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.