Federal Retiree Health Care with/Medicare

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retiredjg
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Re: Federal Retiree Health Care with/Medicare

Post by retiredjg » Wed Nov 08, 2017 2:24 pm

Nearing_Destination wrote:
Wed Nov 08, 2017 1:30 pm
Re: hospitals dropping BC/BS — are the hospitals dropping or is BC/BS dropping the hospitals?
In the case in my area, the healthcare provider system (which includes several hospitals and most of the physicians and labs in the area) withdrew from BCBS. Unfortunately, it will be BCBS that suffers as patients are likely to change plans to have access their doctors. Unfortunately, it is the largest provider of health care in this area. Staying with BCBS means paying more co-pays or driving to other cities for doctors and hospitals that are still covered.

Each points the finger at the other for the impasse.

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dm200
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Re: Federal Retiree Health Care with/Medicare

Post by dm200 » Wed Nov 08, 2017 2:50 pm

retiredjg wrote:
Wed Nov 08, 2017 2:24 pm
Nearing_Destination wrote:
Wed Nov 08, 2017 1:30 pm
Re: hospitals dropping BC/BS — are the hospitals dropping or is BC/BS dropping the hospitals?
In the case in my area, the healthcare provider system (which includes several hospitals and most of the physicians and labs in the area) withdrew from BCBS. Unfortunately, it will be BCBS that suffers as patients are likely to change plans to have access their doctors. Unfortunately, it is the largest provider of health care in this area. Staying with BCBS means paying more co-pays or driving to other cities for doctors and hospitals that are still covered.
Each points the finger at the other for the impasse.
That kind of thing seems to be a "trend". In this area (Washington DC, MD/VA suburbs), hospitals are merging and/or establishing "affiliations" (such as with the Mayo clinic or Johns Hopkins, for example). Kaiser is large and growing in this area - and several yers ago, Kaiser dropped (except for ER) using the largest hospital in Northern Virginia and focused/atrengthened relationships with several smaller hospitals (including the one nearest our home). At first, that large dropped hospital and health plans that still used it - made that an issue during various health insurance "open seasons" against Kaiser. It must not have worked because Kaiser continues to grow membership and add/expand facilities.

Swansea
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Re: Federal Retiree Health Care with/Medicare

Post by Swansea » Wed Nov 08, 2017 4:24 pm

Hospitals are reimbursed for many services at a higher rate than physician's practices. That is one reason more docs are joining hospital affiliated groups.

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dm200
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Re: Federal Retiree Health Care with/Medicare

Post by dm200 » Wed Nov 08, 2017 4:36 pm

Swansea wrote:
Wed Nov 08, 2017 4:24 pm
Hospitals are reimbursed for many services at a higher rate than physician's practices. That is one reason more docs are joining hospital affiliated groups.
Why??

retirednps
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Re: Federal Retiree Health Care with/Medicare

Post by retirednps » Wed Nov 08, 2017 9:06 pm

Excellent discussion above by Info Hound.

As to hospitals no longer being in BC/BS network, at least in my area of western N.C. there is only one "major" hospital within a 50 mile drive, and it parted ways with BC/BS as of early Oct. Both sides blame the other for failure to continue the contract. Rumor has it they may come to an agreement by "the first of the year," but that will be too late for decisions during the open season for 2018 coverage.

I've had excellent claims service from BC/BS Federal Employees Plan for 15+ years, and for the seven years I've been in Medicare Part A and B, haven't paid anything out of pocket except for prescription drug copays. The BC/BS premiums have been expensive, but those seven years have included 3 surgeries - one pretty expensive - and some pricey diagnostic tests, so I'm glad I had the "full coverage" from the combo of Medicare A & B + my BC/BS.

(I have revised this paragraph to correct an error I made in the original post] That said, the recent change that put my area's major hospital - and a number of specialists affiliated with it - "out of network" for BC/BS will likely cause me to switch to the Aetna Direct Plan. I'm sorry now I didn't look at that plan sooner; I'm still studying the fine print, but it appears the Aetna Direct plan has even better coverage than BC/BS Standard Plan, and at major savings for me in premiums. Examples of "better coverage" -(1) Aetna Direct has more generous benefits for skilled nursing care (example: if I need to go into skilled care for a while after major surgery) (2) Aetna Direct has more generous coverage for home health care; (3) Aetna Direct will reimburse my wife and I a total of $1,800 a year for my our of pocket prescription drug copays and Medicare Part B premium ($900 for each of us.) Next year BC/BS Standard will reimburse $600 of those costs per insured individual; their basic plan will not include that benefit. (4) For policyholders with Medicare Part A & B as primary insurance, the Aetna Direct will pay 100% of costs after Medicare pays, whether or not the provider is in the Aetna PPO network- IF the provider "accepts medicare assignment for payment." (If the provider does not accept Medicare assignment, there will likely be some out of pocket costs.)

I had a lengthy phone conversation with my current BC/BS plan to try to clarify what I'd ultimately pay out of pocket if I used a local provider (hospital or specialist) who was not in-network for BC/BS. I never could get a clear answer. An email to BC/BS asking the same question has not been answered after 10 days. As best I can tell, for out-of-network care, I would have to pay the provider any balance due after Medicare, then file a claim with BC/BS to request reimbursement for at least part of what I paid. The answer to how that amount would be determined is thus far a mystery. If anyone on this forum has any insights, that would be very welcome :-)

Finally, I don't believe there is a large population of retired federal employees in my part of western N. C. We moved here 6 years ago, and had no problem finding health providers who accept both Medicare and our BC/BS FEP. According to the Aetna online directory, every provider I've used in this area is also in the Aetna PPO network.

I've seen a few comments about the Aetna Direct plan in this forum. If anyone else has any experience with that plan, I'd welcome their comments.
Last edited by retirednps on Thu Nov 09, 2017 12:27 pm, edited 2 times in total.

retiredjg
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Re: Federal Retiree Health Care with/Medicare

Post by retiredjg » Thu Nov 09, 2017 6:04 am

I've also been reading about Aetna Direct. I gather it is a relatively new plan - maybe only one or two years old - so we may not hear much feedback.

One thing I found that I did not like is their prescription program is one of the less flexible ones - requiring special authorization and/or a "step up" program for some things. I've had a bad experience with this in the past (at GEHA).

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Re: Federal Retiree Health Care with/Medicare

Post by Swansea » Thu Nov 09, 2017 6:16 am

dm200 wrote:
Wed Nov 08, 2017 4:36 pm
Swansea wrote:
Wed Nov 08, 2017 4:24 pm
Hospitals are reimbursed for many services at a higher rate than physician's practices. That is one reason more docs are joining hospital affiliated groups.
Why??
From a NYT article:

But the government didn’t cut what it paid cardiologists who worked for a hospital and provided the same test. It actually paid those doctors more, because the payment systems were completely separate. In general, Medicare assumes that hospital care is by definition more expensive to provide than office-based care.

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dm200
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Re: Federal Retiree Health Care with/Medicare

Post by dm200 » Thu Nov 09, 2017 9:50 am

Swansea wrote:
Thu Nov 09, 2017 6:16 am
dm200 wrote:
Wed Nov 08, 2017 4:36 pm
Swansea wrote:
Wed Nov 08, 2017 4:24 pm
Hospitals are reimbursed for many services at a higher rate than physician's practices. That is one reason more docs are joining hospital affiliated groups.
Why??
From a NYT article:
But the government didn’t cut what it paid cardiologists who worked for a hospital and provided the same test. It actually paid those doctors more, because the payment systems were completely separate. In general, Medicare assumes that hospital care is by definition more expensive to provide than office-based care.
Interesting. Seems to me, though, that while hospitals may have more costs (in some ways), on the other hand a hospital probably has "economies of scale" for many costs that am office based practice does not.

retirednps
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Re: Federal Retiree Health Care with/Medicare

Post by retirednps » Thu Nov 09, 2017 10:41 am

retiredjg wrote:
Thu Nov 09, 2017 6:04 am
I've also been reading about Aetna Direct. I gather it is a relatively new plan - maybe only one or two years old - so we may not hear much feedback.

One thing I found that I did not like is their prescription program is one of the less flexible ones - requiring special authorization and/or a "step up" program for some things. I've had a bad experience with this in the past (at GEHA).
Thanks for that comment. That is the one main concern I've had as well.

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Re: Federal Retiree Health Care with/Medicare

Post by stan1 » Thu Nov 09, 2017 11:07 am

retirednps wrote:
Wed Nov 08, 2017 9:06 pm

As to hospitals no longer being in BC/BS network, at least in my area of western N.C. there is only one "major" hospital within a 50 mile drive, and it parted ways with BC/BS as of early Oct. Both sides blame the other for failure to continue the contract. Rumor has it they may come to an agreement by "the first of the year," but that will be too late for decisions during the open season for 2018 coverage.
My preferred medical provider is a large academic hospital that has multiple clinics and many physicians all over our metro area. They went through a similar disagreement with BCBS several years ago. One year it was a threat resolved at the last minute. A few years later they actually parted ways and came back together after a few weeks. Both times I got letters from the hospital and BCBS notifying me of their pending break up and asking me to call the other side to talk sense into them. I believe the negotiated rates visible to me on the EOB did go up after the disputes were resolved (hard to say as I don't have the same medical needs every year) and I think I'm paying more co-insurance (by absolute $, copay % is the same). There may be more deals behind the scenes that aren't visible to me.

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Re: Federal Retiree Health Care with/Medicare

Post by bartbill » Thu Nov 09, 2017 11:14 am

When I pull up Aetna Direct off the Federal page to compare it with my Federal Blue Cross Standard option I only see HMO. No FFS. Is this correct?

retirednps
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Re: Federal Retiree Health Care with/Medicare

Post by retirednps » Thu Nov 09, 2017 12:15 pm

bartbill wrote:
Thu Nov 09, 2017 11:14 am
When I pull up Aetna Direct off the Federal page to compare it with my Federal Blue Cross Standard option I only see HMO. No FFS. Is this correct?
An earlier post of this site said that was an error on the OPM website; it said the Aetna Direct is a FFS plan, but I can't vouch for the accuracy of that comment.

I just had an on-line '"chat session" with Aetna, and asked that question. The response was: "The Aetna Direct plan is not an HMO, it's a PPO plan but it's a fee for service."

The Aetna rep. on that chat session also said: "When you have Medicare Parts A and B and the provider accepts Medicare assignment, we pick up the balances in full at 100%. The providers do not have to be in network with Aetna at all."

An important point from the plan brochure: "If your provider does not accept Medicare assignment, then you pay the difference between
the "limiting charge" or the provider's charge (whichever is less) and our payment combined with Medicare's payment."

delamer
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Re: Federal Retiree Health Care with/Medicare

Post by delamer » Thu Nov 09, 2017 12:34 pm

I have to make this decision in a little over a year.

Does anyone have any insight into best options when one person on the insurance is Medicare-eligible and one (or more) on the insurance is not?

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Re: Federal Retiree Health Care with/Medicare

Post by trueblueky » Thu Nov 09, 2017 3:49 pm

delamer wrote:
Thu Nov 09, 2017 12:34 pm
I have to make this decision in a little over a year.

Does anyone have any insight into best options when one person on the insurance is Medicare-eligible and one (or more) on the insurance is not?
I'm on Medicare. For us, best was to "suck it up" and stay with our BCBS family plan. When DW becomes Medicare eligible, we will change to Aetna Direct (assuming things then are as they are now).

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Re: Federal Retiree Health Care with/Medicare

Post by delamer » Thu Nov 09, 2017 3:52 pm

trueblueky wrote:
Thu Nov 09, 2017 3:49 pm
delamer wrote:
Thu Nov 09, 2017 12:34 pm
I have to make this decision in a little over a year.

Does anyone have any insight into best options when one person on the insurance is Medicare-eligible and one (or more) on the insurance is not?
I'm on Medicare. For us, best was to "suck it up" and stay with our BCBS family plan. When DW becomes Medicare eligible, we will change to Aetna Direct (assuming things then are as they are now).
Are you taking Part B?

trueblueky
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Re: Federal Retiree Health Care with/Medicare

Post by trueblueky » Thu Nov 09, 2017 4:17 pm

delamer wrote:
Thu Nov 09, 2017 3:52 pm
trueblueky wrote:
Thu Nov 09, 2017 3:49 pm
delamer wrote:
Thu Nov 09, 2017 12:34 pm
I have to make this decision in a little over a year.

Does anyone have any insight into best options when one person on the insurance is Medicare-eligible and one (or more) on the insurance is not?
I'm on Medicare. For us, best was to "suck it up" and stay with our BCBS family plan. When DW becomes Medicare eligible, we will change to Aetna Direct (assuming things then are as they are now).
Are you taking Part B?
Yes. It feels like belt and suspenders now, but may be useful in 20 years. I don't know what Medicare, government share of FEHB, health inflation, our personal health situation will look like that far out. AEtna Direct reimburses part of Part B, as does BCBS Basic.

retiredjg
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Re: Federal Retiree Health Care with/Medicare

Post by retiredjg » Thu Nov 09, 2017 4:55 pm

bartbill wrote:
Thu Nov 09, 2017 11:14 am
When I pull up Aetna Direct off the Federal page to compare it with my Federal Blue Cross Standard option I only see HMO. No FFS. Is this correct?
Look closer. I made the same mistake at first and I will not choose an HMO if there is any other choice.

It is not an HMO nor it is a FFS (Fee for service) It is a CDHP - Consumer Driven Health Plan - which is grouped in at least one place with HMO's.

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dm200
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Re: Federal Retiree Health Care with/Medicare

Post by dm200 » Thu Nov 09, 2017 5:01 pm

I made the same mistake at first and I will not choose an HMO if there is any other choice.


You are certainly entitled to make such a decision.

However, there are may types of HMOs, and many providers as well. Many (but not all) of those enrolled in HMOs (including my wife and I) are, and have been, very pleased with their HMO plan - for both cost and quality.

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Re: Federal Retiree Health Care with/Medicare

Post by retiredjg » Thu Nov 09, 2017 5:10 pm

Yes, I know. I've had one good HMO experience and one bad one. The bad one was worserer than the good one was betterer....I'm not inclined to go back. :happy

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dm200
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Re: Federal Retiree Health Care with/Medicare

Post by dm200 » Thu Nov 09, 2017 5:35 pm

retiredjg wrote:
Thu Nov 09, 2017 5:10 pm
Yes, I know. I've had one good HMO experience and one bad one. The bad one was worserer than the good one was betterer....I'm not inclined to go back. :happy
Maybe we have just been "lucky". While we have encountered some "issues" of what is and is not covered, as well as some limits on seeing certain providers (we had to switch many Physicians), we have never had a "bad" experience. In one or two cases, we ended up with better Physicians/specialists than before the switch.

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Re: Federal Retiree Health Care with/Medicare

Post by retirednps » Thu Nov 09, 2017 5:45 pm

retiredjg wrote:
Thu Nov 09, 2017 4:55 pm
bartbill wrote:
Thu Nov 09, 2017 11:14 am
When I pull up Aetna Direct off the Federal page to compare it with my Federal Blue Cross Standard option I only see HMO. No FFS. Is this correct?
Look closer. I made the same mistake at first and I will not choose an HMO if there is any other choice.

It is not an HMO nor it is a FFS (Fee for service) It is a CDHP - Consumer Driven Health Plan - which is grouped in at least one place with HMO's.
I had an on-line '"chat session" with Aetna earlier today, and asked that question. The response was: "The Aetna Direct plan is not an HMO, it's a PPO plan but it's a fee for service." The "Consumer Driven Health Plan" refers to the fund included in the plan ($900 for member, another $900 for spouse) to help pay for out-of-pocket costs, including prescription copays and Medicare Part B premiums.

If you have medicare part A and B, Aetna Direct Plan says it will pay any balance after Medicare pays, as long as the provider accepts Medicare payments. In those cases, the provider does not have to be "in-network" with Aetna. That does not sound like most HMO plans I"m familiar with.

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Blues
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Re: Federal Retiree Health Care with/Medicare

Post by Blues » Thu Nov 09, 2017 6:01 pm

Out of curiosity, are most of you folks who either intend to, or already have elected "Part B", under the regular care of a physician and taking prescription meds?

I just can't see throwing more money into the healthcare sinkhole when I'm already entitled to Part A and have good coverage via FEHB.

To be honest, having watched various family members and in-laws die a slow death while taking a multitude of medications for various ailments, I don't see it as a lifestyle I care to opt for regardless of how many more years it might afford.

Personally, I'd just as soon go out while lifting weights or hiking a trail...but that's me and my own prejudices at work. I'm not nearly as interested in longevity for its own sake as I am quality of life up until, or close to the finish line.

It's not a matter of ability to afford the coverage...

Edit to add:

The following excerpt is from Consumers' Checkbook from its analysis of 2017 FEHB plans and Medicare Part B:
However, Medicare Part B will rarely save you nearly as much money as you spend on the Part B premium. This is because
the cost sharing for physician visits and tests in almost all FEHBP plans is already so low. And as we discuss below, for
those who pay more for Part B than the normal premium, it is almost always a bad buy in purely financial terms...(snip)...

...If you do decide to drop (or not start) Part B you can join it later. But there is a 10 percent a year penalty if you later decide
to join or rejoin. As a financial matter, however many years you elect to do without Part B, you will be money ahead for
approximately the first five or six years after joining or rejoining (those who start out paying the higher income-tested
premium well be much more money ahead). After that, the penalty will outweigh your earlier savings (except for those who
were once above, but now fall below, the income-tested premium). If you never join or rejoin, you will (on average) save
annually roughly the amounts indicated in our tables showing costs with and without Parts B—generally about half the cost
of the Part B premium, though this varies somewhat from plan to plan. Thus, either not joining or dropping Part B is not an
irrevocable decision, and later rejoining Part need not be highly costly.
“Tactics without strategy is the noise before defeat.” - Sun Tzu | "Everybody has a plan until they get punched in the mouth." - Mike Tyson

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Ricola
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Re: Federal Retiree Health Care with/Medicare

Post by Ricola » Thu Nov 09, 2017 8:29 pm

I guess I don't understand why one would pay for Part B if you have ongoing FEHB insurance. Doesn't your FEHB insurer cover everything that Part B does?

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Re: Federal Retiree Health Care with/Medicare

Post by ChrisC » Thu Nov 09, 2017 8:36 pm

Blues wrote:
Thu Nov 09, 2017 6:01 pm
Out of curiosity, are most of you folks who either intend to, or already have elected "Part B", under the regular care of a physician and taking prescription meds?

I just can't see throwing more money into the healthcare sinkhole when I'm already entitled to Part A and have good coverage via FEHB.

To be honest, having watched various family members and in-laws die a slow death while taking a multitude of medications for various ailments, I don't see it as a lifestyle I care to opt for regardless of how many more years it might afford.

Personally, I'd just as soon go out while lifting weights or hiking a trail...but that's me and my own prejudices at work. I'm not nearly as interested in longevity for its own sake as I am quality of life up until, or close to the finish line.

It's not a matter of ability to afford the coverage...

Edit to add:

The following excerpt is from Consumers' Checkbook from its analysis of 2017 FEHB plans and Medicare Part B:
However, Medicare Part B will rarely save you nearly as much money as you spend on the Part B premium. This is because
the cost sharing for physician visits and tests in almost all FEHBP plans is already so low. And as we discuss below, for
those who pay more for Part B than the normal premium, it is almost always a bad buy in purely financial terms...(snip)...

...If you do decide to drop (or not start) Part B you can join it later. But there is a 10 percent a year penalty if you later decide
to join or rejoin. As a financial matter, however many years you elect to do without Part B, you will be money ahead for
approximately the first five or six years after joining or rejoining (those who start out paying the higher income-tested
premium well be much more money ahead). After that, the penalty will outweigh your earlier savings (except for those who
were once above, but now fall below, the income-tested premium). If you never join or rejoin, you will (on average) save
annually roughly the amounts indicated in our tables showing costs with and without Parts B—generally about half the cost
of the Part B premium, though this varies somewhat from plan to plan. Thus, either not joining or dropping Part B is not an
irrevocable decision, and later rejoining Part need not be highly costly.
Not sure it's really a healthcare sinkhole or flushing money down the toilet drain to have Medicare Part B and a low cost FEHB plan (like BSBC-Basic or Aetna Direct) that covers all Medicare deductibles and co=payments and has decent prescription coverage. I think Aetna Direct and BSBC-Basic, with HRA type reimbursements for Medicare Part B premiums, changes the prior notion followed by many Federal retirees of just sticking with a good FEHB plan (BSBC Standard or GEHA standard) with high premiums and foregoing Medicare Part B. What does Checkbook say about the relative financial merits of going with Aetna Direct (with Medicare Part B) vs BCBS standard without Medicare Part B?

I can tell you that as one gets older and more prone to medical problems -- it's really a blessing to have everything covered by Medicare and FEHB plans and not worry about co-payments and deductibles. Simplicity has its virtue, especially when other family members have to sort out medical payments, deductibles and co-payments.

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TimeRunner
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Re: Federal Retiree Health Care with/Medicare

Post by TimeRunner » Thu Nov 09, 2017 10:43 pm

I'm leaning towards not opting for Part B in 2019 (when I enroll in Medicare A). We'll be subject IRMAA - more than $3,200/year for me, and more than double that for two of us per year by the time my wife applies. Much speculation around the future of FEHB and whether B would be required. If B is required, it's likely penalties for not taking it would be waived at that time, IMO, so it's a risk worth taking for us.
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Blues
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Re: Federal Retiree Health Care with/Medicare

Post by Blues » Thu Nov 09, 2017 11:22 pm

ChrisC wrote:
Thu Nov 09, 2017 8:36 pm
What does Checkbook say about the relative financial merits of going with Aetna Direct (with Medicare Part B) vs BCBS standard without Medicare Part B?
Hopefully you'll find the following excerpt of value. Keep in mind that this analysis is from the 2017 FEHB options, not the open season that will begin next Monday.
Throughout our advice we have highlighted specific advantages and disadvantages of enrolling in Medicare Part B in addition
to your FEHBP enrollment. On the minus side there is one large factor—paying two costly sets of premiums instead of one.
For those who pay the higher part B “income-tested” premiums, this is a very considerable cost, between about $2,500 and
$4,000 extra to join Part B, depending on exact income level (and much more than that for the extra high Part B premiums in
2016).

On the plus side there are several factors, including avoiding network restrictions, better coverage for a few services,
and having the option to join Medicare Advantage plans and paying only one premium without losing FEHBP eligibility.

By now, you should realize that you have many options, each with advantages and disadvantages. Taking into account dollar
costs only, there are four good sets of options. One of these is to enroll in one of the better Medicare Advantage plans and
suspend the FEHBP enrollment. A second option is to enroll in the Aetna Direct CDHP plan, the Mail Handlers HDHP plan,
or in the DC area the CareFirst HDHP plan. Your HRA account will pay towards the Part B premium or for drug or dental
costs not otherwise covered, and you also get a Medicare wrap around. A third cost-saving choice is to enroll in an FEHBP
plan with rich benefits such as APWU, NALC, Blue Cross Basic, or many HMOs, and drop Medicare Part B. As a fourth
choice, you can enroll in a low-premium national plan like GEHA Standard option or Blue Cross Basic, and get a Medicare
wrap around benefit, or join a low-premium HMO and use Part B to fill holes and get services outside the plan’s network. Two
of these good options involve keeping Part B and the FEHBP, but two let you pay only one premium. All of them vary in
details that you can only assess after studying the brochure of one or two plans. All of them can provide most annuitants
substantial annual savings.

What you should generally not do is stay in a high premium FEHBP plan to get the Part B wrap around benefit when you can
join a less costly FEHBP plan with an equally good wrap around benefit. Of course, there are always cases where even the
most expensive combination provides a benefit essential to you. And differences in prescription drug formularies or cost
sharing can make a seemingly more expensive option actually a less expensive option. So there is no simple “once size fits
all” answer. What you should do, regardless, is at least be aware of the dollar costs or gains of whatever decision you reach.
“Tactics without strategy is the noise before defeat.” - Sun Tzu | "Everybody has a plan until they get punched in the mouth." - Mike Tyson

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Re: Federal Retiree Health Care with/Medicare

Post by Swansea » Fri Nov 10, 2017 6:02 am

I have BCBS standard as well as Medicare Part B. I ran the numbers in 2015 found that part Part B almost paid for itself because of picking up numerous PT visits. In a healthier 2016, I recouped very little benefit from Part B, so after evaluating what Checkbook has to say, I may drop it. Just need to be sure BCBS retains catastrophic limits.

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Re: Federal Retiree Health Care with/Medicare

Post by ChrisC » Fri Nov 10, 2017 7:07 am

TimeRunner wrote:
Thu Nov 09, 2017 10:43 pm
I'm leaning towards not opting for Part B in 2019 (when I enroll in Medicare A). We'll be subject IRMAA - more than $3,200/year for me, and more than double that for two of us per year by the time my wife applies. Much speculation around the future of FEHB and whether B would be required. If B is required, it's likely penalties for not taking it would be waived at that time, IMO, so it's a risk worth taking for us.
I suspect that the high IRMAA level is due because your premiums will be based on tax return years which reflects gainful employment at a high income level. We escaped that high level because we retired in 2013, but my wife's enrollment in Medicare Part B in January 2017 was based on 2015 tax returns -- as it was she still landed in the first tier of IRMAA primarily as a result of Roth Conversions, which is something folks should keep in mind.

This really is a very personal situation. And the mental accounting and financial behavior factors are fascinating to me. We have decent sized HSA that can handle Medicare Part B premiums for a long time and though I have WEP-adjusted Social Security retirement benefits (which I consider "free money"), it would take care of my Medicare Part B. Nonetheless, I'm still weighing whether I should enroll in Medicare Part B when I become initially eligible in December 2018.

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Re: Federal Retiree Health Care with/Medicare

Post by retiredjg » Fri Nov 10, 2017 7:59 am

retirednps wrote:
Thu Nov 09, 2017 5:45 pm
retiredjg wrote:
Thu Nov 09, 2017 4:55 pm
bartbill wrote:
Thu Nov 09, 2017 11:14 am
When I pull up Aetna Direct off the Federal page to compare it with my Federal Blue Cross Standard option I only see HMO. No FFS. Is this correct?
Look closer. I made the same mistake at first and I will not choose an HMO if there is any other choice.

It is not an HMO nor it is a FFS (Fee for service) It is a CDHP - Consumer Driven Health Plan - which is grouped in at least one place with HMO's.
I had an on-line '"chat session" with Aetna earlier today, and asked that question. The response was: "The Aetna Direct plan is not an HMO, it's a PPO plan but it's a fee for service." The "Consumer Driven Health Plan" refers to the fund included in the plan ($900 for member, another $900 for spouse) to help pay for out-of-pocket costs, including prescription copays and Medicare Part B premiums.
I suppose this could be correct, but it seems to be inconsistent with what I've seen on their website. Possibly the CDHP is a type of PPO.

The wording I saw indicated that the plan is a Consumer Driven Health Plan (CDHP) which includes a Medical Fund (the $900).
If you have medicare part A and B, Aetna Direct Plan says it will pay any balance after Medicare pays, as long as the provider accepts Medicare payments. In those cases, the provider does not have to be "in-network" with Aetna. That does not sound like most HMO plans I"m familiar with.
This is one thing I was wondering about and is good to hear because I was not sure how to interpret their brochure on this. My physicians do accept Medicare, but there is always the problem of a surgery or something where you have no control over the other people involved (anesthesiologist, pathologist, etc.) Not sure how that is handled.

On the Fed Soup website I found some discussion of Aetna Direct. It apparently is now going into its 3rd year. There were complaints about customer service, but that sounded like beginning business problems - shake down issues.

Thanks for sharing what you learned. I may also do a chat to ask about the step up program for certain Rx's.

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Re: Federal Retiree Health Care with/Medicare

Post by dm200 » Fri Nov 10, 2017 8:02 am

Ricola wrote:
Thu Nov 09, 2017 8:29 pm
I guess I don't understand why one would pay for Part B if you have ongoing FEHB insurance. Doesn't your FEHB insurer cover everything that Part B does?
It depends on what FEHB Insurer you select and what options with that insurer. Even with the FEHB, there are (or may be) copays and required payments for certain services.

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Re: Federal Retiree Health Care with/Medicare

Post by retiredjg » Fri Nov 10, 2017 8:16 am

Blues wrote:
Thu Nov 09, 2017 6:01 pm
Out of curiosity, are most of you folks who either intend to, or already have elected "Part B", under the regular care of a physician and taking prescription meds?

I just can't see throwing more money into the healthcare sinkhole when I'm already entitled to Part A and have good coverage via FEHB.
It is my understanding that prescription meds have nothing to do with this decision. Part B does not cover Rx.

I don't see it as a sinkhole either. I signed up for Part B because at the time I didn't know what either decision meant - thought I'd try it and keep my eligibility rather than not try it and pay more later if I wanted it.

My Medicare Part B costs something in the neighborhood of $1,500 a year. For that, I pay no bills for medical care at all. No copay, no deductible, no nothing. There are some years I might be paying extra. I don't know because I have not checked.

But there are or will be years when it is more than worth it. For example, in any year with a joint injury - MRI, xrays, specialists visits, physical therapy, maybe even surgery - the copays and deductible probably add up to more than $1,500. In years with a serious illness - I think it could be way more than $1,500.

If my Part B cost $10k a year, I might be thinking more like you.

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Re: Federal Retiree Health Care with/Medicare

Post by retiredjg » Fri Nov 10, 2017 8:21 am

Ricola wrote:
Thu Nov 09, 2017 8:29 pm
I guess I don't understand why one would pay for Part B if you have ongoing FEHB insurance. Doesn't your FEHB insurer cover everything that Part B does?
No. If you don't have Part B, you will have a deductible amount and also co-pay for most everything. With Part B, the deductible amount is waived and there are no co-pays.

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Re: Federal Retiree Health Care with/Medicare

Post by Blues » Fri Nov 10, 2017 8:32 am

retiredjg wrote:
Fri Nov 10, 2017 8:16 am
It is my understanding that prescription meds have nothing to do with this decision. Part B does not cover Rx.
I fully understand that Part B doesn't cover prescriptions...but the answer to my question might indicate whether folks were more apt to elect Part B because they were either already on prescription meds, (which might indicate some sort of condition which required physician care), or regularly seeing a physician or therapist for an ongoing matter. This would make the picture much clearer, imho.

In sharing my personal point of view and the excerpted quotes from Consumers' Checkbook I was not trying to convince anyone to opt for or against Part B...rather I was attempting to solicit further info and insight. Perhaps some may still be forthcoming which might convince me that opting in would be advantageous. At this juncture I am still inclined to stay with my original decision which was to enroll only in Part A.
“Tactics without strategy is the noise before defeat.” - Sun Tzu | "Everybody has a plan until they get punched in the mouth." - Mike Tyson

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Re: Federal Retiree Health Care with/Medicare

Post by retiredjg » Fri Nov 10, 2017 8:57 am

Blues wrote:
Fri Nov 10, 2017 8:32 am
I fully understand that Part B doesn't cover prescriptions...but the answer to my question might indicate whether folks were more apt to elect Part B because they were either already on prescription meds, (which might indicate some sort of condition which required physician care), or regularly seeing a physician or therapist for an ongoing matter. This would make the picture much clearer, imho.
That makes sense. I had not thought of it that way.

In sharing my personal point of view and the excerpted quotes from Consumers' Checkbook I was not trying to convince anyone to opt for or against Part B...rather I was attempting to solicit further info and insight. Perhaps some may still be forthcoming which might convince me that opting in would be advantageous. At this juncture I am still inclined to stay with my original decision which was to enroll only in Part A.
Do you know when the next checkbook will be available? Your quotes are causing me to think of some questions I had not thought of. It's all such a crap shoot, but I would NEVER grumble...considering what others are facing these days.

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Re: Federal Retiree Health Care with/Medicare

Post by Blues » Fri Nov 10, 2017 9:20 am

retiredjg wrote:
Fri Nov 10, 2017 8:57 am
Do you know when the next checkbook will be available? Your quotes are causing me to think of some questions I had not thought of. It's all such a crap shoot, but I would NEVER grumble...considering what others are facing these days.
I fully agree with your sentiment. I am very thankful for my health and the healthcare I received via FEHB (even though I only use it pretty much if I need stitches).

The new guide (to my knowledge) is to be available on November 13th when Open Season begins.
“Tactics without strategy is the noise before defeat.” - Sun Tzu | "Everybody has a plan until they get punched in the mouth." - Mike Tyson

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Re: Federal Retiree Health Care with/Medicare

Post by jerryk68 » Fri Nov 10, 2017 9:55 am

retiredjg wrote:
Fri Nov 10, 2017 8:16 am
Blues wrote:
Thu Nov 09, 2017 6:01 pm
Out of curiosity, are most of you folks who either intend to, or already have elected "Part B", under the regular care of a physician and taking prescription meds?

I just can't see throwing more money into the healthcare sinkhole when I'm already entitled to Part A and have good coverage via FEHB.
It is my understanding that prescription meds have nothing to do with this decision. Part B does not cover Rx.

I don't see it as a sinkhole either. I signed up for Part B because at the time I didn't know what either decision meant - thought I'd try it and keep my eligibility rather than not try it and pay more later if I wanted it.

My Medicare Part B costs something in the neighborhood of $1,500 a year. For that, I pay no bills for medical care at all. No copay, no deductible, no nothing. There are some years I might be paying extra. I don't know because I have not checked.

But there are or will be years when it is more than worth it. For example, in any year with a joint injury - MRI, xrays, specialists visits, physical therapy, maybe even surgery - the copays and deductible probably add up to more than $1,500. In years with a serious illness - I think it could be way more than $1,500.

If my Part B cost $10k a year, I might be thinking more like you.
+1
Well said. Why do people trip over dollars trying to save pennies? Never understood that. Your getting older not younger and will need more medical help. If the government is running a program take advantage of it. It's usually a bargain. Besides, I never wanted the cost of a doctor visit copay or medical test costs to be a factor in seeing a doctor.

Plus if you have BCBS basic they give you $600 back this year and you get to use their mail order prescription service for additional savings. In my case, I would consider AETNA Direct but they offer no chiropractor service. BCBS basic has better chiropractor benefits than standard. I guess I'm becoming a basic BCBS fanboy.

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Re: Federal Retiree Health Care with/Medicare

Post by delamer » Fri Nov 10, 2017 11:43 am

retiredjg wrote:
Fri Nov 10, 2017 8:16 am
Blues wrote:
Thu Nov 09, 2017 6:01 pm
Out of curiosity, are most of you folks who either intend to, or already have elected "Part B", under the regular care of a physician and taking prescription meds?

I just can't see throwing more money into the healthcare sinkhole when I'm already entitled to Part A and have good coverage via FEHB.
It is my understanding that prescription meds have nothing to do with this decision. Part B does not cover Rx.

I don't see it as a sinkhole either. I signed up for Part B because at the time I didn't know what either decision meant - thought I'd try it and keep my eligibility rather than not try it and pay more later if I wanted it.

My Medicare Part B costs something in the neighborhood of $1,500 a year. For that, I pay no bills for medical care at all. No copay, no deductible, no nothing. There are some years I might be paying extra. I don't know because I have not checked.

But there are or will be years when it is more than worth it. For example, in any year with a joint injury - MRI, xrays, specialists visits, physical therapy, maybe even surgery - the copays and deductible probably add up to more than $1,500. In years with a serious illness - I think it could be way more than $1,500.

If my Part B cost $10k a year, I might be thinking more like you.
For two of us, the Part B premium will be at least $4,500 per year and possibly as much as $6400 (based on 2017 rates).

While I understand that is a drop in the bucket if you end up being treated for cancer, it covers a lot of co-pays and co-insurance, and deductibles, in a non-crisis year.

I am definitely not comfortable with my understanding or how out-of-pocket limits come into play with FEHB coverage and no Part B.

Aetna Direct is worth a look.

It is also worth remembering that 1) we are talking about whether you pay for outstanding insurance versus just good insurance and 2) you can decline Part B and enroll later; it will be more expensive but the option is not closed off.

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Re: Federal Retiree Health Care with/Medicare

Post by trueblueky » Fri Nov 10, 2017 12:43 pm

The NARFE magazine out yesterday contains an article by Tammy Flanagan on this subject.

She is the federal retirement guru. For any fed approaching retirement, I recommend signing up for her free weekly column in Government Executive.

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Re: Federal Retiree Health Care with/Medicare

Post by Blues » Fri Nov 10, 2017 12:46 pm

trueblueky wrote:
Fri Nov 10, 2017 12:43 pm
The NARFE magazine out yesterday contains an article by Tammy Flanagan on this subject.

She is the federal retirement guru. For any fed approaching retirement, I recommend signing up for her free weekly column in Government Executive.
She did a webinar on this topic a week or so back. It should be available on the NARFE site by signing in with your NARFE account info.
“Tactics without strategy is the noise before defeat.” - Sun Tzu | "Everybody has a plan until they get punched in the mouth." - Mike Tyson

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Re: Federal Retiree Health Care with/Medicare

Post by dm200 » Fri Nov 10, 2017 1:16 pm

trueblueky wrote:
Fri Nov 10, 2017 12:43 pm
The NARFE magazine out yesterday contains an article by Tammy Flanagan on this subject.
She is the federal retirement guru. For any fed approaching retirement, I recommend signing up for her free weekly column in Government Executive.

Yes - it also just occurred to me that NARFE could be a very impartial resource as well as credible.

I wonder if any Financial Advisors have credible and impartial information and/or advice?

A longtime friend is a federal retiree and he chose to not pay for Part B. He has BCBS for himself and his wife (both now on medicare) and he is very, very, very thorough in his analyses. In a short discussion, he indicated that an important factor is whether the federal retiree has dependent(s) on their federal plan. Medicare is 100% individual - no family plans or relevance. While it is already, for most on medicare, complicated about a Medicare Advantage plan or not, this analysis for federal retirees/dependents can also make things more complicated. Another couple we know well has chosen the Kaiser Medicare plan. He is retired military with later several decades of federal government civilian employment.

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Re: Federal Retiree Health Care with/Medicare

Post by mrc » Fri Nov 10, 2017 1:30 pm

Blues wrote:
Fri Nov 10, 2017 9:20 am
retiredjg wrote:
Fri Nov 10, 2017 8:57 am
Do you know when the next checkbook will be available? Your quotes are causing me to think of some questions I had not thought of. It's all such a crap shoot, but I would NEVER grumble...considering what others are facing these days.
I fully agree with your sentiment. I am very thankful for my health and the healthcare I received via FEHB (even though I only use it pretty much if I need stitches).

The new guide (to my knowledge) is to be available on November 13th when Open Season begins.
You can preorder the 2018 Guide now on the checkbook.org website
People often hate what they fear

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Re: Federal Retiree Health Care with/Medicare

Post by Blues » Sat Nov 11, 2017 9:01 am

mrc wrote:
Fri Nov 10, 2017 1:30 pm
You can preorder the 2018 Guide now on the checkbook.org website
That's what I did. It's a bargain for what it provides.
“Tactics without strategy is the noise before defeat.” - Sun Tzu | "Everybody has a plan until they get punched in the mouth." - Mike Tyson

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Re: Federal Retiree Health Care with/Medicare

Post by Nestegg_User » Sat Nov 11, 2017 2:07 pm

While still a couple of years away for me, the complication is the number of years before spouse is covered by Medicare; for us it’s too many years between eligibility and we’ve already had a few major issues.
Leaning to stay with BC/BS standard until we’re both Medicare eligible, then switch to basic. The widespread availability throughout the country of providers means we may be able to travel without concern for medical issues

(we’d started using the BC/BS when, first, the network dropped HMO coverage in our previous location, and second, when we were separated from each other just prior to my retirement and I had stayed in temporary apt for a few months to get my last time in (the moment I was eligible, I was not only gone from work but I was gone from the state/region and ne’er to return)
We’re concerned about the Rx limitation due to spouse’s use of a specific drug— generics or substitutes don’t work or cause reactions (and some insurance providers don’t work with physicians in allowing the drug even though the cost really isn’t high)

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Re: Federal Retiree Health Care with/Medicare

Post by HIinvestor » Sat Nov 11, 2017 2:34 pm

The Tammy Flannagan article I found didn’t talk about Medicare B, just FEHB and is here.

http://m.govexec.com/pay-benefits/retir ... es/142433/

For now, we are still most comfortable paying for both FEHB PPO family plan and Medicare B for H (even though our premium includes a bump up because of higher income).

We aren’t good at reading the future and hoping the penalty for enrolling late in Medicare B will be waived and that things with FEHB will stay as they are, with Fed contribution for significant portion of premium and modest caps on out of pocket spending.

When I’m eligible for Medicare B in a few years, we may revisit the issue. If we are paying more in premiums + out of pocket than we might if we didn’t have Medicare B, we are fine with that, since it allows us to sleep well at night.

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Re: Federal Retiree Health Care with/Medicare

Post by dm200 » Sat Nov 11, 2017 2:42 pm

While I am a big fan (participant) in a Kaiser Medicare plan, I believe there are some significant issues and choices related to whether or not the Medicare recipient has FEHB and whether to choose Part B. I think Part B enrollment is required for Medicare Advantage and Medicare Cost plan, and I think there are some FEHB benefits when so enrolled (vs plain Medicare that we have). I would make sure I understood MA and MC interactions as well.

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Re: Federal Retiree Health Care with/Medicare

Post by dm200 » Sat Nov 11, 2017 2:43 pm

When I’m eligible for Medicare B in a few years, we may revisit the issue. If we are paying more in premiums + out of pocket than we might if we didn’t have Medicare B, we are fine with that, since it allows us to sleep well at night.
And --- in a few years, things may change ...

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Re: Federal Retiree Health Care with/Medicare

Post by Info_Hound » Sun Nov 12, 2017 10:16 am

Nearing_Destination wrote:
Wed Nov 08, 2017 1:30 pm

You can “ suspend “ —**not cancel** — your FEHB benefits and return to using them later.
Canceling results in your no longer being eligible; suspending means you CAN restart at some later open season
I do not believe this is true for those who fall under survivor benefits. Can you point me to a place I can read up on this?

Thanks!

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Re: Federal Retiree Health Care with/Medicare

Post by Blues » Sun Nov 12, 2017 10:28 am

Info_Hound wrote:
Sun Nov 12, 2017 10:16 am
Nearing_Destination wrote:
Wed Nov 08, 2017 1:30 pm

You can “ suspend “ —**not cancel** — your FEHB benefits and return to using them later.
Canceling results in your no longer being eligible; suspending means you CAN restart at some later open season
I do not believe this is true for those who fall under survivor benefits. Can you point me to a place I can read up on this?

Thanks!
This may be a place to start:

https://www.opm.gov/healthcare-insuranc ... url=Health
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Re: Federal Retiree Health Care with/Medicare

Post by Nestegg_User » Sun Nov 12, 2017 10:41 am

Blues wrote:
Sun Nov 12, 2017 10:28 am
Info_Hound wrote:
Sun Nov 12, 2017 10:16 am
Nearing_Destination wrote:
Wed Nov 08, 2017 1:30 pm

You can “ suspend “ —**not cancel** — your FEHB benefits and return to using them later.
Canceling results in your no longer being eligible; suspending means you CAN restart at some later open season
I do not believe this is true for those who fall under survivor benefits. Can you point me to a place I can read up on this?

Thanks!
This may be a place to start:

https://www.opm.gov/healthcare-insuranc ... url=Health

From the instructions of SF 2809 (Part G), it only mentions annuitants and former spouses, but it also gives a phone number to call, which is where I’d direct any questions

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Re: Federal Retiree Health Care with/Medicare

Post by Info_Hound » Sun Nov 12, 2017 10:56 am

Blues

Excellent! I have downloaded the OPM document and it does seem like I might be able to suspend and retain eligibility once my daughter is off of the insurance plan.

Thank you for pointing to something new that I can use. :D

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