Federal Blue Cross Standard versus Basic

Non-investing personal finance issues including insurance, credit, real estate, taxes, employment and legal issues such as trusts and wills
User avatar
Nestegg_User
Posts: 1350
Joined: Wed Aug 05, 2009 1:26 pm

Re: Federal Blue Cross Standard versus Basic

Post by Nestegg_User » Mon Nov 18, 2019 11:57 am

duke

it's up to $800 now for 2020 (see page 155 of link), but for Basic you still need to meet your deductible while for Standard the deductible is waived.... so YMMV depending upon your usage

delamer
Posts: 9297
Joined: Tue Feb 08, 2011 6:13 pm

Re: Federal Blue Cross Standard versus Basic

Post by delamer » Mon Nov 18, 2019 12:27 pm

A Boglehead wrote:
Sun Nov 17, 2019 10:30 pm
I'd rather have the gov't, rather than I, pay a higher portion of the premium.
You should be looking for the best combination of cost-to-you-in-dollars premium and benefits that meets your needs.

retiredjg
Posts: 38447
Joined: Thu Jan 10, 2008 12:56 pm

Re: Federal Blue Cross Standard versus Basic

Post by retiredjg » Mon Nov 18, 2019 3:31 pm

VictoriaF wrote:
Mon Nov 18, 2019 9:46 am
LifeOfRiley wrote:
Sun Dec 04, 2016 3:51 pm
I had basic for a while then switched to standard thinking that it would be better and potentially more expansive coverage. This year saw an expensive outpatient surgery (at a preferred provider facility) and under the standard plan I owed 15% of the accepted cost - several thousand dollars. Under the basic plan I would have owed a $100 co-payment.
BCBS brochures use different units for some services under Basic and Standard: dollars and percents. My assumption has been the same as LifeOfRiley's, i.e., that whether dollars or percents, out-of-pocket costs under Standard would be lower. Apparently, this is not the case.

Has anyone else had a similar to LifeOfRiley's experience?
What is the actuarial reason for having both the plan cost and out-of-pocket expenses higher?

Victoria
Victoria, as a retired person over 65 I have not seen any difference between Standard and Basic. Using either, Medicare pays its part and BCBS pays everything else. The exception is prescriptions - I do pay a copay on Rx.

And there is no need to look for preferred providers either, at least not after Medicare becomes the primary insurer. It just has to be a doctor/facility that accepts Medicare assignment.
This is incorrect for BCBS Basic. See comments below.

For a non-retired person, there are differences between Standard and Basic. I have found none for a retired person who is on Medicare. That's why I switched after starting Medicare.

I'm not sure how to interpret some of this thread because it is not always clear if a person is retired or not or retired but not on Medicare. However, I remember one of your pre-retirement theads (Roth conversions), so I know you are retired. :happy. However, what I'm saying may not apply to you if you are not yet on Medicare.
Last edited by retiredjg on Sun Dec 08, 2019 8:29 am, edited 1 time in total.

mathwhiz
Posts: 813
Joined: Tue Jul 01, 2008 7:58 pm

Re: Federal Blue Cross Standard versus Basic

Post by mathwhiz » Mon Nov 18, 2019 5:39 pm

We've found the GEHA standard plan is similar in benefits and coverage to the Blue Cross Standard plan yet costs hundreds less a month. It's a great value if all your doctors are in network but there is also out of network coverage.

GEHA is basically a patch work of PPO providers that GEHA contracts with state by state. Typically, they use the United or Aetna PPO networks that other large corporations contract with and they are usually quite extensive but you should check your local hospitals and doctors.

A lot of people just pick Blue Cross because they ask others at work what they have and people typically pick Blue Cross because that's what everyone else has. It's also a reason why Blue Cross premiums tend to be higher because the federal pool tends to be older and sicker than GEHA, at least that's what articles I've read attribute the difference in premiums to.

johan_s
Posts: 49
Joined: Thu Jan 19, 2017 6:58 pm

Re: Federal Blue Cross Standard versus Basic

Post by johan_s » Mon Nov 18, 2019 6:15 pm

I’ve had BCBS Basic for the last 15 years: 7 years single, and eight years with a wife and child. (I’m 41.) We’ve never had any issues with coverage/doctors, having lived in Downeast Maine; Lawrence, Kansas; and now central Vermont. I have a chronic condition requiring regular visits and have six prescriptions or so. After crunching the numbers, it was and continues to be cheaper to stick with Basic. We’ve never had to go out of network (knock on wood).

mikeg98
Posts: 1
Joined: Tue Dec 06, 2016 3:40 pm

Re: Federal Blue Cross Standard versus Basic

Post by mikeg98 » Wed Nov 27, 2019 11:10 pm

retiredjg wrote:
Mon Nov 18, 2019 3:31 pm
VictoriaF wrote:
Mon Nov 18, 2019 9:46 am
LifeOfRiley wrote:
Sun Dec 04, 2016 3:51 pm
I had basic for a while then switched to standard thinking that it would be better and potentially more expansive coverage. This year saw an expensive outpatient surgery (at a preferred provider facility) and under the standard plan I owed 15% of the accepted cost - several thousand dollars. Under the basic plan I would have owed a $100 co-payment.
BCBS brochures use different units for some services under Basic and Standard: dollars and percents. My assumption has been the same as LifeOfRiley's, i.e., that whether dollars or percents, out-of-pocket costs under Standard would be lower. Apparently, this is not the case.

Has anyone else had a similar to LifeOfRiley's experience?
What is the actuarial reason for having both the plan cost and out-of-pocket expenses higher?

Victoria
Victoria, as a retired person over 65 I have not seen any difference between Standard and Basic. Using either, Medicare pays its part and BCBS pays everything else. The exception is prescriptions - I do pay a copay on Rx.

And there is no need to look for preferred providers either, at least not after Medicare becomes the primary insurer. It just has to be a doctor/facility that accepts Medicare assignment.

For a non-retired person, there are differences between Standard and Basic. I have found none for a retired person who is on Medicare. That's why I switched after starting Medicare.

I'm not sure how to interpret some of this thread because it is not always clear if a person is retired or not or retired but not on Medicare. However, I remember one of your pre-retirement theads (Roth conversions), so I know you are retired. :happy. However, what I'm saying may not apply to you if you are not yet on Medicare.
Does anyone that's still working/not on Medicare have any experience with coinsurance payments (e.g., 15% of plan allowance) under Standard for procedures? I would think given the higher premiums under Standard, the out of pocket would be less as compared to the copays under Basic... but it's just so difficult to compare when you're talking about a percentage of a generally hidden procedure cost. Basic makes it all pretty clear. Thanks!

[Formatting fixed by admin LadyGeek]

bartbill
Posts: 48
Joined: Fri Apr 02, 2010 11:52 pm

Re: Federal Blue Cross Standard versus Basic

Post by bartbill » Thu Nov 28, 2019 9:59 pm

Retired Fed, age 70, with Blue Cross Standard. I've been comparing the costs of Standard and GEHA Standard. GEHA appears to be about $50 dollars cheaper/month. Additionally you get the $600/per person Medicare part B contribution. So, about $1800/year.

However, my wife has two tier three prescriptions that are much more expensive with GEHA. I called GEHA and CVS to check prices. For us it turns out to be a close call.

I'm going to double check the comparison of BC Basic and Standard Monday and make a decision.

UpperNwGuy
Posts: 2648
Joined: Sun Oct 08, 2017 7:16 pm

Re: Federal Blue Cross Standard versus Basic

Post by UpperNwGuy » Mon Dec 02, 2019 9:29 pm

VictoriaF wrote:
Mon Nov 18, 2019 9:46 am
LifeOfRiley wrote:
Sun Dec 04, 2016 3:51 pm
I had basic for a while then switched to standard thinking that it would be better and potentially more expansive coverage. This year saw an expensive outpatient surgery (at a preferred provider facility) and under the standard plan I owed 15% of the accepted cost - several thousand dollars. Under the basic plan I would have owed a $100 co-payment.
BCBS brochures use different units for some services under Basic and Standard: dollars and percents. My assumption has been the same as LifeOfRiley's, i.e., that whether dollars or percents, out-of-pocket costs under Standard would be lower. Apparently, this is not the case.

Has anyone else had a similar to LifeOfRiley's experience?
What is the actuarial reason for having both the plan cost and out-of-pocket expenses higher?

Victoria
Victoria: Did you ever get an answer to your question?

Iorek
Posts: 1070
Joined: Fri Mar 08, 2013 9:38 am

Re: Federal Blue Cross Standard versus Basic

Post by Iorek » Thu Dec 05, 2019 10:15 pm

UpperNwGuy wrote:
Mon Dec 02, 2019 9:29 pm
VictoriaF wrote:
Mon Nov 18, 2019 9:46 am
LifeOfRiley wrote:
Sun Dec 04, 2016 3:51 pm
I had basic for a while then switched to standard thinking that it would be better and potentially more expansive coverage. This year saw an expensive outpatient surgery (at a preferred provider facility) and under the standard plan I owed 15% of the accepted cost - several thousand dollars. Under the basic plan I would have owed a $100 co-payment.
BCBS brochures use different units for some services under Basic and Standard: dollars and percents. My assumption has been the same as LifeOfRiley's, i.e., that whether dollars or percents, out-of-pocket costs under Standard would be lower. Apparently, this is not the case.

Has anyone else had a similar to LifeOfRiley's experience?
What is the actuarial reason for having both the plan cost and out-of-pocket expenses higher?

Victoria
Victoria: Did you ever get an answer to your question?
I assume the answer is that basic has no out of network coverage

UpperNwGuy
Posts: 2648
Joined: Sun Oct 08, 2017 7:16 pm

Re: Federal Blue Cross Standard versus Basic

Post by UpperNwGuy » Fri Dec 06, 2019 9:47 am

Iorek wrote:
Thu Dec 05, 2019 10:15 pm
UpperNwGuy wrote:
Mon Dec 02, 2019 9:29 pm
VictoriaF wrote:
Mon Nov 18, 2019 9:46 am
LifeOfRiley wrote:
Sun Dec 04, 2016 3:51 pm
I had basic for a while then switched to standard thinking that it would be better and potentially more expansive coverage. This year saw an expensive outpatient surgery (at a preferred provider facility) and under the standard plan I owed 15% of the accepted cost - several thousand dollars. Under the basic plan I would have owed a $100 co-payment.
BCBS brochures use different units for some services under Basic and Standard: dollars and percents. My assumption has been the same as LifeOfRiley's, i.e., that whether dollars or percents, out-of-pocket costs under Standard would be lower. Apparently, this is not the case.

Has anyone else had a similar to LifeOfRiley's experience?
What is the actuarial reason for having both the plan cost and out-of-pocket expenses higher?

Victoria
Victoria: Did you ever get an answer to your question?
I assume the answer is that basic has no out of network coverage
And, for me, that's a problem.

User avatar
VictoriaF
Posts: 18984
Joined: Tue Feb 27, 2007 7:27 am
Location: Black Swan Lake

Re: Federal Blue Cross Standard versus Basic

Post by VictoriaF » Sat Dec 07, 2019 2:47 pm

UpperNwGuy wrote:
Fri Dec 06, 2019 9:47 am
Iorek wrote:
Thu Dec 05, 2019 10:15 pm
UpperNwGuy wrote:
Mon Dec 02, 2019 9:29 pm
VictoriaF wrote:
Mon Nov 18, 2019 9:46 am
LifeOfRiley wrote:
Sun Dec 04, 2016 3:51 pm
I had basic for a while then switched to standard thinking that it would be better and potentially more expansive coverage. This year saw an expensive outpatient surgery (at a preferred provider facility) and under the standard plan I owed 15% of the accepted cost - several thousand dollars. Under the basic plan I would have owed a $100 co-payment.
BCBS brochures use different units for some services under Basic and Standard: dollars and percents. My assumption has been the same as LifeOfRiley's, i.e., that whether dollars or percents, out-of-pocket costs under Standard would be lower. Apparently, this is not the case.

Has anyone else had a similar to LifeOfRiley's experience?
What is the actuarial reason for having both the plan cost and out-of-pocket expenses higher?

Victoria
Victoria: Did you ever get an answer to your question?
I assume the answer is that basic has no out of network coverage
And, for me, that's a problem.
I was not logging in for a while and apologize for a late response. After thinking this over, I chose GEHA-High. I will pay more out of pocket but will be protected if I use services of out-of-network providers.

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

retiredjg
Posts: 38447
Joined: Thu Jan 10, 2008 12:56 pm

Re: Federal Blue Cross Standard versus Basic

Post by retiredjg » Sat Dec 07, 2019 2:53 pm

Victoria, did you see my comment above? I do not believe that would be true if you are on Medicare. But you may not be.
This is incorrect. See below.
Last edited by retiredjg on Sun Dec 08, 2019 8:31 am, edited 1 time in total.

User avatar
HueyLD
Posts: 7217
Joined: Mon Jan 14, 2008 10:30 am

Re: Federal Blue Cross Standard versus Basic

Post by HueyLD » Sun Dec 08, 2019 1:45 am

retiredjg wrote:
Sat Dec 07, 2019 2:53 pm
Victoria, did you see my comment above? I do not believe that would be true if you are on Medicare. But you may not be.
For those on the Original Medicare, BCBS Basic Plan will pay benefits only when a preferred provider is used.

See page 154 of the Service Benefit Plan brochure.

retiredjg
Posts: 38447
Joined: Thu Jan 10, 2008 12:56 pm

Re: Federal Blue Cross Standard versus Basic

Post by retiredjg » Sun Dec 08, 2019 8:47 am

HueyLD wrote:
Sun Dec 08, 2019 1:45 am
retiredjg wrote:
Sat Dec 07, 2019 2:53 pm
Victoria, did you see my comment above? I do not believe that would be true if you are on Medicare. But you may not be.
For those on the Original Medicare, BCBS Basic Plan will pay benefits only when a preferred provider is used.

See page 154 in the Service Benefit Plan brochure.
HueyLD, thank you for bringing this to my attention. I corrected my statement above.

I don't remember where I got that incorrect information. I've spent an hour this morning doing a deep dive trying to find it, but I have not. I have found independent confirmation that you are correct. Even when Medicare becomes primary, Federal BCBS Basic requires the use of preferred providers. Standard apparently does not.

There are some significant exceptions listed on page 20 of the plan brochure and I'm guessing that these exceptions are why I have not run into any problem in the years I've been on Medicare using Basic (in addition to the fact that my physician and hospital and pharmacy do happen to be preferred providers.)


https://media.fepblue.org/-/media/PDFs/ ... ochure.pdf
  • Under Basic Option, you must use Preferred providers in order to receive benefits, except under the situations listed below.In addition, we must approve certain types of care in advance. Please refer to Section 4, Y our Costs for Covered Services, for related benefits information.

    Exceptions:

    1. Medical emergency or accidental injury care in a hospital emergency room and related ambulance transport as described in Section 5(d), Emergency Services/Accidents;
    2. Professional care provided at Preferred facilities by Non-preferred radiologists, anesthesiologists, certified registered nurse anesthetists (CRNAs), pathologists, emergency room physicians, and assistant surgeons;
    3. Laboratory and pathology services, X-rays, and diagnostic tests billed by Non-preferred laboratories, radiologists, and outpatient facilities;
    4. Services of assistant surgeons;
    5. Care received outside the United States, Puerto Rico, and the U.S. Virgin Islands; or
    6. Special provider access situations, other than those described above. W e encourage you to contact your Local Plan for more information in these types of situations before you receive services from a Non-preferred provider.

User avatar
HueyLD
Posts: 7217
Joined: Mon Jan 14, 2008 10:30 am

Re: Federal Blue Cross Standard versus Basic

Post by HueyLD » Sun Dec 08, 2019 9:39 am

Yes, there are exceptions as shown on page 20.

However, deductibles and copays will apply. In addition, one may be responsible for any difference between the insurance allowance and the billed amount (balance billing).

Fortunately, I live in an area where virtually 100% of providers and facilities accept Medicare and are preferred BCBS providers. YMMV.

retiredjg
Posts: 38447
Joined: Thu Jan 10, 2008 12:56 pm

Re: Federal Blue Cross Standard versus Basic

Post by retiredjg » Sun Dec 08, 2019 10:07 am

I seem to be in such an area as well. I have paid $0 in medical costs while on Medicare + BCBS Basic. No deductible, no co-pays (other than Rx), no extra costs, no nothing.

Post Reply