Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills
Post Reply
Topic Author
saver007
Posts: 166
Joined: Fri Nov 07, 2014 9:18 pm

Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by saver007 » Thu Feb 20, 2020 12:42 am

My father is considering 3 options listed below for medical insurance.
He is a federal employee in NY metro area. He will be retiring this year. He takes 5 drugs. Health OK but need to control cholesterol, BP and diabetics. 2 of 5 drugs are branded/tier 3 types. He will be in relatively tight budget in retirement.

Main factors in evaluating options are
A) Total Overall Cost (3 options below are affordable - at least premiums)
B) Freedom of the Doctor to treat ailment with little interference from Insurance provider
C) Wide provider network especially access to top national hospitals
D) Coverage for expensive drugs. What if he is ever prescribed super expensive ($10K+) drugs?
E) Premium stability/cost increase

Option 1) FEHB Blue Cross Blue Shield Basic Plan with Part B
Monthly cost is $242 ($165 for BCBS basic + $144 Part B – $67 in Part B Reimbursement)

Pro: cost is acceptable, no copay/coinsurance, BCBS network is good. Father is on BCBS standard plan currently. It covers dental and overseas.

Concern: BCBS basic seems to act like a HMO –it doesn’t cover out of network providers.
Should we be overly worried about this? I know BCBS has good local network but in case my father need services in top national hospitals like Mayo, Cleveland , John Hopkins, is it considered in network for a BSBS participant from New York?

Option 2) Original Medicare with Medigap Plan G high deductible
Monthly premium is $242 ($144 part B premium +$ 72 for Medigap plan G High Deductible + $26 for plan D)

Pro: Large network – not controlled by insurance companies, less interference of private insurance.

Concern: Need to get High deductible G plan ($2300 deductible) to make this option affordable. Also Plan Ds don’t seem to have a out of pocket max? Plan D coverage appear to be inferior to BCBS or other full service insurance plans due to donut hole and deductible,etc. Also, what if he is prescribed a super expensive drug?
Also it feels like getting less for the money spent although I fully understand value of a network not constrained by insurance companies.

Option 3) Medicare Advantage with AARP/United Health Care- PPO
Monthly premium $190 ($46 for AARP Medicare advantage premium + 144 part B premium)
Pro: low Cost.

Concern are restriction of network and the fear of the insurance company interfering on doctors judgement. I am also skeptical of MA plans in general.. Worried if low premium is a marketing gimmick?

I am on the fence with Option 1 or 2 .. I like Option 1 over 2 by a tad. I am basically worried about the no out of network coverage for option 1 and poor drug coverage for option 2. Please let me know if these concerns are valid in your judgement or I am missing something major not considered in the thought process outlined.

What Option would you recommend in this situation?
Last edited by saver007 on Fri Feb 21, 2020 12:46 am, edited 2 times in total.

chalet
Posts: 47
Joined: Wed Aug 28, 2019 9:59 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by chalet » Thu Feb 20, 2020 1:49 am

consider that FEHB premiums do not go up with age.

consider that FEHB is very flexible. the main insurance companies offer national plans, plus several HMOs are available. and you can switch between them once a year for any reason. !

also, look at the max-out-of-pocket numbers for the plans/combinations you are considering.

elvisimprsntr
Posts: 133
Joined: Wed Jan 08, 2020 7:24 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by elvisimprsntr » Thu Feb 20, 2020 2:33 am

Things to consider:

1. Advantage plans receive premiums from Medicare+recipient. They make $ by denying claims/coverage (based on my and others experiences.)
2. Once you are on an Advantage plan, if you have pre-existing conditions, it is difficult to get back on a traditional Medicare+supplemental plan.
My father had an Advantage plan and pre-exiting conditions, and a bunch of Tier 3 and 1 Tier 4 medication. We had to submit some paperwork to the insurance company underwriting department in order to switch back to a Medicare+supplemental plan. We switched from AARP UH Advantage to AARP UH supplemental plans (Mx+Rx). Thankfully, the underwriters accepted his application with his pre-existing conditions, likely because it transfers the bulk of the liability back to Medicare. I suspect if we were trying to switch insurance companies at the same time, it may have been a different outcome.
3. When the time comes to go on Hospice, from what others have posted, Advantage plans a PITA when on Hospice. My father is on Hospice, but thankfully we had previously got him on a supplemental plan, so we haven't had any issues.

Swansea
Posts: 885
Joined: Sat Feb 13, 2016 5:16 am

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by Swansea » Thu Feb 20, 2020 6:36 am

How much more is the Standard BCBS in your area? If affordable, it wold provide greater flexibility in providers if necessary. Also, are costs such that Medicare B pays for itself? I tried it for two years, then stopped.

chemocean
Posts: 199
Joined: Mon Dec 19, 2016 9:45 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by chemocean » Thu Feb 20, 2020 12:37 pm

I had to make the same choice a couple of years ago. I chose the Medicare advantage plan with FEHB. I considered the extra Medicare premium over 30 years worth the coverage when I am 80 and my FEHB only deductibles would be high. With our FEHB plan and coordination of benefits between the FEHB and Medicare plans, my wife and I were each given an HSA account that just increased to $100 month, meaning the Medicare premiums are only $37/month for each of us. In addition, we were given a membership to the Y, which we use 2 or 3 times a week. Check the coordination of benefits with each FEHB insurer that is available to you.
But note with in a Medicare Advantage plan, the private provider (FEHB insurer) is the primary insurer. Private insurers are notorious for kicking patients off skilled nursing after 3 days of hospitalization under Medicare A. I had to appeal my father’s coverage through the Medicare Advantage appeal process, which initially is controlled by the private insurer. Not until you get to Level 3 appeals, do you enter the Medicare controlled appeal process. If you had traditional Medicare as the primary insurer with the FEHB as the secondary, Medicare usually accepts the judgment of the skilled nursing personnel on the assessment of when the improvement of a patient has plateaued or has reached their pre-hospitalization condition and skilled nursing coverage can continue under Part A. Our plan is to switch to Medicare as primary when we predict we might need hospitalization and rehab. Of course, if I could accurately predict that year, I wouldn’t need insurance because I could self-insure because I could as easily predict the market.

mbres60
Posts: 998
Joined: Tue Jul 03, 2007 1:47 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by mbres60 » Thu Feb 20, 2020 5:18 pm

My dh is a retired fed. FEHB is great. I would not drop it. Once dropped you can not get back on. Your dad's monthly premium will cost the same when he is retired as when he worked. You have lots of choices for medical. You can even suspend FEHB for an advantage plan if you want.(I would check carefully to make sure this is done correctly so he can go back to FEHB again). Look on opm.gov. Even though we do not have Blue Cross Basic, it is NOT an HMO but a PPO fee for service plan. You are right that you can not go out of network but any doctor in the USA who is part of their network will be available to your father. That means he can go out of state to see someone as long as they are part of the Blue Cross network. Call Blue Cross to confirm. On opm's website you can even view the brochures for the different plans. Please keep in mind that this can be really overwhelming!

Don't hesitate to ask questions here as there are many retired feds on this site.

Good luck.

bayview
Posts: 2215
Joined: Thu Aug 02, 2012 7:05 pm
Location: WNC

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by bayview » Thu Feb 20, 2020 7:39 pm

We went with MC A&B plus FEHB Blue Cross Basic. Very happy.

There were at least two good threads on this topic through last fall, I think. I have had no luck searching on BH (my brain is wired wrong, I suppose), but you might try. They would be (or should be) on this Personal Finance forum, since they deal with insurance.
The continuous execution of a sound strategy gives you the benefit of the strategy. That's what it's all about. --Rick Ferri

Topic Author
saver007
Posts: 166
Joined: Fri Nov 07, 2014 9:18 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by saver007 » Fri Feb 21, 2020 12:06 am

chalet wrote:
Thu Feb 20, 2020 1:49 am
consider that FEHB premiums do not go up with age.

consider that FEHB is very flexible. the main insurance companies offer national plans, plus several HMOs are available. and you can switch between them once a year for any reason. !

also, look at the max-out-of-pocket numbers for the plans/combinations you are considering.
Chalet, thanks for sharing your insights. Yes I should compare max out of pocket for different options and should consider potential for premium increases as a factor but I am not sure if there is a way to estimate/predict medigap increase vs FEHB plan increases?
elvisimprsntr wrote:
Thu Feb 20, 2020 2:33 am
Things to consider:

1. Advantage plans receive premiums from Medicare+recipient. They make $ by denying claims/coverage (based on my and others experiences.)
2. Once you are on an Advantage plan, if you have pre-existing conditions, it is difficult to get back on a traditional Medicare+supplemental plan.
My father had an Advantage plan and pre-exiting conditions, and a bunch of Tier 3 and 1 Tier 4 medication. We had to submit some paperwork to the insurance company underwriting department in order to switch back to a Medicare+supplemental plan. We switched from AARP UH Advantage to AARP UH supplemental plans (Mx+Rx). Thankfully, the underwriters accepted his application with his pre-existing conditions, likely because it transfers the bulk of the liability back to Medicare. I suspect if we were trying to switch insurance companies at the same time, it may have been a different outcome.
3. When the time comes to go on Hospice, from what others have posted, Advantage plans a PITA when on Hospice. My father is on Hospice, but thankfully we had previously got him on a supplemental plan, so we haven't had any issues.


Thanks for sharing your experience. This is my reason to consider MA plans as the least favorite option although it has cheapest premium.
Swansea wrote:
Thu Feb 20, 2020 6:36 am
How much more is the Standard BCBS in your area? If affordable, it wold provide greater flexibility in providers if necessary. Also, are costs such that Medicare B pays for itself? I tried it for two years, then stopped.
Standard BCBS cost $89/month more than BCBS basic ( $165 vs $253). Part B reimbursement (worth $67/month) will also go away in this case. So it make sense only if we drop Part B coverage with standard but I am afraid if my father will be exposed too much to future private insurance premium increases if we go this route.

With BCBS basic + Part B, I think reimbursed part B premium more than pays for itself because of no copay/coinsurance feature.
chemocean wrote:
Thu Feb 20, 2020 12:37 pm
I had to make the same choice a couple of years ago. I chose the Medicare advantage plan with FEHB. I considered the extra Medicare premium over 30 years worth the coverage when I am 80 and my FEHB only deductibles would be high. With our FEHB plan and coordination of benefits between the FEHB and Medicare plans, my wife and I were each given an HSA account that just increased to $100 month, meaning the Medicare premiums are only $37/month for each of us. In addition, we were given a membership to the Y, which we use 2 or 3 times a week. Check the coordination of benefits with each FEHB insurer that is available to you.
But note with in a Medicare Advantage plan, the private provider (FEHB insurer) is the primary insurer. Private insurers are notorious for kicking patients off skilled nursing after 3 days of hospitalization under Medicare A. I had to appeal my father’s coverage through the Medicare Advantage appeal process, which initially is controlled by the private insurer. Not until you get to Level 3 appeals, do you enter the Medicare controlled appeal process. If you had traditional Medicare as the primary insurer with the FEHB as the secondary, Medicare usually accepts the judgment of the skilled nursing personnel on the assessment of when the improvement of a patient has plateaued or has reached their pre-hospitalization condition and skilled nursing coverage can continue under Part A. Our plan is to switch to Medicare as primary when we predict we might need hospitalization and rehab. Of course, if I could accurately predict that year, I wouldn’t need insurance because I could self-insure because I could as easily predict the market.
Thanks for the insight about the appeal process.
By Medicare advantage plan , you mean a plan from FEHB (like BCBS), correct? Are you not paying part B premium with the current FEHB plan? I am assuming if you pay Part B premium, medicare will be primary unless one choose not to?
mbres60 wrote:
Thu Feb 20, 2020 5:18 pm
My dh is a retired fed. FEHB is great. I would not drop it. Once dropped you can not get back on. Your dad's monthly premium will cost the same when he is retired as when he worked. You have lots of choices for medical. You can even suspend FEHB for an advantage plan if you want.(I would check carefully to make sure this is done correctly so he can go back to FEHB again). Look on opm.gov. Even though we do not have Blue Cross Basic, it is NOT an HMO but a PPO fee for service plan. You are right that you can not go out of network but any doctor in the USA who is part of their network will be available to your father. That means he can go out of state to see someone as long as they are part of the Blue Cross network. Call Blue Cross to confirm. On opm's website you can even view the brochures for the different plans. Please keep in mind that this can be really overwhelming!

Don't hesitate to ask questions here as there are many retired feds on this site.

Good luck.
Thanks for sharing your insight mbres60. Yes, i do realize FEHB is a great option available to only to a limited set of the population. I am basically trying to decide if a network controlled FEHB plan ( albeit network is the widest it can get) is that much superior to Original Medicare option .
bayview wrote:
Thu Feb 20, 2020 7:39 pm
We went with MC A&B plus FEHB Blue Cross Basic. Very happy.

There were at least two good threads on this topic through last fall, I think. I have had no luck searching on BH (my brain is wired wrong, I suppose), but you might try. They would be (or should be) on this Personal Finance forum, since they deal with insurance.
Thanks for your comments. I have already red thorough a few prior threads. I will search more.

I have couple more questions regarding option 1 (FEHB BCBS basic + Part B):

Will Medicare pay its share (as primary insurer) if we go to an out of network BCBS provider? Assuming provider accept medicare.
Will Drug co-pay/co-insurance count toward the out of pocket max for BCBS basic plan?
Also, please share if anyone has good/bad experience with either Part D plans or drug plans embedded in fedblue BCBS basic or similar plans.

BTW, I have updated my initial cost estimates for options 1 and 2. Now, Monthly premium for option 1 & 2 is exactly the same! I realized BCBS premium is higher than I initially thought and I found a cheaper Part D plan although It still cost about $1500 for annual premium+ drug.

chalet
Posts: 47
Joined: Wed Aug 28, 2019 9:59 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by chalet » Fri Feb 21, 2020 1:18 am

I am not sure if there is a way to estimate/predict medigap increase vs FEHB plan increases
both will have future inflation increases. so leave it out of the comparison.

I would go to an online quote website and get the supplement price for age 65 and the price for age 85. this will give you a rough idea of the impact of age on supplement cost.

mbres60
Posts: 998
Joined: Tue Jul 03, 2007 1:47 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by mbres60 » Fri Feb 21, 2020 8:56 am

Keep in mind that with your option 2 - original medicare + supplement G. You also have to purchase a drug plan (Medicare D). If you do not like the company you go with for the supplement (price rise too much or whatever reason) then to change insurers your dad would have to go under medical underwriting and might not be accepted. This is especially true as one gets older. With FEHB, every open season you can change to whatever company you want... just like when you are working. Far superior as there are many options.

Another point. With FEHB and medicare part b - FEHB is not like a medicare supplement (If medicare pays then the supplement pays the remaining 20%). FEHB is secondary insurance. If medicare does NOT pay the FEHB might pay. Ex. medicare may pay for something every 3 years but FEHB might pay every year. Another ex is physical therapy. I think medicare covers 30 visits/year. Some FEHB plans (I'n on Aetna Direct) cover 60 visits/year. I also get some extras that medicare does not cover. I would never get it if on original medicare with a supplement G (or any other letter) plan.

All in all, you are wise to stick with FEHB. If an advantage plan is better in your eyes then read up on opm.gov about suspending (not cancelling) FEHB and picking an advantage plan. Original medicare + G is NOT better than FEHB.

Also, BCBS Basic has an HRA (I think it is $600) to help cover some of your dad's part b premium costs.


pahkcah
Posts: 83
Joined: Tue Dec 15, 2015 10:50 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by pahkcah » Fri Feb 21, 2020 10:06 pm

DW and I are both retired Federal employees who chose to combine Federal Employee Health Benefits (FEHB) Blue Cross and Blue Shield (BCBS) Basic and Medicare B. We live in eastern MA and have found that almost all the doctors that accept Medicare (which becomes the prime once an employee is retired) are in network for BCBS Basic. It may or may not be the same where your father lives. We had BCBS Standard until our last child turned 26 this past year. The $800 DW and I each receive to cover some of our Medicare B costs also helped our decision to move from Standard to Basic.

For a high-level comparison of how things work under Medicare with the FEHB BCBS plans, check out this page:
https://www.fepblue.org/benefit-plans/m ... r-coverage

As was previously mentioned, the number of “free” physical therapy sessions is different based on the option selected (Standard = 75, Basic = 50). How a particular plan works with Medicare should be covered in Section 9 of the plan’s brochure (available on the OPM site), so make sure to read this section before deciding to stay with a plan or choose a different plan.

Check the formulary for any plan that you choose. The formulary lists the specific tiers that each drug is assigned. A prescription under one FEHB plan might be Tier 1 (lowest cost), while under a different plan the same drug could be a higher tier and cost much more. This is really a big consideration for people who need to use brand name or “specialty” drugs in Tiers 4 and 5. Here’s a link to the Blue Cross formulary page: https://www.fepblue.org/formulary

A good source of information for cost comparisons is the Consumer’s Checkbook Guide to Health Plans for Federal Employees 2020. It costs $10.95 to subscribe online and provides a comparison of overall costs depending on plan selected. Here’s the link: https://www.checkbook.org/newhig2/hig.cfm

You asked, “Will Medicare pay its share (as primary insurer) if we go to an out of network BCBS provider? Assuming provider accept medicare.” - If I understand the question correctly, I believe that if the provider accepts Medicare, Medicare doesn't care whether the provider is in or out of network for the secondary insurer. It would be up to the secondary insurer to determine how much of the remaining costs (if there are any) that would be covered. Stated in a simpler way, Medicare pays first and then sends any remaining costa to the secondary insurer.

And lastly, please be aware that when your father is retired he will be paying his FEHB premiums in after-tax dollars, not pre-tax dollars.

pahkcah

User avatar
dodecahedron
Posts: 5078
Joined: Tue Nov 12, 2013 12:28 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by dodecahedron » Fri Feb 21, 2020 10:12 pm

elvisimprsntr wrote:
Thu Feb 20, 2020 2:33 am

2. Once you are on an Advantage plan, if you have pre-existing conditions, it is difficult to get back on a traditional Medicare+supplemental plan.
This is true in *most* states, but it is not true in New York State. NY does not allow Medicare supplement providers to discriminate based on preexisting conditions. Since the OP said father is in NYC area, this may be relevant.

Topic Author
saver007
Posts: 166
Joined: Fri Nov 07, 2014 9:18 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by saver007 » Fri Feb 21, 2020 10:17 pm

BBBob wrote:
Fri Feb 21, 2020 6:46 pm
This might be helpful:
https://www.nytimes.com/2020/02/21/busi ... ement.html
Thanks. Precicly the internal debate we were having..

We have ruled out pure Medicare advantage plans but still not convinced what plan is better option between original Medicare and FEHB offered plans..

I wish FEHB has a medigap like plan that also with drug
coverage.. BCBS basic fits the bill but it not covering out of network is a bummer. So doesn't entirely fit the bill..

Are there any other FEHB low premium plans that work well with Medicare part A&B?
Last edited by saver007 on Fri Feb 21, 2020 10:32 pm, edited 1 time in total.

User avatar
dodecahedron
Posts: 5078
Joined: Tue Nov 12, 2013 12:28 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by dodecahedron » Fri Feb 21, 2020 10:23 pm

mbres60 wrote:
Fri Feb 21, 2020 8:56 am
You also have to purchase a drug plan (Medicare D). If you do not like the company you go with for the supplement (price rise too much or whatever reason) then to change insurers your dad would have to go under medical underwriting and might not be accepted. This is especially true as one gets older.
Again, not true in New York. You can switch Part D at any age with no underwriting for preexisting conditions. Folks with modest incomes (less than $75K for singles or $100K for married couples) also qualify for a state program called EPIC that supplements the Part D.

Topic Author
saver007
Posts: 166
Joined: Fri Nov 07, 2014 9:18 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by saver007 » Fri Feb 21, 2020 10:31 pm

pahkcah wrote:
Fri Feb 21, 2020 10:06 pm
DW and I are both retired Federal employees who chose to combine Federal Employee Health Benefits (FEHB) Blue Cross and Blue Shield (BCBS) Basic and Medicare B. We live in eastern MA and have found that almost all the doctors that accept Medicare (which becomes the prime once an employee is retired) are in network for BCBS Basic. It may or may not be the same where your father lives. We had BCBS Standard until our last child turned 26 this past year. The $800 DW and I each receive to cover some of our Medicare B costs also helped our decision to move from Standard to Basic.

For a high-level comparison of how things work under Medicare with the FEHB BCBS plans, check out this page:
https://www.fepblue.org/benefit-plans/m ... r-coverage

As was previously mentioned, the number of “free” physical therapy sessions is different based on the option selected (Standard = 75, Basic = 50). How a particular plan works with Medicare should be covered in Section 9 of the plan’s brochure (available on the OPM site), so make sure to read this section before deciding to stay with a plan or choose a different plan.

Check the formulary for any plan that you choose. The formulary lists the specific tiers that each drug is assigned. A prescription under one FEHB plan might be Tier 1 (lowest cost), while under a different plan the same drug could be a higher tier and cost much more. This is really a big consideration for people who need to use brand name or “specialty” drugs in Tiers 4 and 5. Here’s a link to the Blue Cross formulary page: https://www.fepblue.org/formulary

A good source of information for cost comparisons is the Consumer’s Checkbook Guide to Health Plans for Federal Employees 2020. It costs $10.95 to subscribe online and provides a comparison of overall costs depending on plan selected. Here’s the link: https://www.checkbook.org/newhig2/hig.cfm

You asked, “Will Medicare pay its share (as primary insurer) if we go to an out of network BCBS provider? Assuming provider accept medicare.” - If I understand the question correctly, I believe that if the provider accepts Medicare, Medicare doesn't care whether the provider is in or out of network for the secondary insurer. It would be up to the secondary insurer to determine how much of the remaining costs (if there are any) that would be covered. Stated in a simpler way, Medicare pays first and then sends any remaining costa to the secondary insurer.

And lastly, please be aware that when your father is retired he will be paying his FEHB premiums in after-tax dollars, not pre-tax dollars.

pahkcah
Thanks pahkcah for taking the time to share your thoughts. Very helpful comments for our situation.

I have red in some other thread or in fedblue site BCBS covers 96% of providers in USA.. hope that is true. Yes BCBS drug plans definitely Superior to plan D PDPs. My father would have to pay $800/ year extra for same drugs..

Topic Author
saver007
Posts: 166
Joined: Fri Nov 07, 2014 9:18 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by saver007 » Fri Feb 21, 2020 10:40 pm

dodecahedron wrote:
Fri Feb 21, 2020 10:12 pm
elvisimprsntr wrote:
Thu Feb 20, 2020 2:33 am

2. Once you are on an Advantage plan, if you have pre-existing conditions, it is difficult to get back on a traditional Medicare+supplemental plan.
This is true in *most* states, but it is not true in New York State. NY does not allow Medicare supplement providers to discriminate based on preexisting conditions. Since the OP said father is in NYC area, this may be relevant.
The Ny Times article posted earlier also mentioned this.. that New York , Connecticut, Massachusetts and Main allow switch back from medicare Advantage to medigap.

One thing I wasn't sure about is, does he have to go through under writing if he decides to switch from MA to medigap when he is 80?

Topic Author
saver007
Posts: 166
Joined: Fri Nov 07, 2014 9:18 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by saver007 » Fri Feb 21, 2020 10:42 pm

dodecahedron wrote:
Fri Feb 21, 2020 10:23 pm
mbres60 wrote:
Fri Feb 21, 2020 8:56 am
You also have to purchase a drug plan (Medicare D). If you do not like the company you go with for the supplement (price rise too much or whatever reason) then to change insurers your dad would have to go under medical underwriting and might not be accepted. This is especially true as one gets older.
Again, not true in New York. You can switch Part D at any age with no underwriting for preexisting conditions. Folks with modest incomes (less than $75K for singles or $100K for married couples) also qualify for a state program called EPIC that supplements the Part D.
Thanks for clarifying dodecahedron . I will need to read up on this EPIC program.

Tdubs
Posts: 1034
Joined: Tue Apr 24, 2018 7:50 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by Tdubs » Fri Feb 21, 2020 10:46 pm

Option 1: With diabetes, your father is at an elevated risk of dementia. With no copay or coinsurance, Option 1 is the easiest to manage.

Topic Author
saver007
Posts: 166
Joined: Fri Nov 07, 2014 9:18 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by saver007 » Fri Feb 21, 2020 11:11 pm

Tdubs wrote:
Fri Feb 21, 2020 10:46 pm
Option 1: With diabetes, your father is at an elevated risk of dementia. With no copay or coinsurance, Option 1 is the easiest to manage.
Thanks for your input. Agree Option 1 is certainly easier to manage.

chemocean
Posts: 199
Joined: Mon Dec 19, 2016 9:45 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by chemocean » Fri Feb 21, 2020 11:24 pm

saver007 wrote:
Fri Feb 21, 2020 12:06 am
chemocean wrote:
Thu Feb 20, 2020 12:37 pm
I had to make the same choice a couple of years ago. I chose the Medicare advantage plan with FEHB. I considered the extra Medicare premium over 30 years worth the coverage when I am 80 and my FEHB only deductibles would be high. With our FEHB plan and coordination of benefits between the FEHB and Medicare plans, my wife and I were each given an HSA account that just increased to $100 month, meaning the Medicare premiums are only $37/month for each of us. In addition, we were given a membership to the Y, which we use 2 or 3 times a week. Check the coordination of benefits with each FEHB insurer that is available to you.
But note with in a Medicare Advantage plan, the private provider (FEHB insurer) is the primary insurer. Private insurers are notorious for kicking patients off skilled nursing after 3 days of hospitalization under Medicare A. I had to appeal my father’s coverage through the Medicare Advantage appeal process, which initially is controlled by the private insurer. Not until you get to Level 3 appeals, do you enter the Medicare controlled appeal process. If you had traditional Medicare as the primary insurer with the FEHB as the secondary, Medicare usually accepts the judgment of the skilled nursing personnel on the assessment of when the improvement of a patient has plateaued or has reached their pre-hospitalization condition and skilled nursing coverage can continue under Part A. Our plan is to switch to Medicare as primary when we predict we might need hospitalization and rehab. Of course, if I could accurately predict that year, I wouldn’t need insurance because I could self-insure because I could as easily predict the market.
Thanks for the insight about the appeal process.
By Medicare advantage plan , you mean a plan from FEHB (like BCBS), correct? Are you not paying part B premium with the current FEHB plan? I am assuming if you pay Part B premium, medicare will be primary unless one choose not to?
We are paying FEHB (self +1) premium plus two Medicare Premiums. Each FEHB insurer has different coordination of care contracts with Medicare. With our FEHB insurer, the only choice with the standard option FEBH coverage is the Advantage Medicare Plan. With an Advantage plan, the FEHB insurer reduces our out-of-pocket costs and adds services, but we do not charge Medicare directly (as the secondary insurer) for anything per the insurer's contract with Medicare (Evidence of Coverage book 152 pp). The private insurer is the only insurer as far as we are concerned (period). There is a whole chapter on appeal of denied coverage (36 pp) which is consistent with the appeal process that I encountered with my father's appeal of another Advantage plan. We do get Monthly Reports from the insurer per the Medicare contract.

In order for Medicare to be our primary insurer with our insurer, we have to choice the FEHB high option, in which case the FEHB is secondary.

Topic Author
saver007
Posts: 166
Joined: Fri Nov 07, 2014 9:18 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by saver007 » Sat Feb 22, 2020 9:59 am

I came across the FEHB Aetna direct plan which seems to address some concern I have with BCBS Basic.

I am trying to determine advantage and disadvantage FEHB BCBS basic vs Aetna direct ? (With Medicare A&B)

Aetna direct premium is $10/month cheaper ..annual Part b reimbursement is $100 more than BCBS.
so it is about $17/month net cheaper than BCBS basic.

Aetna direct brochure says it pays for out of network providers .. this was a major concern with BCBS basic.

Aetna direct also waive copay and coinsurance when Medicare is primary. This is similar to BCBS.

For drug side , I am bit concerned about Aetna direct as it seems to have higher coinsurance for branded drugs.

what gives me a pause is Aetna direct is classified as a HMO in FEHB (OPM) website. But features listed in their brochure doesn't fit with the description of a HMO (they cover out of network). So I am bit confused about it . Am I missing something important about how Aetna direct is set up?

Also my assumptions ( not sure if these valid assumptions) are:
BCBS a non profit while Aetna is a for profit company. So BCBS may be more honest/direct with consumers.

BCBS network will be larger than Aetna's network?

User avatar
VictoriaF
Posts: 19317
Joined: Tue Feb 27, 2007 7:27 am
Location: Black Swan Lake

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by VictoriaF » Sat Feb 22, 2020 11:57 am

Starting in 2020, if you have Medicare Part B and GEHA High option, GEHA reimburses $600 of your annual Part B expenses, https://www.geha.com/plans/medical/2020/high-option . GEHA High is a little more expensive than BCBS Basic, but it has no restrictions on out-of-network providers. GEHA also partly covers vision and dental expenses.

Victoria
WINNER of the 2015 Boglehead Contest. | Every joke has a bit of a joke. ... The rest is the truth. (Marat F)

chemocean
Posts: 199
Joined: Mon Dec 19, 2016 9:45 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by chemocean » Sat Feb 22, 2020 12:03 pm

saver007 wrote:
Sat Feb 22, 2020 9:59 am
I came across the FEHB Aetna direct plan which seems to address some concern I have with BCBS Basic.

I am trying to determine advantage and disadvantage FEHB BCBS basic vs Aetna direct ? (With Medicare A&B)

Aetna direct premium is $10/month cheaper ..annual Part b reimbursement is $100 more than BCBS.
so it is about $17/month net cheaper than BCBS basic.
When you say direct plan do you mean Medicare is primary and the FEHB is secondary through the coordination of benefits (i.e. NOT an Advantage plan). I suggest you obtain the "Evidence of Coverage" for any plan you are considering to get down into the weeds and confirm what you are being told.

If Medicare is primary insurer, denial of coverage is less important, but you might want to get a sense of the denial rates of Aetna vs BSCS Basic, as mentioned by a previous poster.

Topic Author
saver007
Posts: 166
Joined: Fri Nov 07, 2014 9:18 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by saver007 » Sat Feb 22, 2020 1:07 pm

chemocean wrote:
Sat Feb 22, 2020 12:03 pm
saver007 wrote:
Sat Feb 22, 2020 9:59 am
I came across the FEHB Aetna direct plan which seems to address some concern I have with BCBS Basic.

I am trying to determine advantage and disadvantage FEHB BCBS basic vs Aetna direct ? (With Medicare A&B)

Aetna direct premium is $10/month cheaper ..annual Part b reimbursement is $100 more than BCBS.
so it is about $17/month net cheaper than BCBS basic.
When you say direct plan do you mean Medicare is primary and the FEHB is secondary through the coordination of benefits (i.e. NOT an Advantage plan). I suggest you obtain the "Evidence of Coverage" for any plan you are considering to get down into the weeds and confirm what you are being told.

If Medicare is primary insurer, denial of coverage is less important, but you might want to get a sense of the denial rates of Aetna vs BSCS Basic, as mentioned by a previous poster.
"Aetna Direct" is the name of the plan. Under this plan Medicare will be primary and FEHB Aetna direct plan will be secondary. That's my understanding. See https://www.aetnafeds.com/aetna-direct-details.php

Topic Author
saver007
Posts: 166
Joined: Fri Nov 07, 2014 9:18 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by saver007 » Sat Feb 22, 2020 1:14 pm

VictoriaF wrote:
Sat Feb 22, 2020 11:57 am
Starting in 2020, if you have Medicare Part B and GEHA High option, GEHA reimburses $600 of your annual Part B expenses, https://www.geha.com/plans/medical/2020/high-option . GEHA High is a little more expensive than BCBS Basic, but it has no restrictions on out-of-network providers. GEHA also partly covers vision and dental expenses.

Victoria
Thanks for pointing out this option. I see GEHA high drug plan does have lower coinsurance for branded drugs than Aetna direct but yes it's more expensive. About $75 more month than Aetna direct!

UpperNwGuy
Posts: 3664
Joined: Sun Oct 08, 2017 7:16 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by UpperNwGuy » Sat Feb 22, 2020 1:37 pm

I would recommend Original Medicare (Parts A and B) plus FEHB. Focus your analysis on the various FEHB choices.

mbres60
Posts: 998
Joined: Tue Jul 03, 2007 1:47 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by mbres60 » Sat Feb 22, 2020 1:47 pm

Aetna Direct is not offered everywhere. I think that might be why it is listed as an HMO. My health card says I'm in a PPO not HMO. I can go to ANY doctor who accepts medicare assignment and then Aetna Direct will pay what medicare does not. The doctor does not need to be in Aetna's network because I have Part B.

I think you could be right about prescriptions. the good news is that if one has to start taking an expensive prescription on an ongoing basis, then at the next open season you can change your health plan to one that has better prescription coverage.

DustyDebris
Posts: 22
Joined: Sat Jul 27, 2019 6:42 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by DustyDebris » Sat Feb 22, 2020 1:55 pm

saver007 wrote:
Fri Feb 21, 2020 10:17 pm
BBBob wrote:
Fri Feb 21, 2020 6:46 pm
This might be helpful:
https://www.nytimes.com/2020/02/21/busi ... ement.html
Thanks. Precicly the internal debate we were having..

We have ruled out pure Medicare advantage plans but still not convinced what plan is better option between original Medicare and FEHB offered plans..
At 64 1/2 I am following this and other sources very carefully and learning a lot. I read that NYT article and began much more research and reading/studying of MA vs T-medicare and to question my assumption that I would go with a Kaiser Permanente of Washington MA plan. I go there now and really like the place. I wasn't able to link the issue in that article with the Kaiser MA plan and wonder if a MA plan from a large established hospital system might not be different from one created by an insurance company.

chalet
Posts: 47
Joined: Wed Aug 28, 2019 9:59 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by chalet » Sat Feb 22, 2020 2:20 pm

GEHA standard plan looks like it works well with medicare B.

if one is seriously considering an MA plan, then take a look at using original medicare with one of the FEHB HMO plans.


mbres60 wrote:
Sat Feb 22, 2020 1:47 pm
if one has to start taking an expensive prescription on an ongoing basis, then at the next open season you can change your health plan to one that has better prescription coverage.
the flexibility is great. want to change? do it next open season. no problem. 8-)

ChrisC
Posts: 901
Joined: Tue Jun 19, 2012 9:10 am
Location: North Carolina

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by ChrisC » Sat Feb 22, 2020 5:59 pm

I have GEHA standard (self plus 1) and it works well with my wife's Medicare Part B (which I don't have). My BIL has BCBS-Basic and Medicare Part B and it works fabulously well with his expensive drug treatments for MS. The annual retail bills for his drug treatment is around $210K, all paid by Medicare and BCBS-Basic. Perhaps I'm missing something, why would anyone sign up for Medicare Part D or Medicare Advantage when they have a FEHB plan that can be used with or without Medicare Part B?

User avatar
dodecahedron
Posts: 5078
Joined: Tue Nov 12, 2013 12:28 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by dodecahedron » Sat Feb 22, 2020 7:02 pm

saver007 wrote:
Fri Feb 21, 2020 10:40 pm
dodecahedron wrote:
Fri Feb 21, 2020 10:12 pm
elvisimprsntr wrote:
Thu Feb 20, 2020 2:33 am

2. Once you are on an Advantage plan, if you have pre-existing conditions, it is difficult to get back on a traditional Medicare+supplemental plan.
This is true in *most* states, but it is not true in New York State. NY does not allow Medicare supplement providers to discriminate based on preexisting conditions. Since the OP said father is in NYC area, this may be relevant.
The Ny Times article posted earlier also mentioned this.. that New York , Connecticut, Massachusetts and Main allow switch back from medicare Advantage to medigap.

One thing I wasn't sure about is, does he have to go through under writing if he decides to switch from MA to medigap when he is 80?
No underwriting in NY at any age. There is an allowable *waiting period* of up to six months for preexisting conditions BUT as long as he maintains continuous creditable coverage (for example, an Advantage Plan or FEHB) the supplement carrier is required to *waive* the waiting period.

User avatar
VictoriaF
Posts: 19317
Joined: Tue Feb 27, 2007 7:27 am
Location: Black Swan Lake

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by VictoriaF » Sat Feb 22, 2020 8:14 pm

chalet wrote:
Sat Feb 22, 2020 2:20 pm
GEHA standard plan looks like it works well with medicare B.
ChrisC wrote:I have GEHA standard (self plus 1) and it works well with my wife's Medicare Part B (which I don't have).
If you are using GEHA Standard with Part-B, check your numbers for GEHA High, which now includes $600/year compensation for Part B.

Victoria
WINNER of the 2015 Boglehead Contest. | Every joke has a bit of a joke. ... The rest is the truth. (Marat F)

Topic Author
saver007
Posts: 166
Joined: Fri Nov 07, 2014 9:18 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by saver007 » Sat Feb 22, 2020 8:42 pm

Thanks everyone. I tend to agree FEHB options (Medicare primary , fehb secondary) is most ideal..

I will be also ok if my father went with original Medicare with medigap G high. Part D sucks but the NY State EPIC program mentioned above provides some backstop.

Also good to see NY State is very consumer friendly with Medicare choices.. looks like going with MA plans in NY is not that risky because of the ability to switch back to medigaps and it appears all NY medigap plans are community rated - no age based premium increases.

rupalb9
Posts: 82
Joined: Mon Jun 02, 2008 10:41 pm
Location: Bay Area, CA

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by rupalb9 » Sat Feb 22, 2020 9:10 pm

Here's a pertinent article from yesterday's NYT.
I like choice.
NYT (2/21/20) Medicare’s Private Option Is Gaining Popularity, and Critics

chemocean
Posts: 199
Joined: Mon Dec 19, 2016 9:45 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by chemocean » Sun Feb 23, 2020 10:35 am

DustyDebris wrote:
Sat Feb 22, 2020 1:55 pm

At 64 1/2 I am following this and other sources very carefully and learning a lot. I read that NYT article and began much more research and reading/studying of MA vs T-medicare and to question my assumption that I would go with a Kaiser Permanente of Washington MA plan. I go there now and really like the place. I wasn't able to link the issue in that article with the Kaiser MA plan and wonder if a MA plan from a large established hospital system might not be different from one created by an insurance company.
Skilled nursing after hospitalization may one of the largest expenses in later life. Kaiser is a HMO. I suggest you contact Kaiser and ask them for the list of skilled nursing facilities in their Network under Medicare A after 3 days of hospitalization. I think you will be surprised at the lack of choices. Also, note that the skilled nursing facility most convenient to your family may be full when the patient is released from the hospital and the patient may only be admitted to a network facility far way. I don't know what the appeal process to the HMO to be admitted to a closer out-of-network facility that has openings.

As I mentioned above a HMO advantage has its advantages until it doesn't (i.e., skilled nursing after hospitalization and wanting to go to out-of-network doctor for major surgery. With FEHB, you can switch plans during open season to schedule a knee replacement. But its hard to schedule a heart attach or a stroke.

DustyDebris
Posts: 22
Joined: Sat Jul 27, 2019 6:42 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by DustyDebris » Sun Feb 23, 2020 11:12 am

chemocean wrote:
Sun Feb 23, 2020 10:35 am
DustyDebris wrote:
Sat Feb 22, 2020 1:55 pm

At 64 1/2 I am following this and other sources very carefully and learning a lot. I read that NYT article and began much more research and reading/studying of MA vs T-medicare and to question my assumption that I would go with a Kaiser Permanente of Washington MA plan. I go there now and really like the place. I wasn't able to link the issue in that article with the Kaiser MA plan and wonder if a MA plan from a large established hospital system might not be different from one created by an insurance company.
Skilled nursing after hospitalization may one of the largest expenses in later life. Kaiser is a HMO. I suggest you contact Kaiser and ask them for the list of skilled nursing facilities in their Network under Medicare A after 3 days of hospitalization. I think you will be surprised at the lack of choices. Also, note that the skilled nursing facility most convenient to your family may be full when the patient is released from the hospital and the patient may only be admitted to a network facility far way. I don't know what the appeal process to the HMO to be admitted to a closer out-of-network facility that has openings.

As I mentioned above a HMO advantage has its advantages until it doesn't (i.e., skilled nursing after hospitalization and wanting to go to out-of-network doctor for major surgery. With FEHB, you can switch plans during open season to schedule a knee replacement. But its hard to schedule a heart attach or a stroke.
I'm not eligible for FEHB so it's MA plan yes or no. Thanks for the advice, I'll check it out. How would I compare that to the T-medicare options? Find then call them individually?

DustyDebris
Posts: 22
Joined: Sat Jul 27, 2019 6:42 pm

Re: Medicare Options FEHB Vs Original Medicare Vs Medicare Advantage

Post by DustyDebris » Sun Feb 23, 2020 12:05 pm

DustyDebris wrote:
Sun Feb 23, 2020 11:12 am
chemocean wrote:
Sun Feb 23, 2020 10:35 am
DustyDebris wrote:
Sat Feb 22, 2020 1:55 pm

At 64 1/2 I am following this and other sources very carefully and learning a lot. I read that NYT article and began much more research and reading/studying of MA vs T-medicare and to question my assumption that I would go with a Kaiser Permanente of Washington MA plan. I go there now and really like the place. I wasn't able to link the issue in that article with the Kaiser MA plan and wonder if a MA plan from a large established hospital system might not be different from one created by an insurance company.
Skilled nursing after hospitalization may one of the largest expenses in later life. Kaiser is a HMO. I suggest you contact Kaiser and ask them for the list of skilled nursing facilities in their Network under Medicare A after 3 days of hospitalization. I think you will be surprised at the lack of choices. Also, note that the skilled nursing facility most convenient to your family may be full when the patient is released from the hospital and the patient may only be admitted to a network facility far way. I don't know what the appeal process to the HMO to be admitted to a closer out-of-network facility that has openings.

As I mentioned above a HMO advantage has its advantages until it doesn't (i.e., skilled nursing after hospitalization and wanting to go to out-of-network doctor for major surgery. With FEHB, you can switch plans during open season to schedule a knee replacement. But its hard to schedule a heart attach or a stroke.
I'm not eligible for FEHB so it's MA plan yes or no. Thanks for the advice, I'll check it out. How would I compare that to the T-medicare options? Find then call them individually?
Chemocean, figured it out, thanks again for your view on this.

Post Reply