not an active employee). See section 9 for an explanation of the FEHB law:
When you are age 65 or over and do not have Medicare
Under the FEHB law , we must limit our payments for inpatient hospital care and physician care to those payments you would be entitled to if you had Medicare. Y our physician and hospital must follow Medicare rules and cannot bill you for more than they could bill you if you had Medicare. Y ou and the FEHB benefit from these payment limits. Outpatient hospital care and non-physician-based care are not covered by this law; regular Plan benefits apply. The following chart has more information about the limits.
Then review the details of your payment responsibility in the table that follows this explanation.

I know nothing about the other plans, but I do know the Medicare rate cap is FEHB-based and not BCBS-specific.
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rosemary11
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Re: Why should FEHB members buy Medicare Part B?

Post by rosemary11 » Wed Apr 24, 2019 5:58 am

I am planning on getting medicareB and FEHB.
FEHB would be Blue cross basic or GEHA standard.
I appreciate any final thoughts.

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

Post by retiredjg » Wed Apr 24, 2019 7:10 am

rosemary11 wrote:
Wed Apr 24, 2019 5:58 am
I am planning on getting medicareB and FEHB.
FEHB would be Blue cross basic or GEHA standard.
I appreciate any final thoughts.
This is what I do and I'm very happy with it. I am single and do not pay any extra due to IRMAA.

A couple with large IRMAA payments might not be as happy with this plan.

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

Post by MnD » Wed Apr 24, 2019 7:19 am

I expect by the time I'm up to make this decision in 9 years or so, it won't be a choice to opt of Part B out if you want to continue FEHB.
Which would be fine with me.

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

Post by Blues » Wed Apr 24, 2019 7:49 am

I am on Medicare Part A and FEHB. The missus is not yet of age. (Another couple of years.)

I have done the research and am satisfied that opting out of Part B was the right decision for me. No doubt it's not the right answer for everyone.
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Beatle Boots
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Re: Why should FEHB members buy Medicare Part B?

Post by Beatle Boots » Wed Apr 24, 2019 9:44 am

Disabled retired lady friend has both Medicare Part B and GEHA Standard. Medicare Part B is her primary with GEHA secondary. She justifies keeping both (apparent duplications) due to her unique medical illness and Med Part B loop hole. She has Osteoporosis and the generic front line drugs are ineffective. Her Dr prescribed the non-generic (expensive) drug Prolia. Part B provides a "loop hole" if the patient meets certain criteria (mainly can't administer drug in home). Lady does not have Med Part D. Here is the Medicare carve out:

https://www.medicare.gov/coverage/osteoporosis-drugs

(Not sure how many similar "loop holes" there are and certainly YMMV depending on reader's medical situation.)

Bottom line:

Without insurance, 2 injections of this drug cost about $1,650 (excluding office charges).

(support: google keyword search term: Prolia Cost)

Not sure how much GEHA would charge for this drug but the lady claims to have done the Cost benefit Analysis and says the "loop hole" justifies having both FEHB and Medicare Part B.

DrGoogle2017
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Re: Why should FEHB members buy Medicare Part B?

Post by DrGoogle2017 » Wed Apr 24, 2019 10:05 am

They reimburse $50 per month if you have Medicare part B, so it’s about $85 for my husband. Honestly, one reason why we feel our retirement planning is so good is because we pay up front on payment so it can simplify our live. So far it has been excellent. Very limited out of pocket payment. We are not even sick yet, but my husband is approaching 70, so he is most likely will need more Medicare so I’m not going to worry about $85 per month.
Last edited by DrGoogle2017 on Wed Apr 24, 2019 11:33 am, edited 1 time in total.

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

Post by retiredjg » Wed Apr 24, 2019 10:21 am

DrGoogle2017 wrote:
Wed Apr 24, 2019 10:05 am
They reimburse $50 per month if you have Medicare part B, so it’s about $85 for my husband. Honestly, one reason why we feel our retirement planning is so good is because we pay up front on payment so it can simplify our live. So far it has been excellent. Very limited out of pocket payment. We are not even sick yet, but my husband is approaching 70, sohe most likely will need more Medicare so I’m not going to worry about $85 per month.
This is a good point. FEHB BCBS Basic reimburses you $600 a year for Medicare Part B premiums. Makes it pretty darn cheap!

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

Post by delamer » Wed Apr 24, 2019 10:33 am

retiredjg wrote:
Wed Apr 24, 2019 10:21 am
DrGoogle2017 wrote:
Wed Apr 24, 2019 10:05 am
They reimburse $50 per month if you have Medicare part B, so it’s about $85 for my husband. Honestly, one reason why we feel our retirement planning is so good is because we pay up front on payment so it can simplify our live. So far it has been excellent. Very limited out of pocket payment. We are not even sick yet, but my husband is approaching 70, sohe most likely will need more Medicare so I’m not going to worry about $85 per month.
This is a good point. FEHB BCBS Basic reimburses you $600 a year for Medicare Part B premiums. Makes it pretty darn cheap!
That would only cover 3 months of Part B for me. It depends on individual circumstances.

DrGoogle2017
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Re: Why should FEHB members buy Medicare Part B?

Post by DrGoogle2017 » Wed Apr 24, 2019 11:36 am

delamer wrote:
Wed Apr 24, 2019 10:33 am
retiredjg wrote:
Wed Apr 24, 2019 10:21 am
DrGoogle2017 wrote:
Wed Apr 24, 2019 10:05 am
They reimburse $50 per month if you have Medicare part B, so it’s about $85 for my husband. Honestly, one reason why we feel our retirement planning is so good is because we pay up front on payment so it can simplify our live. So far it has been excellent. Very limited out of pocket payment. We are not even sick yet, but my husband is approaching 70, sohe most likely will need more Medicare so I’m not going to worry about $85 per month.
This is a good point. FEHB BCBS Basic reimburses you $600 a year for Medicare Part B premiums. Makes it pretty darn cheap!
That would only cover 3 months of Part B for me. It depends on individual circumstances.
It’s not meant to cover everything. I thought about not buying Medicare part B at one point, but now I’m glad I have both. Actually my husband, I don’t have Medicare yet.

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dm200
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Re: Why should FEHB members buy Medicare Part B?

Post by dm200 » Wed Apr 24, 2019 11:43 am

While the benefits of having Medicare Part B are the same for different folks with the same other overages, the costs to different folks might be quite different due to IRMAA - and, perhaps, spousal factors.

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

Post by delamer » Wed Apr 24, 2019 11:51 am

DrGoogle2017 wrote:
Wed Apr 24, 2019 11:36 am
delamer wrote:
Wed Apr 24, 2019 10:33 am
retiredjg wrote:
Wed Apr 24, 2019 10:21 am
DrGoogle2017 wrote:
Wed Apr 24, 2019 10:05 am
They reimburse $50 per month if you have Medicare part B, so it’s about $85 for my husband. Honestly, one reason why we feel our retirement planning is so good is because we pay up front on payment so it can simplify our live. So far it has been excellent. Very limited out of pocket payment. We are not even sick yet, but my husband is approaching 70, sohe most likely will need more Medicare so I’m not going to worry about $85 per month.
This is a good point. FEHB BCBS Basic reimburses you $600 a year for Medicare Part B premiums. Makes it pretty darn cheap!
That would only cover 3 months of Part B for me. It depends on individual circumstances.
It’s not meant to cover everything. I thought about not buying Medicare part B at one point, but now I’m glad I have both. Actually my husband, I don’t have Medicare yet.
Yes, I understand that. But for those of us subject to IRMAA, the savings are small relative to the total Medicare B outlay. For me, this year, my Part B premiums would still be $2700 after the reimbursement.

DrGoogle2017
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Re: Why should FEHB members buy Medicare Part B?

Post by DrGoogle2017 » Wed Apr 24, 2019 12:11 pm

delamer wrote:
Wed Apr 24, 2019 11:51 am
DrGoogle2017 wrote:
Wed Apr 24, 2019 11:36 am
delamer wrote:
Wed Apr 24, 2019 10:33 am
retiredjg wrote:
Wed Apr 24, 2019 10:21 am
DrGoogle2017 wrote:
Wed Apr 24, 2019 10:05 am
They reimburse $50 per month if you have Medicare part B, so it’s about $85 for my husband. Honestly, one reason why we feel our retirement planning is so good is because we pay up front on payment so it can simplify our live. So far it has been excellent. Very limited out of pocket payment. We are not even sick yet, but my husband is approaching 70, sohe most likely will need more Medicare so I’m not going to worry about $85 per month.
This is a good point. FEHB BCBS Basic reimburses you $600 a year for Medicare Part B premiums. Makes it pretty darn cheap!
That would only cover 3 months of Part B for me. It depends on individual circumstances.
It’s not meant to cover everything. I thought about not buying Medicare part B at one point, but now I’m glad I have both. Actually my husband, I don’t have Medicare yet.
Yes, I understand that. But for those of us subject to IRMAA, the savings are small relative to the total Medicare B outlay. For me, this year, my Part B premiums would still be $2700 after the reimbursement.
Ouch, I don’t know what I would do if I were in your situation. But I have to admit the FEHB service has been outstanding, I’m not sure because it’s the FEHB or regular BCBS. But we’re very satisfied customer.

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dm200
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Re: Why should FEHB members buy Medicare Part B?

Post by dm200 » Wed Apr 24, 2019 12:19 pm

One potential risk of either decision would be if the rules about those so eligible change in the future.

I thing such risks are very low for federal retirees vs. retirees from other employers.

For those with other employers, these risks will be higher, in my opinion.

rosemary11
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Re: Why should FEHB members buy Medicare Part B?

Post by rosemary11 » Wed Apr 24, 2019 12:29 pm

Is Standard GEHA OR BASIC BCBS better as a supplement to Medicare part B?

DrGoogle2017
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Re: Why should FEHB members buy Medicare Part B?

Post by DrGoogle2017 » Wed Apr 24, 2019 12:36 pm

rosemary11 wrote:
Wed Apr 24, 2019 12:29 pm
Is Standard GEHA OR BASIC BCBS better as a supplement to Medicare part B?
You have to look up a website that comparing both plans. But in the past when we switched to GEHA dental plan, we heard it was good or better than Delta Dental. It wasn’t.

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

Post by tj » Wed Apr 24, 2019 6:34 pm

rosemary11 wrote:
Wed Apr 24, 2019 12:29 pm
Is Standard GEHA OR BASIC BCBS better as a supplement to Medicare part B?
Aetna direct is the one people mention a lot for Medicare. Not sure why it's not in this thread.

jerryk68
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Re: Why should FEHB members buy Medicare Part B?

Post by jerryk68 » Thu Apr 25, 2019 7:29 am

dm200 wrote:
Tue Apr 23, 2019 3:04 pm
No firsthand knowledge or research, but a longtime friend and federal retiree (under CSRS) researches everything - to the ultimate. You ask him what time it is - and he will tell you how to make a watch!

His very extensive research led him to NOT get (and pay for) Medicare Part B. He told me that one important factor for him was that his wife used and depended upon his health/medical insurance. His wife has also chosen to NOT get )and pay for) Medicare part B either. They, especially his wife, probably have above average use of medical services - for their ages.
My "guy" at the office who has since retired decided to take Part B. I don't know about his watch capability but he read every brochure like he was reading a novel. When asked he would counsel his coworker's on the pro's and con's of each plan. His theory on Part B was he was eventually going to die in retirement and wanted full coverage not only for himself but for his wife. He didn't want treatment cost to be a factor in the decision making process. Beside, he said BC/BS Basic reimbursed $600 of the cost and provided mail order services for Part B participants saving an additional $50 a quarter ($200) for each of his tier 2 drug.

Yooper16
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Re: Why should FEHB members buy Medicare Part B?

Post by Yooper16 » Thu Apr 25, 2019 8:15 am

tj wrote:
Wed Apr 24, 2019 6:34 pm
rosemary11 wrote:
Wed Apr 24, 2019 12:29 pm
Is Standard GEHA OR BASIC BCBS better as a supplement to Medicare part B?
Aetna direct is the one people mention a lot for Medicare. Not sure why it's not in this thread.


We are intending to switch to it in May/June after I turn 65, as it is not recommended for use (Aetna customer support) other than in conjunction with Part B. Without checking, it is a higher premium than Basic and a couple of others approx 300/mo for self plus one, vs 250ish for the others. It does come with an 900 each person reimbursement account that we intend to apply towards part B premiums.

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

Post by tj » Thu Aug 01, 2019 10:05 pm

Yooper16 wrote:
Thu Apr 25, 2019 8:15 am
tj wrote:
Wed Apr 24, 2019 6:34 pm
rosemary11 wrote:
Wed Apr 24, 2019 12:29 pm
Is Standard GEHA OR BASIC BCBS better as a supplement to Medicare part B?
Aetna direct is the one people mention a lot for Medicare. Not sure why it's not in this thread.


We are intending to switch to it in May/June after I turn 65, as it is not recommended for use (Aetna customer support) other than in conjunction with Part B. Without checking, it is a higher premium than Basic and a couple of others approx 300/mo for self plus one, vs 250ish for the others. It does come with an 900 each person reimbursement account that we intend to apply towards part B premiums.
Maybe take a look at MHBP Consumer option as well, it appears to offer $1,200/year each person, waives medicare copays, coinsurance and deductibles, and has a smaller premium than Aetna Direct? You have to join the Mail Handlers Union though.

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

Post by mrc » Fri Aug 02, 2019 11:25 am

tj wrote:
Thu Aug 01, 2019 10:05 pm
Maybe take a look at MHBP Consumer option as well, it appears to offer $1,200/year each person, waives medicare copays, coinsurance and deductibles, and has a smaller premium than Aetna Direct? You have to join the Mail Handlers Union though.
The reviews here for that plan are abysmal, which underscores the importance of doing thorough research every year. Oh, and being able to see into the future is always helpful.
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