2018 FEHB HDHP Recommendations

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Drain
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Re: 2018 FEHB HDHP Recommendations

Post by Drain » Wed Jan 24, 2018 4:07 pm

I have just discovered an advantage that Aetna’s HDHP has over GEHA’s, and I thought I’d share it even though the information comes too late to be actionable this year. My family and I had used Aetna’s plans for several years, but we decided to try GEHA this time around, in part because there are always aspects—pro or con—of a policy that I never seem to notice until I actually have the policy. At some point, I need to go ahead an try it. I cannot go back and read this entire thread, but I don’t believe anyone has mentioned the issue I will raise.

Let’s say you have a procedure done at an in-network hospital. Even though the facility is in-network, one or more of the providers (e.g., radiologist, anesthesiologist) may not be. Under GEHA’s HDHP, you can be balance-billed. That is, GEHA will pay 95 percent (after the deductible is met, of course) of the allowable charge, and you are responsible for the rest, which can theoretically be anything. Under Aetna’s HDHP, you cannot be balance-billed. If an out-of-network provider’s charge exceeds what Aetna considers usual and customary, Aetna and the provider hash it out between themselves. Whatever they decide, Aetna pays 90 percent. It’s hard to estimate the actuarial value of this feature, but it’s certainly not zero. I’d also say that, for me at least, there is a meaningful emotional advantage. If I or a member of my family is going in for surgery, the last thing I want to worry about is whether I will be billed hundreds—or thousands—of dollars more than I’d normally anticipate.

Note that Checkbook’s cost estimates assume that all your care is in-network, so the above is not reflected in those tables.

So that’s the new info. In the past, I’ve noted that GEHA’s limit on skilled nursing is only 14 days at a time. Aetna’s limit is 60. While it is very unlikely that anyone in my family will be needing skilled nursing at all this year, let alone more than two weeks…again, from an emotional perspective, if one of us did, I would not want to be watching the calendar. Days in skilled nursing are not subject to the out-of-pocket maximum.

I do not mean to imply that Aetna’s HDHP is therefore a better deal than GEHA’s. I am just pointing out a couple of things that probably aren’t being considered when people compare costs.

I’ll also note that Aetna’s provider network seems to be slightly broader in the DC metro area, or so my experience indicates. This is a non-issue if you stick with the big clinics that accept all major insurance, but it can matter if you use individual practices.

For myself, the out-of-network charges in in-network facilities will probably make me switch back to Aetna during the next open season, on the grounds that the difference in expected cost isn't as great as Checkbook says, and isn't worth the additional risk. But we'll see.

Oh, and Aetna's catastrophic limit is more protective overall, as well...although GEHA's is somewhat complicated and could work out more favorably in many situations.

I guess you could say GEHA is cheaper on average, but Aetna provides more peace of mind at not that much greater expected cost.
Darin

Snezz1e
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Re: 2018 FEHB HDHP Recommendations

Post by Snezz1e » Wed Jan 24, 2018 5:26 pm

Where are you getting this from. I looked through the brochure for Aetna HDHP (http://www.aetnafeds.com/pdf/2018/2018_ ... ochure.pdf) and I don't see anything about them not allowing balance billing.

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Drain
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Re: 2018 FEHB HDHP Recommendations

Post by Drain » Thu Jan 25, 2018 1:30 pm

I have been told about the policy several times over a period of years by various phone reps, plus my family has never been legitimately balance-billed. There was an incident last year, but all parties agree it was an error. Or predatory billing. But the important thing is that everyone agreed it was not allowed.

To be sure there's no confusion...the policy applies only when the patient is treated at an in-network facility. Go to an out-of-network facility, and all bets are off. Aetna does not do anything about balance billing at out-of-network facilities.

Further clarification: Aetna doesn't actually prohibit balance billing. What it does do is treat those cases as though the charge was a contracted rate from an in-network provider.

Example: You have surgery at an in-network hospital, and an out-of -network provider charges $2000. Aetna says the usual and customary fee is $1000, and tries to pay the provider $900, with your responsibility being $100. If the provider won't accept that, Aetna engages in some degree of negotiation. If the provider won't budge from $2000, Aetna pays $1800, and you are responsible for $200.
Darin

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BogleFanGal
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Re: 2018 FEHB HDHP Recommendations

Post by BogleFanGal » Tue Feb 06, 2018 4:41 pm

c5ruzr wrote:
Sun Dec 10, 2017 2:27 am
BogleFanGal wrote:
Sat Nov 18, 2017 9:55 am
I have been with the Aetna HDHP for 11 years now, and I'm about to jump to GEHA. They keep upping the premiums at Aetna, and the fluoride on the dental preventive care isn't included on the Aetna whereas it is on GEHA. I probably average ~$50 a year in spend so the HSA basically becomes another savings account. I also started maxing it out as once my backdoor Roth and TSP's are maxed; it's the next easiest tax advantaged plan available. And it will become accessible without penalty down the road.

I do still have a few questions though. One is the Aetna PayFlex to GEHA HSA transfer. Will I likely have to pay the $25 account closing fee at PayFlex? With assets of VSMAX and AVUAX in PayFlex, should I sell and transfer the cash? Or are those funds I can use with the GEHA TDAmeritrade plan? Do I have it correct that there's no monthly low balance or investment fees with the TDA account? If they are phasing out the no load etf's, what are their other trading fees like?
Hi c5ruzr: just wondering -- did you end up switching insurance carriers? If so, were you charged the $25 fee? I did switch from Aetna to GEHA and was charged $25 by payflex to transfer the acct. Was wondering if that was correct or a mischarge.

Arlington Traveler
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Re: 2018 FEHB HDHP Recommendations

Post by Arlington Traveler » Fri Jun 08, 2018 9:13 pm

For those who have GEHA, I do have a question. In the official brochure, the first thing there is under prescription benefits is that they say their prescription drug benefit is not compatible with copay cards/coupons. My question to you is this provision actually enforced. The big weakness of GEHA plans in general is their prescription drug coverage is not as good as other plans, that is IMHO the main way they have lower premiums than the competition. I'm fine with that, as long as I can use copay cards because two of my medications are still brand name and very expensive, but they have a copay card and coupon program available that brings the cost down. Both drugs are used to treat my asthma and for now neither has a generic alternative, so I'm not someone scheming to use a brand name drug when a generic is available. Without the ability to use copay cards/coupons, GEHA's FEHBP plans don't make sense for me.

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