Federal Blue Cross Standard versus Basic

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Topic Author
Nearly A Moose
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Federal Blue Cross Standard versus Basic

Post by Nearly A Moose » Fri Dec 02, 2016 4:55 pm

Greetings, I'm hoping some of the current or former federal employees may be able to help me here. We have decided we are going to consolidate my entire family (me, wife, one toddler, one soon-to-be newborn) onto one insurance plan available to my wife as a federal employee. We've narrowed it down to either the Federal Blue Cross Basic or Standard option. The basic is a few hundred a month cheaper for the family plan, has no deductible, fixed co-pays for most things, but provides *no* coverage for out of network providers. Standard is a few hundred more per month, has a $700(ish) deductible, and has tiered benefits for in-network providers, participating providers, and out of network providers.

I find it frustratingly hard to actually run numbers to get my head around this. My sense is that Basic may be a somewhat better deal if we can keep all of our providers in network, but it could be potentially catastrophic if we need to obtain care outside the network (eg a serious medical condition for which we want a certain recognized specialist who is out of network). It also seems there could be some risk if a non-plan provider gets involved in surgical care, although I'm finding the benefits booklet a bit unclear on how that is covered.

We live in DC, and intuitively it feels like a lot of providers in our area take Basic, but that's not scientific, we haven't researched every potential specialist that we (or especially our unborn child) might need, and it's always possible we need non-ER care in another city.

So, my question, which is admittedly vague, is how have people seen these risks materialize or not materialize in real life, and are there any other fundamental differences I'm overlooking?

I've read the entire long-form brochure but am still having a hard time getting my head around this. I think I'm naturally conservative when it comes to insurance and am leaning toward Standard to protect against the need for out of network coverage. But I'd be interested in whether people find that to be an actual issue in real life. All else equal, I'd rather save a few hundred a month on insurance premiums, but that's not going to make or break things for us. (And, we considered a high deductible plan but aren't inclined to go that route this year. Maybe in the future once we understand whether kid 2 has any special medical issues.)

Thanks for any input!
Pardon typos, I'm probably using my fat thumbs on a tiny phone.

mrc
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Re: Federal Blue Cross Standard versus Basic

Post by mrc » Fri Dec 02, 2016 5:07 pm

Providers employ armies of staff that spend countless hours developing and pricing these plans. The average person spends an hour choosing a plan -- perhaps just before open season ends -- or simply keeps what they had last year. It seems that these are inherently a comparison of apples to oranges, where you must predict the future to boot. One of the most frustrating aspects of managing the household. I would love it if someone smart could chime in with an algorithm for figuring out problems like this (even with the assumptions required for the next year).

Good luck Moose, and congratulations!
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Taylor Larimore
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Re: Federal Blue Cross Standard versus Basic

Post by Taylor Larimore » Fri Dec 02, 2016 5:21 pm

Nearly A Moose:

I am certainly no expert on this although I have had Federal Blue X for many years.

We have never been denied Federal Blue X benefits at any doctor or hospital we have visited so this may be an unnecessary concern.

Whether to use Basic or Standard, I don't know enough to say.

Best wishes
Taylor
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Trapper
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Re: Federal Blue Cross Standard versus Basic

Post by Trapper » Fri Dec 02, 2016 5:53 pm

When I changed from Blue Cross standard to Blue Cross Basic I called the providers I used or looked them up on the Blue Cross site to ensure they were a preferred provider.
That is my suggestion on what you should do.

Topic Author
Nearly A Moose
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Re: Federal Blue Cross Standard versus Basic

Post by Nearly A Moose » Fri Dec 02, 2016 8:46 pm

Trapper wrote:When I changed from Blue Cross standard to Blue Cross Basic I called the providers I used or looked them up on the Blue Cross site to ensure they were a preferred provider.
That is my suggestion on what you should do.
Thanks. Yes, we've confirmed that everyone we currently use is under either plan. It's just the unknowns that are bothering me.
Pardon typos, I'm probably using my fat thumbs on a tiny phone.

stormswami
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Re: Federal Blue Cross Standard versus Basic

Post by stormswami » Sat Dec 03, 2016 5:03 pm

Nearly A Moose,

You are on the right track and, in short, I think you can have confidence in the BCBS Basic plan given your research and locality (DC area).

I am a current Federal employee. I was once in your shoes. Years ago, in my younger pre-Boglehead days, my attention span for decisions such as this was minimal. I largely went with BCBS Standard because it sounded more robust than "Basic". Years later I discovered I was essentially just wasting my money. I (and now family) have been on Basic for the past 10 years and I have never encountered an issue.

It has been a few years since I have exhaustively studied the differences, but my summary recollection is that essentially the only practical vulnerabilities were more rural/remote areas where choices in providers may be limited (higher chance of non-suitable out-of-network options). I also remember some of the pharmacy perks or options possibly being better under Standard than Basic.

retiredjg
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Re: Federal Blue Cross Standard versus Basic

Post by retiredjg » Sat Dec 03, 2016 5:31 pm

I once switched from a high tier plan to a lower tier plan and lost a lot of physical therapy coverage. Of course, that was the year I needed it. I think I was paying $25 co-pay 3 times a week for 2 or 3 months.

Unfortunately, I don't remember if it was on BC/BS or GEHA and it may not be the same now, but this is something to watch out for. Never occurred to me to check for that. When I chose the plan, I was comparing the big stuff, but the little stuff is what "got" me.

mwm158
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Re: Federal Blue Cross Standard versus Basic

Post by mwm158 » Sat Dec 03, 2016 7:06 pm

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Last edited by mwm158 on Mon Jan 02, 2017 10:49 pm, edited 1 time in total.

Kristen
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Re: Federal Blue Cross Standard versus Basic

Post by Kristen » Sat Dec 03, 2016 8:31 pm

I have had BCBS Basic for 12 years. Every year I spent a lot of time researching, but always came back to that one because the costs were set dollar amounts, which I find less scary (15% of WHAT??). I got cancer in early 2015 and that plan has been fantastic. I was treated at a top cancer hospital with tons of scans, biopsies, chemo, other really expensive drugs, radiation, 3 surgeries...maybe that's all. I never had a single thing denied or delayed, no drive-by dr. charges (though I think that is a function of the facility), no issues whatsoever. I can't tell you how many times others in the waiting room were on the phone with insurance companies, at times even fighting about a test they were there for that very day. I felt very fortunate that my insurance was not a stressor. In my case, cancer=out of pocket max in terms of cost for a couple of years. That's just one data point for one major illness, which is probably not the scenario most people face, but I won't ever change plans unless that one becomes cost prohibitive.

emkute
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Re: Federal Blue Cross Standard versus Basic

Post by emkute » Sat Dec 03, 2016 8:58 pm

A long time ago, I switched from Standard to Basic after confirming my providers would be in network. It worked very well. More recently, I switched to GEHA Standard which costs even less, my providers are in network and there is a benefit for out of network providers. The important factor was that my prescriptions became generic and the superior drug benefit of the Blues was no longer worth the extra cost.
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fundseeker
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Re: Federal Blue Cross Standard versus Basic

Post by fundseeker » Sat Dec 03, 2016 9:55 pm

We had standard for years, but one year after reading the material, we decided we had been wasting money on it. In the years since the switch, basic has worked great and at much less cost. But, you could consider going with standard just for this coming year if you have some indication of issues with your next child, and if there is some benefit if he/she has issues. Otherwise, basic should serve you well.

stan1
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Re: Federal Blue Cross Standard versus Basic

Post by stan1 » Sat Dec 03, 2016 10:22 pm

I think Basic is best for many people who live in locations where BCBS has a dominant presence and who don't need high priced medication.

I found two main differences:
1) Out of network providers. When I had emergency surgery a few years ago a random physician (assisting anesthesiologist) who I never heard of popped up with an out of network charge. Because I had Standard the charge to me was under $50 and I didn't push the issue with the hospital (wasn't worth my time).

2) Prescriptions. Tier 1/2 can cost less than the Basic co-pay (sometimes a lot less). For Tier 3/4/5 prescriptions co-pays are much higher on Basic. Under Standard you get a 90 day fill for one co-pay; under Basic a 90 day fill is billed as 3 x 30 day co-pays.

Topic Author
Nearly A Moose
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Re: Federal Blue Cross Standard versus Basic

Post by Nearly A Moose » Sat Dec 03, 2016 11:31 pm

Thanks, all, this is very helpful, although not surprisingly there doesn't seem to be a clear consensus. It seems that people are liking both Standard and Basic, whichever they have. We're transitioning from a very expensive (my employer's) plan that is set up very much like Standard but with low fixed drug copays, which is making me instinctively favor the Standard option. But the monthly cost plus deductible makes Standard $2700 more expensive (we will use up the deductible based on past experience), so Basic by default is ahead by a good margin.

The two things that really are bothering me are (1) potentially needing urgent (but non ER) care while traveling and risking not having an in-network provider; and (2) the drive by doctor issue. Is anyone able to share an actual dollar charge the've been presented with for drive-by "service"? I have no idea if I'd be looking at $1,000 (I'd assume that risk) or $10,000 (I would take Standard to protect against that).

@Kristen - Very sorry to hear about your illness; I very much hope you're in remission and are doing well. Thanks for sharing your experience.
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delamer
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Re: Federal Blue Cross Standard versus Basic

Post by delamer » Sun Dec 04, 2016 12:02 am

Your wife's department/agency may provide free online access to this publication: https://www.checkbook.org/newhig2/hig.cfm

I used it a few years ago to make my choice, and found it very helpful.

I feel that I need to point out the BCBS Standard employee premium is twice as large as that for GEHA Standard, which also provides out-of-network coverage. That is $3300 per year more (before taking into account premium conversion).

Make sure that you are looking at your maximum out-of-pocket expenses for each plan you are considering. In the final analysis, that should be what insurance is all about -- protecting against catastrophic loss.

Topic Author
Nearly A Moose
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Re: Federal Blue Cross Standard versus Basic

Post by Nearly A Moose » Sun Dec 04, 2016 1:41 am

delamer wrote:Your wife's department/agency may provide free online access to this publication: https://www.checkbook.org/newhig2/hig.cfm

I used it a few years ago to make my choice, and found it very helpful.

I feel that I need to point out the BCBS Standard employee premium is twice as large as that for GEHA Standard, which also provides out-of-network coverage. That is $3300 per year more (before taking into account premium conversion).

Make sure that you are looking at your maximum out-of-pocket expenses for each plan you are considering. In the final analysis, that should be what insurance is all about -- protecting against catastrophic loss.
Her agency in theory does, but she hasn't been able to figure out how to get credentials. That's frustrating (the agency, not her).
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Kristen
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Re: Federal Blue Cross Standard versus Basic

Post by Kristen » Sun Dec 04, 2016 6:45 am

Someone mentioned prescriptions, which reminded me that years ago I did discuss the two plans with a co-worker who chose standard each year because I couldn't figure out what the higher premiums bought you. I don't recall the details but based on some recurring costly medications they needed, they felt standard was a better option for them. That's probably a good comparison to dig into.

And thank you, I am doing great. Have a half marathon planned for next weekend. :D

fundseeker
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Re: Federal Blue Cross Standard versus Basic

Post by fundseeker » Sun Dec 04, 2016 7:44 am

Oh, and while we are here discussing these things, I assume you will be maxing out the FSA?

Topic Author
Nearly A Moose
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Re: Federal Blue Cross Standard versus Basic

Post by Nearly A Moose » Sun Dec 04, 2016 8:32 am

fundseeker wrote:Oh, and while we are here discussing these things, I assume you will be maxing out the FSA?
Absolutely (doing that through my employer, which is apparently allowed). Healthcare and dependent care.
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Iorek
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Re: Federal Blue Cross Standard versus Basic

Post by Iorek » Sun Dec 04, 2016 9:00 am

I also struggle with this every year. We have stuck with std on the theory that we are insuring against the worst case but tbh I would guess we are spending more than necessary.

mrc
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Re: Federal Blue Cross Standard versus Basic

Post by mrc » Sun Dec 04, 2016 9:27 am

It looks to me like the biggest difference is prescription drug coverage. Basic without Medicare-B doesn't allow a 90-day mail order pharmacy. So, what appears to be lower copay amounts in the "compare" table are actually only 30-day prices. A family with several chronic prescriptions (esp. if non-generic, and more so with non-preferred brand) can add up quickly. It's still looking like a good switch for us. Thanks for those above pointing on the $X copay with basic vs the % of our allowance (whatever that is) for standard.
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Iorek
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Re: Federal Blue Cross Standard versus Basic

Post by Iorek » Sun Dec 04, 2016 9:46 am

fundseeker wrote:Oh, and while we are here discussing these things, I assume you will be maxing out the FSA?
Maxing out a healthcare FSA is not necc. a good idea.

Topic Author
Nearly A Moose
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Re: Federal Blue Cross Standard versus Basic

Post by Nearly A Moose » Sun Dec 04, 2016 9:47 am

Iorek wrote:
fundseeker wrote:Oh, and while we are here discussing these things, I assume you will be maxing out the FSA?
Maxing out a healthcare FSA is not necc. a good idea.
Agreed. But in our case it will work. We're out of pocket at least a grand on contact lenses alone...
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stan1
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Re: Federal Blue Cross Standard versus Basic

Post by stan1 » Sun Dec 04, 2016 10:02 am

Nearly A Moose wrote:
Agreed. But in our case it will work. We're out of pocket at least a grand on contact lenses alone...
Wow. How many people wearing contacts? Unless you've already exhausted other medical options and have no other choice look into getting your contacts from a lower priced source or tell your optometrist/opthamologist you'd like to look at lower cost options. I'd also wear glasses more often.

Ksil
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Re: Federal Blue Cross Standard versus Basic

Post by Ksil » Sun Dec 04, 2016 10:08 am

We used to be BCBS standard and switched to Basic once both on Medicare(obviously not your situation). Have you looked at the cost differences between the two policies for ER visits, in patient per day charges and certain labs. As I recall they add up quicker for Basic than Standard. Once Medicare becomes primary(again not your situation) those costs are waived but I would wonder what the difference in coverage would be between the two plans for those types of expenses. But I would also point out that we have never had a single provider be out of network in the 5-6 years we have been on Basic. And that plan is nationwide so if care is needed while traveling, mist likely those providers would be in network as well.

NAD83
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Re: Federal Blue Cross Standard versus Basic

Post by NAD83 » Sun Dec 04, 2016 10:25 am

I've always had Basic, and no problems, even in a smaller metro area. Both hospitals in the area accept. Standard may be better for high users of prescription drugs.

Also--have you checked out the vision insurance providers? I get a free or very low cost pair of glasses and/or year supply of contacts at a pretty small monthly premium (about $14/mo for spouse and I.) Check out Benefeds for options.

delamer
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Re: Federal Blue Cross Standard versus Basic

Post by delamer » Sun Dec 04, 2016 12:27 pm

Ksil wrote:We used to be BCBS standard and switched to Basic once both on Medicare(obviously not your situation). Have you looked at the cost differences between the two policies for ER visits, in patient per day charges and certain labs. As I recall they add up quicker for Basic than Standard. Once Medicare becomes primary(again not your situation) those costs are waived but I would wonder what the difference in coverage would be between the two plans for those types of expenses. But I would also point out that we have never had a single provider be out of network in the 5-6 years we have been on Basic. And that plan is nationwide so if care is needed while traveling, mist likely those providers would be in network as well.
Seems to me this is exactly how I would expect it to work. You pay higher premiums in order to have lower out-of-pocket costs, when/if the need arises. You are basically paying more for predictability, and forgoing the savings of lower expenses if you don't need much care.

Both for BCBS and GEHA, it is my understanding that the higher level, more expensive coverage makes sense if you take high cost prescription drugs.

My observation is that many people in FEHB pay too much money for peace-of-mind, in part due to inertia.

It is important to keep in mind that this is not a irrevocable decision -- you can switch plans every year. That is why I focus on maximum out-of-pocket for a single year, knowing that I can change plans in the following year if someone in my family develops a serious illness or condition that warrants a plan with better coverage.

delamer
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Re: Federal Blue Cross Standard versus Basic

Post by delamer » Sun Dec 04, 2016 12:31 pm

Nearly A Moose wrote:
delamer wrote:Your wife's department/agency may provide free online access to this publication: https://www.checkbook.org/newhig2/hig.cfm

I used it a few years ago to make my choice, and found it very helpful.

I feel that I need to point out the BCBS Standard employee premium is twice as large as that for GEHA Standard, which also provides out-of-network coverage. That is $3300 per year more (before taking into account premium conversion).

Make sure that you are looking at your maximum out-of-pocket expenses for each plan you are considering. In the final analysis, that should be what insurance is all about -- protecting against catastrophic loss.
Her agency in theory does, but she hasn't been able to figure out how to get credentials. That's frustrating (the agency, not her).
In my previous agency (I am retired now), it was accessible through the employee intranet where we could get a variety of information on our benefits. I just had to log in there, and a link to the report was available.

Northern Flicker
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Re: Federal Blue Cross Standard versus Basic

Post by Northern Flicker » Sun Dec 04, 2016 2:44 pm

My concern with plans with local networks and no out of network coverage centers on what happens if one has to be hospitalized while traveling. Emergency treatment is covered, but when does treatment stop being emergency care and become (uncovered) non-emergency care? Risks might include a massive out of network bill or being discharged from a hospital earlier than otherwise with a possibly compromised health outcome.

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Nearly A Moose
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Re: Federal Blue Cross Standard versus Basic

Post by Nearly A Moose » Sun Dec 04, 2016 3:08 pm

stan1 wrote:
Nearly A Moose wrote:
Agreed. But in our case it will work. We're out of pocket at least a grand on contact lenses alone...
Wow. How many people wearing contacts? Unless you've already exhausted other medical options and have no other choice look into getting your contacts from a lower priced source or tell your optometrist/opthamologist you'd like to look at lower cost options. I'd also wear glasses more often.
Long story short, after years of headaches and related issues, I learned through trial and error that only one of the most expensive soft contact lenses on the market works. Fun stuff. Yes, eye surgery at some point. But not now.
Pardon typos, I'm probably using my fat thumbs on a tiny phone.

Topic Author
Nearly A Moose
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Re: Federal Blue Cross Standard versus Basic

Post by Nearly A Moose » Sun Dec 04, 2016 3:11 pm

jalbert wrote:My concern with plans with local networks and no out of network coverage centers on what happens if one has to be hospitalized while traveling. Emergency treatment is covered, but when does treatment stop being emergency care and become (uncovered) non-emergency care? Risks might include a massive out of network bill or being discharged from a hospital earlier than otherwise with a possibly compromised health outcome.
Anyone know the answer to this question - when does Emergency care switch to regular care? We've been struggling with this one.
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mrc
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Re: Federal Blue Cross Standard versus Basic

Post by mrc » Sun Dec 04, 2016 3:43 pm

About the possibility of premature discharge, no comment.

About a massive bill: not while your are in the ED. When you leave the ED, things change. The question may be how much control you'd have.

See 2017 Service Benefit Plan

Section 5(d). Emergency services/accidents
Note: These benefit levels apply only to professional provider services performed in the emergency room. Regular benefit levels apply to covered services provided in all other settings. See Sections 5(a) and 5(b) for those benefits.
Also
Important things you should keep in mind about these benefits:

• You should be aware that some Preferred (PPO) hospitals may have Non-preferred (non-PPO) professional providers on staff.

• We provide benefits at Preferred benefit levels for emergency room services performed by both PPO and non-PPO providers when their services are related to an accidental injury or medical emergency. The Plan allowance for these services is determined by the contracting status of the provider. If services are performed by non-PPO professional providers in a PPO facility, you will be responsible for your cost-share for those services, plus any difference between our allowance and the billed amount.

• PPO benefits apply only when you use a PPO provider (except as described above). When no PPO provider is available, non-PPO benefits apply.

...

• You must use Preferred providers in order to receive benefits, except in cases of medical emergency or accidental injury. Refer to the guidelines appearing below for additional information.
The later on ...

Non-participating: You pay any difference between our allowance and the billed amount
A simple question without a simple straight-forward clear answer.
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dm200
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Re: Federal Blue Cross Standard versus Basic

Post by dm200 » Sun Dec 04, 2016 3:45 pm

Nearly A Moose wrote:Greetings, I'm hoping some of the current or former federal employees may be able to help me here. We have decided we are going to consolidate my entire family (me, wife, one toddler, one soon-to-be newborn) onto one insurance plan available to my wife as a federal employee. We've narrowed it down to either the Federal Blue Cross Basic or Standard option. The basic is a few hundred a month cheaper for the family plan, has no deductible, fixed co-pays for most things, but provides *no* coverage for out of network providers. Standard is a few hundred more per month, has a $700(ish) deductible, and has tiered benefits for in-network providers, participating providers, and out of network providers.
I find it frustratingly hard to actually run numbers to get my head around this. My sense is that Basic may be a somewhat better deal if we can keep all of our providers in network, but it could be potentially catastrophic if we need to obtain care outside the network (eg a serious medical condition for which we want a certain recognized specialist who is out of network). It also seems there could be some risk if a non-plan provider gets involved in surgical care, although I'm finding the benefits booklet a bit unclear on how that is covered.
We live in DC, and intuitively it feels like a lot of providers in our area take Basic, but that's not scientific, we haven't researched every potential specialist that we (or especially our unborn child) might need, and it's always possible we need non-ER care in another city.
So, my question, which is admittedly vague, is how have people seen these risks materialize or not materialize in real life, and are there any other fundamental differences I'm overlooking?
I've read the entire long-form brochure but am still having a hard time getting my head around this. I think I'm naturally conservative when it comes to insurance and am leaning toward Standard to protect against the need for out of network coverage. But I'd be interested in whether people find that to be an actual issue in real life. All else equal, I'd rather save a few hundred a month on insurance premiums, but that's not going to make or break things for us. (And, we considered a high deductible plan but aren't inclined to go that route this year. Maybe in the future once we understand whether kid 2 has any special medical issues.)
Thanks for any input!
I do not know the answer to this, but if you have not already done so, verify what possible impact YOUR employer's plan may have on this consolidation (rules of the federal plan regarding spouses with employer plan available, coordination of benefits rules, etc.)

LifeOfRiley
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Re: Federal Blue Cross Standard versus Basic

Post by LifeOfRiley » Sun Dec 04, 2016 3:51 pm

I had basic for a while then switched to standard thinking that it would be better and potentially more expansive coverage. This year saw an expensive outpatient surgery (at a preferred provider facility) and under the standard plan I owed 15% of the accepted cost - several thousand dollars. Under the basic plan I would have owed a $100 co-payment. I'm switching back to the basic plan in this open season.

Two Headed Mule
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Re: Federal Blue Cross Standard versus Basic

Post by Two Headed Mule » Sun Dec 04, 2016 4:56 pm

Another cancer patient here who has taken Basic for a pretty thorough test drive this year. Through surgery, radiation, complications, we've paid about $3K out of pocket on charges well into the several hundred thousands of dollars (i.e., the insurance negotiated charges). Absolutely not changing it this year (though we will once again max out our FSA which we didn't this year because, hey, we are so healthy we never use it all).

Mule

rivers03
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Re: Federal Blue Cross Standard versus Basic

Post by rivers03 » Sun Dec 04, 2016 6:29 pm

Fededal employee here- we've used BCBS Basic for our family of 4 for over 6 years now. We've been in the DC area, in a smaller but still major metro area, and now we live in a small rural area. We've had only 1 problem with running into an "out of network" provider and that was this year in the rural area. My husband had to be treated at the ER (though it wasn't really a true "emergency/life or death situation") because of a lack of alternative/after hours providers in our area. Although the hospital is "preferred" so hospital charges were covered, the specific doctor he saw was not in network and we were charged ~$850. Although I was annoyed by this, we still have saved lots with Basic over the years with the lower premiums. Obviously, our experience may not be the same as yours but I think in the DC area you are unlikely to come across too many out of network providers. Hope this helps. Good luck with your decision!

delamer
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Re: Federal Blue Cross Standard versus Basic

Post by delamer » Sun Dec 04, 2016 7:26 pm

rivers03 wrote:Fededal employee here- we've used BCBS Basic for our family of 4 for over 6 years now. We've been in the DC area, in a smaller but still major metro area, and now we live in a small rural area. We've had only 1 problem with running into an "out of network" provider and that was this year in the rural area. My husband had to be treated at the ER (though it wasn't really a true "emergency/life or death situation") because of a lack of alternative/after hours providers in our area. Although the hospital is "preferred" so hospital charges were covered, the specific doctor he saw was not in network and we were charged ~$850. Although I was annoyed by this, we still have saved lots with Basic over the years with the lower premiums. Obviously, our experience may not be the same as yours but I think in the DC area you are unlikely to come across too many out of network providers. Hope this helps. Good luck with your decision!
You make a very good point regarding the $850. It is easy/common to focus on the most recent outlay, without thinking about all the money that you saved in premiums over the years.

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Re: Federal Blue Cross Standard versus Basic

Post by Northern Flicker » Sun Dec 04, 2016 9:03 pm

mrc wrote:About the possibility of premature discharge, no comment.

About a massive bill: not while your are in the ED. When you leave the ED, things change. The question may be how much control you'd have.
If the emergency room doc wants to admit you to the hospital for treatment, I don't think you can insist the treatment be done in the ER or coded as an ER visit. You would be fighting the insurance company over it.

With different insurance, I've never been able to get a satisfactory answer. I now use a criterion of only considering plans with an out-of-network, out-of-pocket maximum that we can live with as a worst case outcome, and plans that have a broad nat'l network if the OON OOP max would be painful.

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Nearly A Moose
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Re: Federal Blue Cross Standard versus Basic

Post by Nearly A Moose » Tue Dec 06, 2016 8:59 pm

All - Thanks for the good input, this is always such a helpful place. In case folks are interested, we opted for Federal Blue Cross Standard. We couldn't get comfortable with the risk of being stuck with paying full costs for out of network care, so we'll pay the higher premiums for now until we better understand the type of medical care our family will need. The right side is, even with the higher premiums, it's still saving ~400 a month off my current plan! Thanks again!
Pardon typos, I'm probably using my fat thumbs on a tiny phone.

mrc
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Re: Federal Blue Cross Standard versus Basic

Post by mrc » Wed Dec 07, 2016 11:04 am

We shall see I guess. We just chose Basic this year after many years on Standard. If one of us lands in the ED, we'll hope for recovery and deal with the costs if they occur. The premium savings alone is around $1900, which should go a long way toward any extra costs from Basic. This thread is what got us thinking about switching in the first place. Great site.
Macs are for those who don’t want to know why their computer works | Linux is for those who do | DOS is for those who want to know why their computer doesn’t work | Windows is for those who don’t

Topic Author
Nearly A Moose
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Re: Federal Blue Cross Standard versus Basic

Post by Nearly A Moose » Wed Dec 07, 2016 1:21 pm

mrc wrote:We shall see I guess. We just chose Basic this year after many years on Standard. If one of us lands in the ED, we'll hope for recovery and deal with the costs if they occur. The premium savings alone is around $1900, which should go a long way toward any extra costs from Basic. This thread is what got us thinking about switching in the first place. Great site.
We were on the fence and leaned both ways at various points. I eventually just asked myself which choice would let me sleep better at night. I hope to get into Basic or a HDHP at some point in time. Best of luck!
Pardon typos, I'm probably using my fat thumbs on a tiny phone.

Northern Flicker
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Re: Federal Blue Cross Standard versus Basic

Post by Northern Flicker » Sat Dec 10, 2016 4:10 pm

Another option may be to use cheaper insurance with a local network, and buy single trip travel medical insurance for travel. It also includes international coverage. I have no experience with these types of products.

A Boglehead
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Re: Federal Blue Cross Standard versus Basic

Post by A Boglehead » Sun Nov 17, 2019 7:41 pm

I noticed the government pays 67% of the premium for the Standard Option, vs. 75% of the premium for the Basic Option. My interpretation of this discussion has been to favor the Basic Option for the savings on the premium, even before noticing the difference in what the gov't pays. Are you still happy with the Basic Option? I'm planning to switch from Standard to Basic. Thanks!

UpperNwGuy
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Re: Federal Blue Cross Standard versus Basic

Post by UpperNwGuy » Sun Nov 17, 2019 8:35 pm

A Boglehead wrote:
Sun Nov 17, 2019 7:41 pm
I noticed the government pays 67% of the premium for the Standard Option, vs. 75% of the premium for the Basic Option. My interpretation of this discussion has been to favor the Basic Option for the savings on the premium, even before noticing the difference in what the gov't pays. Are you still happy with the Basic Option? I'm planning to switch from Standard to Basic. Thanks!
I'm sticking with Standard Option.

delamer
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Re: Federal Blue Cross Standard versus Basic

Post by delamer » Sun Nov 17, 2019 9:24 pm

A Boglehead wrote:
Sun Nov 17, 2019 7:41 pm
I noticed the government pays 67% of the premium for the Standard Option, vs. 75% of the premium for the Basic Option. My interpretation of this discussion has been to favor the Basic Option for the savings on the premium, even before noticing the difference in what the gov't pays. Are you still happy with the Basic Option? I'm planning to switch from Standard to Basic. Thanks!
Why would the portion/percentage of the premium paid by the government factor into your decision?

A Boglehead
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Re: Federal Blue Cross Standard versus Basic

Post by A Boglehead » Sun Nov 17, 2019 10:30 pm

I'd rather have the gov't, rather than I, pay a higher portion of the premium.

Swansea
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Re: Federal Blue Cross Standard versus Basic

Post by Swansea » Mon Nov 18, 2019 6:09 am

I've been on the Standard for a large number of years. One reason for me is that it is more generous with PT visits, up to 75 per year. I forget how may Basic will spring for.

UpperNwGuy
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Re: Federal Blue Cross Standard versus Basic

Post by UpperNwGuy » Mon Nov 18, 2019 6:18 am

A Boglehead wrote:
Sun Nov 17, 2019 10:30 pm
I'd rather have the gov't, rather than I, pay a higher portion of the premium.
That makes no sense. You should be looking for best value, especially in your individual medical circumstances.

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VictoriaF
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Re: Federal Blue Cross Standard versus Basic

Post by VictoriaF » Mon Nov 18, 2019 9:46 am

LifeOfRiley wrote:
Sun Dec 04, 2016 3:51 pm
I had basic for a while then switched to standard thinking that it would be better and potentially more expansive coverage. This year saw an expensive outpatient surgery (at a preferred provider facility) and under the standard plan I owed 15% of the accepted cost - several thousand dollars. Under the basic plan I would have owed a $100 co-payment.
BCBS brochures use different units for some services under Basic and Standard: dollars and percents. My assumption has been the same as LifeOfRiley's, i.e., that whether dollars or percents, out-of-pocket costs under Standard would be lower. Apparently, this is not the case.

Has anyone else had a similar to LifeOfRiley's experience?
What is the actuarial reason for having both the plan cost and out-of-pocket expenses higher?

Victoria
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Nestegg_User
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Re: Federal Blue Cross Standard versus Basic

Post by Nestegg_User » Mon Nov 18, 2019 10:12 am

Victoria

The big concern for us is the need for preferred providers for Basic; which might not be a problem for you in DC but is a problem for those of us in smaller cities/rural areas. There's also a bit more issues with "coordination of benefits" vis-a-vis Medicare with Basic versus Standard (see pages 148-155 of 2020 booklet)

{https://www.opm.gov/healthcare-insuranc ... 71-005.pdf}

I'm also not quite at Medicare age, but have been looking at those issues, and as a couple (unlike you) with enough age difference we'll be on BC/BS Standard for a while since we have had a quite varied need for service that Basic would not have been optimal. (GEHA providers are virtually nonexistent in our area so that's not an option; when we do travel domestically we haven't found any issues with BCBS Standard being accepted anywhere but would be concerned with GEHA based on our situation with providers)

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theduke
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Re: Federal Blue Cross Standard versus Basic

Post by theduke » Mon Nov 18, 2019 11:09 am

I am on Medicare with the BCBS Basic plan. It works great, medicare pays their portion and Basic pays the rest including any deductables. I don't have to pay anything, except the premiums of course. And if a person is on medicare with Basic, BCBS will refund $600 of the premium.

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