NALC FEHB With Medicare

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills
Post Reply
Topic Author
tallguy3891
Posts: 21
Joined: Sat Jul 03, 2021 10:47 am

NALC FEHB With Medicare

Post by tallguy3891 »

Anyone have any experience with NALC/Medicare together?

If I am reading the brochure correctly (High Option), it apparently states:

In and out of network are covered 100%

Zero out of pocket catastrophic limit per year

When Medicare exhausted for Skilled Nursing Facility, pay zero for another 30 days? (If Medicare is "exhausted" at 100 days, do they really pay copay for days 21-100 in full, then give another 30 days? I've never seen anything like that in any FEHB plan I've looked at.)

When I used the prescription cost calculator for those on Medicare, it gave me copays of under $1 for a 30 day supply on about 15 different common meds I checked. Is their Rx coverage really that good?

The premium is higher than some plans, and it doesn't appear to give any "fund" for use or Part B reimbursement, but it looks like a very solid plan.

I appreciate any comments.
Tdubs
Posts: 1271
Joined: Tue Apr 24, 2018 7:50 pm

Re: NALC FEHB With Medicare

Post by Tdubs »

I haven't used it, but looked at it on Checkbook. It looks like a good plan and has high satisfaction ratings, but even with Checkbook's high usage scenario, it is more expensive than a range of plans I picked to compare. Prescriptions are listed as more expensive than you indicate--generics were 20% copay. One flag for me was that the Johns Hopkins physicians I typed in were not in network. Could be an error on Checkbook's part.

Worth looking at in open season, but it is pricey.
tj
Posts: 5231
Joined: Thu Dec 24, 2009 12:10 am

Re: NALC FEHB With Medicare

Post by tj »

Not sure why you'd used NALC with Medicare when there are several more cost efficient options.
Tdubs wrote: Mon Sep 13, 2021 7:48 pm I haven't used it, but looked at it on Checkbook. It looks like a good plan and has high satisfaction ratings, but even with Checkbook's high usage scenario, it is more expensive than a range of plans I picked to compare. Prescriptions are listed as more expensive than you indicate--generics were 20% copay. One flag for me was that the Johns Hopkins physicians I typed in were not in network. Could be an error on Checkbook's part.

Worth looking at in open season, but it is pricey.

The checkbook lets you search specific doctors and facilities?
Tdubs
Posts: 1271
Joined: Tue Apr 24, 2018 7:50 pm

Re: NALC FEHB With Medicare

Post by Tdubs »

tj wrote: Mon Sep 13, 2021 11:49 pm Not sure why you'd used NALC with Medicare when there are several more cost efficient options.
Tdubs wrote: Mon Sep 13, 2021 7:48 pm I haven't used it, but looked at it on Checkbook. It looks like a good plan and has high satisfaction ratings, but even with Checkbook's high usage scenario, it is more expensive than a range of plans I picked to compare. Prescriptions are listed as more expensive than you indicate--generics were 20% copay. One flag for me was that the Johns Hopkins physicians I typed in were not in network. Could be an error on Checkbook's part.

Worth looking at in open season, but it is pricey.

The checkbook lets you search specific doctors and facilities?
Yes, you can put in multiple physicians at once. The problems is that Checkbook isn't always accurate--sometimes physicians who do take my insurance aren't listed. So, if your Dr. doesn't show up as in-network, it is worth following up with the office directly.
barber
Posts: 63
Joined: Sun Feb 25, 2007 12:50 pm

Re: NALC FEHB With Medicare

Post by barber »

We compare each open season and continue to select BCBS basic which has an $800 per person refund towards medicare.
Topic Author
tallguy3891
Posts: 21
Joined: Sat Jul 03, 2021 10:47 am

Re: NALC FEHB With Medicare

Post by tallguy3891 »

barber wrote: Tue Sep 14, 2021 9:42 am We compare each open season and continue to select BCBS basic which has an $800 per person refund towards medicare.
Sounds like you look at this thoroughly each year. Would you mind sharing why you don't choose Aetna Direct, since it seems to be so highly regarded by many on Medicare?
barber
Posts: 63
Joined: Sun Feb 25, 2007 12:50 pm

Re: NALC FEHB With Medicare

Post by barber »

BCBS is highly regarded by all of our providers. While DW was working we used BCBS standard, but after retirement switched to basic. We have not had any changes in coverage. We both require meds and numerous specialists. We only pay when receiving meds which makes us not switch plans.
tj
Posts: 5231
Joined: Thu Dec 24, 2009 12:10 am

Re: NALC FEHB With Medicare

Post by tj »

barber wrote: Tue Sep 14, 2021 5:56 pm BCBS is highly regarded by all of our providers. While DW was working we used BCBS standard, but after retirement switched to basic. We have not had any changes in coverage. We both require meds and numerous specialists. We only pay when receiving meds which makes us not switch plans.
You have had a change in coverage though, BCBS Basic does not cover any provider outside of the BCBS network, even if they take medicare.

So if a doctor or facility is in the Medicare network but not in the BCBS network, you'll be on the hook for a portion of the cost.

BCBS Standard (as well as GEHA High, GEHA Standard, and Aetna Direct) does not have that issue.
Tdubs
Posts: 1271
Joined: Tue Apr 24, 2018 7:50 pm

Re: NALC FEHB With Medicare

Post by Tdubs »

tj wrote: Tue Sep 14, 2021 6:05 pm
barber wrote: Tue Sep 14, 2021 5:56 pm BCBS is highly regarded by all of our providers. While DW was working we used BCBS standard, but after retirement switched to basic. We have not had any changes in coverage. We both require meds and numerous specialists. We only pay when receiving meds which makes us not switch plans.
You have had a change in coverage though, BCBS Basic does not cover any provider outside of the BCBS network, even if they take medicare.

So if a doctor or facility is in the Medicare network but not in the BCBS network, you'll be on the hook for a portion of the cost.

BCBS Standard (as well as GEHA High, GEHA Standard, and Aetna Direct) does not have that issue.
Any indication about the size the the BCBS Basic network? Every one of my providers comes up as in network.
tj
Posts: 5231
Joined: Thu Dec 24, 2009 12:10 am

Re: NALC FEHB With Medicare

Post by tj »

Tdubs wrote: Tue Sep 14, 2021 7:27 pm
tj wrote: Tue Sep 14, 2021 6:05 pm
barber wrote: Tue Sep 14, 2021 5:56 pm BCBS is highly regarded by all of our providers. While DW was working we used BCBS standard, but after retirement switched to basic. We have not had any changes in coverage. We both require meds and numerous specialists. We only pay when receiving meds which makes us not switch plans.
You have had a change in coverage though, BCBS Basic does not cover any provider outside of the BCBS network, even if they take medicare.

So if a doctor or facility is in the Medicare network but not in the BCBS network, you'll be on the hook for a portion of the cost.

BCBS Standard (as well as GEHA High, GEHA Standard, and Aetna Direct) does not have that issue.
Any indication about the size the the BCBS Basic network? Every one of my providers comes up as in network.
96% of providers are supposedly in the BCBS network.
Topic Author
tallguy3891
Posts: 21
Joined: Sat Jul 03, 2021 10:47 am

Re: NALC FEHB With Medicare

Post by tallguy3891 »

barber wrote: Tue Sep 14, 2021 5:56 pm BCBS is highly regarded by all of our providers. While DW was working we used BCBS standard, but after retirement switched to basic. We have not had any changes in coverage. We both require meds and numerous specialists. We only pay when receiving meds which makes us not switch plans.
Thank you. Another thing to consider besides what was said in another post about out-of-network providers with BCBS Basic is the Skilled Nursing Facility days. BCBS Standard gives 30 (including the 20 totally covered which Medicare gives); Basic gives no extra days, and Aetna Direct covers 60 per year. That's nice to have just in case.
Post Reply