Increasing Number of FEHB "Advantage" Plans

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tallguy3891
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Increasing Number of FEHB "Advantage" Plans

Post by tallguy3891 »

As I have thought would be the case for awhile now, FEHB seems to be rolling out more "hybrid" plans as I call them, regular plans with an option to take the regular FEHB plan and do a second step to enroll in their Part C Medicare Advantage Plan. Members do NOT have to "suspend" regular FEHB to enroll, but rather must stay enrolled in the regular plan. These are unique FEHB plans not open to the public.

Aetna Advantage started a few years ago with the Part C add-on, and then I believe came MHBP Standard, APWU High, and now looks like NALC High. Looks like one can stay in the original plan, or do the second step to go into their Advantage Plan with no additional or higher premium, and adds a Medicare reimbursement of varying amounts, some other perks and benefits.

The ones I looked at do not have the "donut hole " issue with Rx like regular Advantage plans for the public, and up to 100 days skilled nursing, which is nice, as my opinion is this was a weak area for most FEHB plans in the past.

It seems FEHB is moving in this direction slowly. The Aetna Advantage Plan has a relatively low premium, and the others' premiums I saw are also the same as the "regular" FEHB plan. From the ones I looked into, they use an "extended area" of providers, and one can use any provider who accepts Medicare and is willing to see one even if not in network. However, that concerns me, as in my area it shows there are none to few in-network (for the Part C option) which would give me more confidence if they were. Perhaps that is because the plans are fairly new. I personally would not use the Aetna Advantage plan without the Part C enrollment due to our coverage needs, but the other plans in my opinion look great either way.

Anyone have any experience with these or heard from elsewhere about them, or have any general comments?
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tallguy3891
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Re: Increasing Number of FEHB "Advantage" Plans

Post by tallguy3891 »

At the risk of being accused of bumping my own thread, I wanted to add some more info. The plans I mentioned have Medicare reimbursement of $1800 per year for self+one with both on Part B (I think APWU was $1200?), and it looks like APWU may be going up to $2040 if I read the 2023 info correctly? A lot of people look at this as a reimbursement for Medicare part B premiums. I look at it as an offset to lower the average monthly premium. In other words, if my FEHB premium this year was approx $345 per month, and the reimbursement is $1800, that averages as $345- $150= a premium like $195 per month. Hard to beat. These reimbursements make these plans all the more appealing. Maybe that is the point, although personally I still like Aetna Direct with its low premium, great medical fund, and convenient use options of the medical fund.
chemocean
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Re: Increasing Number of FEHB "Advantage" Plans

Post by chemocean »

tallguy3891 wrote: Wed Oct 05, 2022 10:52 am As I have thought would be the case for awhile now, FEHB seems to be rolling out more "hybrid" plans as I call them, regular plans with an option to take the regular FEHB plan and do a second step to enroll in their Part C Medicare Advantage Plan. Members do NOT have to "suspend" regular FEHB to enroll, but rather must stay enrolled in the regular plan. These are unique FEHB plans not open to the public.

Aetna Advantage started a few years ago with the Part C add-on, and then I believe came MHBP Standard, APWU High, and now looks like NALC High. Looks like one can stay in the original plan, or do the second step to go into their Advantage Plan with no additional or higher premium, and adds a Medicare reimbursement of varying amounts, some other perks and benefits.

The ones I looked at do not have the "donut hole " issue with Rx like regular Advantage plans for the public, and up to 100 days skilled nursing, which is nice, as my opinion is this was a weak area for most FEHB plans in the past.

It seems FEHB is moving in this direction slowly. The Aetna Advantage Plan has a relatively low premium, and the others' premiums I saw are also the same as the "regular" FEHB plan. From the ones I looked into, they use an "extended area" of providers, and one can use any provider who accepts Medicare and is willing to see one even if not in network. However, that concerns me, as in my area it shows there are none to few in-network (for the Part C option) which would give me more confidence if they were. Perhaps that is because the plans are fairly new. I personally would not use the Aetna Advantage plan without the Part C enrollment due to our coverage needs, but the other plans in my opinion look great either way.

Anyone have any experience with these or heard from elsewhere about them, or have any general comments?
Stay away from AETNA Advantage. They denied my father continued skilled nursing coverage after hospitalization prematurely. We had to pay out of pocket until he won a Level 3 appeal. Even then, we had to fight Aetna to pay the settlement.
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tallguy3891
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Re: Increasing Number of FEHB "Advantage" Plans

Post by tallguy3891 »

chemocean wrote: Wed Oct 05, 2022 6:37 pm
tallguy3891 wrote: Wed Oct 05, 2022 10:52 am As I have thought would be the case for awhile now, FEHB seems to be rolling out more "hybrid" plans as I call them, regular plans with an option to take the regular FEHB plan and do a second step to enroll in their Part C Medicare Advantage Plan. Members do NOT have to "suspend" regular FEHB to enroll, but rather must stay enrolled in the regular plan. These are unique FEHB plans not open to the public.

Aetna Advantage started a few years ago with the Part C add-on, and then I believe came MHBP Standard, APWU High, and now looks like NALC High. Looks like one can stay in the original plan, or do the second step to go into their Advantage Plan with no additional or higher premium, and adds a Medicare reimbursement of varying amounts, some other perks and benefits.

The ones I looked at do not have the "donut hole " issue with Rx like regular Advantage plans for the public, and up to 100 days skilled nursing, which is nice, as my opinion is this was a weak area for most FEHB plans in the past.

It seems FEHB is moving in this direction slowly. The Aetna Advantage Plan has a relatively low premium, and the others' premiums I saw are also the same as the "regular" FEHB plan. From the ones I looked into, they use an "extended area" of providers, and one can use any provider who accepts Medicare and is willing to see one even if not in network. However, that concerns me, as in my area it shows there are none to few in-network (for the Part C option) which would give me more confidence if they were. Perhaps that is because the plans are fairly new. I personally would not use the Aetna Advantage plan without the Part C enrollment due to our coverage needs, but the other plans in my opinion look great either way.

Anyone have any experience with these or heard from elsewhere about them, or have any general comments?
Stay away from AETNA Advantage. They denied my father continued skilled nursing coverage after hospitalization prematurely. We had to pay out of pocket until he won a Level 3 appeal. Even then, we had to fight Aetna to pay the settlement.
Do you know if this was a regular public Aetna Medicare Advantage plan or the FEHB only Aetna Advantage with Part C added on?
Tdubs
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Re: Increasing Number of FEHB "Advantage" Plans

Post by Tdubs »

Still too young to sign up, but United Healthcare also had in past years what seemed like a very generous plan with reimbursement of more than $3000 for a self plus one policy. Checkbook indicated it was one of the best plans as far as total premiums and out of pocket. I just worried they may be an excessive gatekeeper regarding access to care.
delamer
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Re: Increasing Number of FEHB "Advantage" Plans

Post by delamer »

Are you wedded to having Medicare Part B?

We’ll be paying $320/month for GEHA Standard in 2023, and that’s it.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
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tallguy3891
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Re: Increasing Number of FEHB "Advantage" Plans

Post by tallguy3891 »

delamer wrote: Wed Oct 05, 2022 9:34 pm Are you wedded to having Medicare Part B?

We’ll be paying $320/month for GEHA Standard in 2023, and that’s it.
I have thought about the part B issue a lot; you unknowingly did a nice pun with the "Are you wedded to having Medicare Part B?" question because, sort of, since my spouse has heavy healthcare needs, and between Aetna Direct and Medicare we pay zero out of pocket with only a premium of about $345/mo this year and about $352/mo in 2023. She also has approx $100 in copays for Rx per month, which is covered completely by the Aetna Direct medical fund of $1800 per year, free money, hence zero out of pocket for Rx too. GEHA simply wouldn't work as well for her particular meds in that the copays would have been more.

Your question does lead to an interesting topic which is regularly discussed, as far as is Part B worth it with a good FEHB plan? We are non-IRMAA but still pay approx $4000 per year for part B for us both. In 2018-2019 when she had over $1.3 million in medical bills, we had BCBS Standard at the time and what their part paid after Medicare paid was about $1900 in one year and $2400 in the other, so it wasn't much more paid than the part B premiums those years, and most years has been much less with BCBS Standard, then Basic, and now Direct.

And of course, there are catastrophic limits which would have helped. So, we pay the approx $4000 part B premiums to avoid $6000-$12000 or more in catastrophic limit costs (depending on plan). Nice to not have to think about it although some would think it is a waste of money. In the long run it might be. Back to your question, I think that if we were to go without Medicare Part B, in our case we would probably go with NALC High, which isn't the lowest premium, but has a much lower catastrophic limit than many other plans which could be helpful.
Last edited by tallguy3891 on Wed Oct 05, 2022 11:49 pm, edited 1 time in total.
tj
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Re: Increasing Number of FEHB "Advantage" Plans

Post by tj »

delamer wrote: Wed Oct 05, 2022 9:34 pm Are you wedded to having Medicare Part B?

We’ll be paying $320/month for GEHA Standard in 2023, and that’s it.
There would be zero reason to choose a medicare advantage plan without part b. Not sure if it's even allowed
chemocean
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Re: Increasing Number of FEHB "Advantage" Plans

Post by chemocean »

tallguy3891 wrote: Wed Oct 05, 2022 8:27 pm
chemocean wrote: Wed Oct 05, 2022 6:37 pm
tallguy3891 wrote: Wed Oct 05, 2022 10:52 am As I have thought would be the case for awhile now, FEHB seems to be rolling out more "hybrid" plans as I call them, regular plans with an option to take the regular FEHB plan and do a second step to enroll in their Part C Medicare Advantage Plan. Members do NOT have to "suspend" regular FEHB to enroll, but rather must stay enrolled in the regular plan. These are unique FEHB plans not open to the public.

Aetna Advantage started a few years ago with the Part C add-on, and then I believe came MHBP Standard, APWU High, and now looks like NALC High. Looks like one can stay in the original plan, or do the second step to go into their Advantage Plan with no additional or higher premium, and adds a Medicare reimbursement of varying amounts, some other perks and benefits.

The ones I looked at do not have the "donut hole " issue with Rx like regular Advantage plans for the public, and up to 100 days skilled nursing, which is nice, as my opinion is this was a weak area for most FEHB plans in the past.

It seems FEHB is moving in this direction slowly. The Aetna Advantage Plan has a relatively low premium, and the others' premiums I saw are also the same as the "regular" FEHB plan. From the ones I looked into, they use an "extended area" of providers, and one can use any provider who accepts Medicare and is willing to see one even if not in network. However, that concerns me, as in my area it shows there are none to few in-network (for the Part C option) which would give me more confidence if they were. Perhaps that is because the plans are fairly new. I personally would not use the Aetna Advantage plan without the Part C enrollment due to our coverage needs, but the other plans in my opinion look great either way.

Anyone have any experience with these or heard from elsewhere about them, or have any general comments?
Stay away from AETNA Advantage. They denied my father continued skilled nursing coverage after hospitalization prematurely. We had to pay out of pocket until he won a Level 3 appeal. Even then, we had to fight Aetna to pay the settlement.
Do you know if this was a regular public Aetna Medicare Advantage plan or the FEHB only Aetna Advantage with Part C added on?
It was not a FEHB plan.
As a federal employee or retiree, you pay for FEHB, enroll in Medicare A free at age 65 based your 1.45% payroll deduction through your career, and then enroll in Medicare Part B at age 65 by paying the premiums based on Income.
But FEHB plus Medicare is not a Part C add-on. You are using FEHB coordination of benefits with Medicare A and B to get an Advantage Plan (Plan C) which is private insurance. Instead of paying the insurance company for a plan C, you are paying for FEHB to coordinate benefits with Medicare.

"up to 100 days skilled nursing, which is nice, as my opinion is this was a weak area for most FEHB plans in the past." The 100 days of skilled nursing after hospitalization is a Medicare A benefit with many requirements, and would not be available if your did not enroll in Medicare A at age 65.

I get that your question suggests that FEHB Advantage Plans provide more protection than a privately purchased Advantage plan. I don't know if that is the case. You would need to look at the fine print in the FEHB document to understand whether you appeal to FEHB or go through the usual Medicare advantage plan appeal process. The first two levels of appeal of the privately purchased are controlled by the insurance company.
delamer
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Re: Increasing Number of FEHB "Advantage" Plans

Post by delamer »

tj wrote: Wed Oct 05, 2022 11:19 pm
delamer wrote: Wed Oct 05, 2022 9:34 pm Are you wedded to having Medicare Part B?

We’ll be paying $320/month for GEHA Standard in 2023, and that’s it.
There would be zero reason to choose a medicare advantage plan without part b. Not sure if it's even allowed
I’m aware.

I just was pointing the OP toward other possibilities, since he asked for general comments.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
delamer
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Re: Increasing Number of FEHB "Advantage" Plans

Post by delamer »

tallguy3891 wrote: Wed Oct 05, 2022 11:18 pm
delamer wrote: Wed Oct 05, 2022 9:34 pm Are you wedded to having Medicare Part B?

We’ll be paying $320/month for GEHA Standard in 2023, and that’s it.
I have thought about the part B issue a lot; you unknowingly did a nice pun with the "Are you wedded to having Medicare Part B?" question because, sort of, since my spouse has heavy healthcare needs, and between Aetna Direct and Medicare we pay zero out of pocket with only a premium of about $345/mo this year and about $352/mo in 2023. She also has approx $100 in copays for Rx per month, which is covered completely by the Aetna Direct medical fund of $1800 per year, free money, hence zero out of pocket for Rx too. GEHA simply wouldn't work as well for her particular meds in that the copays would have been more.

Your question does lead to an interesting topic which is regularly discussed, as far as is Part B worth it with a good FEHB plan? We are non-IRMAA but still pay approx $4000 per year for part B for us both. In 2018-2019 when she had over $1.3 million in medical bills, we had BCBS Standard at the time and what their part paid after Medicare paid was about $1900 in one year and $2400 in the other, so it wasn't much more paid than the part B premiums those years, and most years has been much less with BCBS Standard, then Basic, and now Direct.

And of course, there are catastrophic limits which would have helped. So, we pay the approx $4000 part B premiums to avoid $6000-$12000 or more in catastrophic limit costs (depending on plan). Nice to not have to think about it although some would think it is a waste of money. In the long run it might be. Back to your question, I think that if we were to go without Medicare Part B, in our case we would probably go with NALC High, which isn't the lowest premium, but has a much lower catastrophic limit than many other plans which could be helpful.
Obviously, you’ve put some thought into this. We are fortunate in that neither of us is a heavy healthcare user (so far), which I do think requires a somewhat different analysis.

Plus we would be subject to IRMAA premiums if we enrolled in Part B. Which means an extra $5700/year, and it would be higher unless we avoided all but minimal Roth conversions.

I’m comfortable with our choice, given that we could enroll in Part B later (albeit with a premium penalty). I suspect that Part B will become required in the foreseeable future. Hopefully, we will be grandfathered in or allowed to enroll without the premium penalty.

Good luck.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
Topic Author
tallguy3891
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Re: Increasing Number of FEHB "Advantage" Plans

Post by tallguy3891 »

chemocean wrote: Wed Oct 05, 2022 11:44 pm
tallguy3891 wrote: Wed Oct 05, 2022 8:27 pm
chemocean wrote: Wed Oct 05, 2022 6:37 pm
tallguy3891 wrote: Wed Oct 05, 2022 10:52 am As I have thought would be the case for awhile now, FEHB seems to be rolling out more "hybrid" plans as I call them, regular plans with an option to take the regular FEHB plan and do a second step to enroll in their Part C Medicare Advantage Plan. Members do NOT have to "suspend" regular FEHB to enroll, but rather must stay enrolled in the regular plan. These are unique FEHB plans not open to the public.

Aetna Advantage started a few years ago with the Part C add-on, and then I believe came MHBP Standard, APWU High, and now looks like NALC High. Looks like one can stay in the original plan, or do the second step to go into their Advantage Plan with no additional or higher premium, and adds a Medicare reimbursement of varying amounts, some other perks and benefits.

The ones I looked at do not have the "donut hole " issue with Rx like regular Advantage plans for the public, and up to 100 days skilled nursing, which is nice, as my opinion is this was a weak area for most FEHB plans in the past.

It seems FEHB is moving in this direction slowly. The Aetna Advantage Plan has a relatively low premium, and the others' premiums I saw are also the same as the "regular" FEHB plan. From the ones I looked into, they use an "extended area" of providers, and one can use any provider who accepts Medicare and is willing to see one even if not in network. However, that concerns me, as in my area it shows there are none to few in-network (for the Part C option) which would give me more confidence if they were. Perhaps that is because the plans are fairly new. I personally would not use the Aetna Advantage plan without the Part C enrollment due to our coverage needs, but the other plans in my opinion look great either way.

Anyone have any experience with these or heard from elsewhere about them, or have any general comments?
Stay away from AETNA Advantage. They denied my father continued skilled nursing coverage after hospitalization prematurely. We had to pay out of pocket until he won a Level 3 appeal. Even then, we had to fight Aetna to pay the settlement.
Do you know if this was a regular public Aetna Medicare Advantage plan or the FEHB only Aetna Advantage with Part C added on?
It was not a FEHB plan.
As a federal employee or retiree, you pay for FEHB, enroll in Medicare A free at age 65 based your 1.45% payroll deduction through your career, and then enroll in Medicare Part B at age 65 by paying the premiums based on Income.
But FEHB plus Medicare is not a Part C add-on. You are using FEHB coordination of benefits with Medicare A and B to get an Advantage Plan (Plan C) which is private insurance. Instead of paying the insurance company for a plan C, you are paying for FEHB to coordinate benefits with Medicare.

"up to 100 days skilled nursing, which is nice, as my opinion is this was a weak area for most FEHB plans in the past." The 100 days of skilled nursing after hospitalization is a Medicare A benefit with many requirements, and would not be available if your did not enroll in Medicare A at age 65.

I get that your question suggests that FEHB Advantage Plans provide more protection than a privately purchased Advantage plan. I don't know if that is the case. You would need to look at the fine print in the FEHB document to understand whether you appeal to FEHB or go through the usual Medicare advantage plan appeal process. The first two levels of appeal of the privately purchased are controlled by the insurance company.
Thanks for the clarification. I now understand these plans a little better. This is why I have personally been somewhat hesitant about these plans, and if they are much like the publicly offered Advantage plans, I personally would rather stick with a regular FEHB plan. However, it does seem that the total premium of these FEHB Advantage plans might be way higher than public plans, when one adds up the annuitant premium and the part the govt pays, so one would think one gets a lot more for the money? Then again, I don't know what the govt pays to these companies for the public Advantage plans so I don't know.
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tallguy3891
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Re: Increasing Number of FEHB "Advantage" Plans

Post by tallguy3891 »

delamer wrote: Thu Oct 06, 2022 10:34 am
tallguy3891 wrote: Wed Oct 05, 2022 11:18 pm
delamer wrote: Wed Oct 05, 2022 9:34 pm Are you wedded to having Medicare Part B?

We’ll be paying $320/month for GEHA Standard in 2023, and that’s it.
I have thought about the part B issue a lot; you unknowingly did a nice pun with the "Are you wedded to having Medicare Part B?" question because, sort of, since my spouse has heavy healthcare needs, and between Aetna Direct and Medicare we pay zero out of pocket with only a premium of about $345/mo this year and about $352/mo in 2023. She also has approx $100 in copays for Rx per month, which is covered completely by the Aetna Direct medical fund of $1800 per year, free money, hence zero out of pocket for Rx too. GEHA simply wouldn't work as well for her particular meds in that the copays would have been more.

Your question does lead to an interesting topic which is regularly discussed, as far as is Part B worth it with a good FEHB plan? We are non-IRMAA but still pay approx $4000 per year for part B for us both. In 2018-2019 when she had over $1.3 million in medical bills, we had BCBS Standard at the time and what their part paid after Medicare paid was about $1900 in one year and $2400 in the other, so it wasn't much more paid than the part B premiums those years, and most years has been much less with BCBS Standard, then Basic, and now Direct.

And of course, there are catastrophic limits which would have helped. So, we pay the approx $4000 part B premiums to avoid $6000-$12000 or more in catastrophic limit costs (depending on plan). Nice to not have to think about it although some would think it is a waste of money. In the long run it might be. Back to your question, I think that if we were to go without Medicare Part B, in our case we would probably go with NALC High, which isn't the lowest premium, but has a much lower catastrophic limit than many other plans which could be helpful.
Obviously, you’ve put some thought into this. We are fortunate in that neither of us is a heavy healthcare user (so far), which I do think requires a somewhat different analysis.

Plus we would be subject to IRMAA premiums if we enrolled in Part B. Which means an extra $5700/year, and it would be higher unless we avoided all but minimal Roth conversions.

I’m comfortable with our choice, given that we could enroll in Part B later (albeit with a premium penalty). I suspect that Part B will become required in the foreseeable future. Hopefully, we will be grandfathered in or allowed to enroll without the premium penalty.

Good luck.
The IRMAA aspect definitely adds a different angle on the decision. If we were paying the same or more in Part B premiums as whatever the plan catastrophic yearly limit was, I think we might just drop Part B and go with a solid FEHB plan only, with Part A. That is why I mentioned NALC High. At this time I believe the catastrophic limit is a relatively low 3500/5000. Of course, I do know there are some benefits to Part B that could be worth holding onto it for some people, such as perhaps DME and Therapy limits, etc.?
Tdubs
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Re: Increasing Number of FEHB "Advantage" Plans

Post by Tdubs »

Here's the link to the United Healthcare plan--has a $3,500 reimbursement for a couple. Checkbook lists it as being a superior bargain to FEHB alone, at least for the lower couple tiers of IRMAA.

https://www.uhcfeds.com/medicare-plans/ ... .advantage
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tallguy3891
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Re: Increasing Number of FEHB "Advantage" Plans

Post by tallguy3891 »

Tdubs wrote: Thu Oct 06, 2022 11:56 am Here's the link to the United Healthcare plan--has a $3,500 reimbursement for a couple. Checkbook lists it as being a superior bargain to FEHB alone, at least for the lower couple tiers of IRMAA.

https://www.uhcfeds.com/medicare-plans/ ... .advantage
This plan is not available in my State as of now. Also, I encourage people to always look at Section 9 of FEHB brochures to see how the plan coordinates with Medicare A and/or B. Some plans waive copays and coinsurance, and some apparently do not waive various costs.
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tallguy3891
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Re: Increasing Number of FEHB "Advantage" Plans

Post by tallguy3891 »

Just an additional bit of info on this topic: It looks like the FEHB Aetna Medicare Advantage plan is now giving up to a $1200 per year Medicare Reimbursement per eligible person, so $2400 per year Medicare reimbursement for a self+one couple. Significant. This means as a couple on this plan with both on Parts A and B Medicare, with the FEHB premium being $275/mo, it is like the couple is "getting" their FEHB plan for $75 net per month ($275-$200), and a self only for $25/mo ($125-$100).

Or, of course, since it is a $100 per month reimbursement for each on Part B premium, which apparently is added back into one's ssa check each month (or reduces the premium due for those not receiving Social Security benefits), that is for many a significantly reduced Part B premium.

See 2023 brochures for info. Might work for some, maybe not for others.
Swansea
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Re: Increasing Number of FEHB "Advantage" Plans

Post by Swansea »

delamer wrote: Thu Oct 06, 2022 10:34 am
tallguy3891 wrote: Wed Oct 05, 2022 11:18 pm
delamer wrote: Wed Oct 05, 2022 9:34 pm Are you wedded to having Medicare Part B?

We’ll be paying $320/month for GEHA Standard in 2023, and that’s it.
I have thought about the part B issue a lot; you unknowingly did a nice pun with the "Are you wedded to having Medicare Part B?" question because, sort of, since my spouse has heavy healthcare needs, and between Aetna Direct and Medicare we pay zero out of pocket with only a premium of about $345/mo this year and about $352/mo in 2023. She also has approx $100 in copays for Rx per month, which is covered completely by the Aetna Direct medical fund of $1800 per year, free money, hence zero out of pocket for Rx too. GEHA simply wouldn't work as well for her particular meds in that the copays would have been more.

Your question does lead to an interesting topic which is regularly discussed, as far as is Part B worth it with a good FEHB plan? We are non-IRMAA but still pay approx $4000 per year for part B for us both. In 2018-2019 when she had over $1.3 million in medical bills, we had BCBS Standard at the time and what their part paid after Medicare paid was about $1900 in one year and $2400 in the other, so it wasn't much more paid than the part B premiums those years, and most years has been much less with BCBS Standard, then Basic, and now Direct.

And of course, there are catastrophic limits which would have helped. So, we pay the approx $4000 part B premiums to avoid $6000-$12000 or more in catastrophic limit costs (depending on plan). Nice to not have to think about it although some would think it is a waste of money. In the long run it might be. Back to your question, I think that if we were to go without Medicare Part B, in our case we would probably go with NALC High, which isn't the lowest premium, but has a much lower catastrophic limit than many other plans which could be helpful.
Obviously, you’ve put some thought into this. We are fortunate in that neither of us is a heavy healthcare user (so far), which I do think requires a somewhat different analysis.

Plus we would be subject to IRMAA premiums if we enrolled in Part B. Which means an extra $5700/year, and it would be higher unless we avoided all but minimal Roth conversions.

I’m comfortable with our choice, given that we could enroll in Part B later (albeit with a premium penalty). I suspect that Part B will become required in the foreseeable future. Hopefully, we will be grandfathered in or allowed to enroll without the premium penalty.

Good luck.
I find your prediction that part B may become mandatory at some point interesting and not unthinkable.
A friend who retired under TriCare (military) is required to enroll in part B. That was not required in the past.
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LonePrairie
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Re: Increasing Number of FEHB "Advantage" Plans

Post by LonePrairie »

I read in the September 2022 NARFE magazine about the new Medicare Advantage plans for federal annuitants. I'm planning to get the Consumers' Checkbook Guide when it comes out next month so I can see whether one of these would work for me. I'm single and subject to IRMAA.
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tallguy3891
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Re: Increasing Number of FEHB "Advantage" Plans

Post by tallguy3891 »

Swansea wrote: Sat Oct 15, 2022 1:08 pm
delamer wrote: Thu Oct 06, 2022 10:34 am
tallguy3891 wrote: Wed Oct 05, 2022 11:18 pm
delamer wrote: Wed Oct 05, 2022 9:34 pm Are you wedded to having Medicare Part B?

We’ll be paying $320/month for GEHA Standard in 2023, and that’s it.
I have thought about the part B issue a lot; you unknowingly did a nice pun with the "Are you wedded to having Medicare Part B?" question because, sort of, since my spouse has heavy healthcare needs, and between Aetna Direct and Medicare we pay zero out of pocket with only a premium of about $345/mo this year and about $352/mo in 2023. She also has approx $100 in copays for Rx per month, which is covered completely by the Aetna Direct medical fund of $1800 per year, free money, hence zero out of pocket for Rx too. GEHA simply wouldn't work as well for her particular meds in that the copays would have been more.

Your question does lead to an interesting topic which is regularly discussed, as far as is Part B worth it with a good FEHB plan? We are non-IRMAA but still pay approx $4000 per year for part B for us both. In 2018-2019 when she had over $1.3 million in medical bills, we had BCBS Standard at the time and what their part paid after Medicare paid was about $1900 in one year and $2400 in the other, so it wasn't much more paid than the part B premiums those years, and most years has been much less with BCBS Standard, then Basic, and now Direct.

And of course, there are catastrophic limits which would have helped. So, we pay the approx $4000 part B premiums to avoid $6000-$12000 or more in catastrophic limit costs (depending on plan). Nice to not have to think about it although some would think it is a waste of money. In the long run it might be. Back to your question, I think that if we were to go without Medicare Part B, in our case we would probably go with NALC High, which isn't the lowest premium, but has a much lower catastrophic limit than many other plans which could be helpful.
Obviously, you’ve put some thought into this. We are fortunate in that neither of us is a heavy healthcare user (so far), which I do think requires a somewhat different analysis.

Plus we would be subject to IRMAA premiums if we enrolled in Part B. Which means an extra $5700/year, and it would be higher unless we avoided all but minimal Roth conversions.

I’m comfortable with our choice, given that we could enroll in Part B later (albeit with a premium penalty). I suspect that Part B will become required in the foreseeable future. Hopefully, we will be grandfathered in or allowed to enroll without the premium penalty.

Good luck.
I find your prediction that part B may become mandatory at some point interesting and not unthinkable.
A friend who retired under TriCare (military) is required to enroll in part B. That was not required in the past.
If only FEHB enrollees knew if the gov't would handle the Part B late enrollment penalty like they apparently are doing for the postal workers under their reform act...

I think droves of people now enrolled in Part B with FEHB would not be on Part B if they knew they could opt in at a future point with no penalty. Seems like that would have been a smart fiscal move by the gov't to keep Medicare costs down but maybe I am looking at it from the wrong angle. The ones I see benefitting most from enrollees being on FEHB and Part B are the insurance companies. My opinion only.
delamer
Posts: 17453
Joined: Tue Feb 08, 2011 5:13 pm

Re: Increasing Number of FEHB "Advantage" Pl

Post by delamer »

tallguy3891 wrote: Sat Oct 15, 2022 2:42 pm
Swansea wrote: Sat Oct 15, 2022 1:08 pm
delamer wrote: Thu Oct 06, 2022 10:34 am
tallguy3891 wrote: Wed Oct 05, 2022 11:18 pm
delamer wrote: Wed Oct 05, 2022 9:34 pm Are you wedded to having Medicare Part B?

We’ll be paying $320/month for GEHA Standard in 2023, and that’s it.
I have thought about the part B issue a lot; you unknowingly did a nice pun with the "Are you wedded to having Medicare Part B?" question because, sort of, since my spouse has heavy healthcare needs, and between Aetna Direct and Medicare we pay zero out of pocket with only a premium of about $345/mo this year and about $352/mo in 2023. She also has approx $100 in copays for Rx per month, which is covered completely by the Aetna Direct medical fund of $1800 per year, free money, hence zero out of pocket for Rx too. GEHA simply wouldn't work as well for her particular meds in that the copays would have been more.

Your question does lead to an interesting topic which is regularly discussed, as far as is Part B worth it with a good FEHB plan? We are non-IRMAA but still pay approx $4000 per year for part B for us both. In 2018-2019 when she had over $1.3 million in medical bills, we had BCBS Standard at the time and what their part paid after Medicare paid was about $1900 in one year and $2400 in the other, so it wasn't much more paid than the part B premiums those years, and most years has been much less with BCBS Standard, then Basic, and now Direct.

And of course, there are catastrophic limits which would have helped. So, we pay the approx $4000 part B premiums to avoid $6000-$12000 or more in catastrophic limit costs (depending on plan). Nice to not have to think about it although some would think it is a waste of money. In the long run it might be. Back to your question, I think that if we were to go without Medicare Part B, in our case we would probably go with NALC High, which isn't the lowest premium, but has a much lower catastrophic limit than many other plans which could be helpful.
Obviously, you’ve put some thought into this. We are fortunate in that neither of us is a heavy healthcare user (so far), which I do think requires a somewhat different analysis.

Plus we would be subject to IRMAA premiums if we enrolled in Part B. Which means an extra $5700/year, and it would be higher unless we avoided all but minimal Roth conversions.

I’m comfortable with our choice, given that we could enroll in Part B later (albeit with a premium penalty). I suspect that Part B will become required in the foreseeable future. Hopefully, we will be grandfathered in or allowed to enroll without the premium penalty.

Good luck.
I find your prediction that part B may become mandatory at some point interesting and not unthinkable.
A friend who retired under TriCare (military) is required to enroll in part B. That was not required in the past.
If only FEHB enrollees knew if the gov't would handle the Part B late enrollment penalty like they apparently are doing for the postal workers under their reform act...

I think droves of people now enrolled in Part B with FEHB would not be on Part B if they knew they could opt in at a future point with no penalty. Seems like that would have been a smart fiscal move by the gov't to keep Medicare costs down but maybe I am looking at it from the wrong angle. The ones I see benefitting most from enrollees being on FEHB and Part B are the insurance companies. My opinion only.
The new rules for postal retirees are probably the canaries in the coal mine for other federal retirees.

The penalty for late enrollment in Part B is undoubtedly driven by the desire to avoid free riders. You don’t want people to delay enrolling in insurance until they have an expensive illness/condition. Insurance works, in terms of financial sustainability, because both the healthy and the sick buy it.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
Topic Author
tallguy3891
Posts: 703
Joined: Sat Jul 03, 2021 10:47 am

Re: Increasing Number of FEHB "Advantage" Pl

Post by tallguy3891 »

delamer wrote: Sat Oct 15, 2022 3:39 pm
tallguy3891 wrote: Sat Oct 15, 2022 2:42 pm
Swansea wrote: Sat Oct 15, 2022 1:08 pm
delamer wrote: Thu Oct 06, 2022 10:34 am
tallguy3891 wrote: Wed Oct 05, 2022 11:18 pm

I have thought about the part B issue a lot; you unknowingly did a nice pun with the "Are you wedded to having Medicare Part B?" question because, sort of, since my spouse has heavy healthcare needs, and between Aetna Direct and Medicare we pay zero out of pocket with only a premium of about $345/mo this year and about $352/mo in 2023. She also has approx $100 in copays for Rx per month, which is covered completely by the Aetna Direct medical fund of $1800 per year, free money, hence zero out of pocket for Rx too. GEHA simply wouldn't work as well for her particular meds in that the copays would have been more.

Your question does lead to an interesting topic which is regularly discussed, as far as is Part B worth it with a good FEHB plan? We are non-IRMAA but still pay approx $4000 per year for part B for us both. In 2018-2019 when she had over $1.3 million in medical bills, we had BCBS Standard at the time and what their part paid after Medicare paid was about $1900 in one year and $2400 in the other, so it wasn't much more paid than the part B premiums those years, and most years has been much less with BCBS Standard, then Basic, and now Direct.

And of course, there are catastrophic limits which would have helped. So, we pay the approx $4000 part B premiums to avoid $6000-$12000 or more in catastrophic limit costs (depending on plan). Nice to not have to think about it although some would think it is a waste of money. In the long run it might be. Back to your question, I think that if we were to go without Medicare Part B, in our case we would probably go with NALC High, which isn't the lowest premium, but has a much lower catastrophic limit than many other plans which could be helpful.
Obviously, you’ve put some thought into this. We are fortunate in that neither of us is a heavy healthcare user (so far), which I do think requires a somewhat different analysis.

Plus we would be subject to IRMAA premiums if we enrolled in Part B. Which means an extra $5700/year, and it would be higher unless we avoided all but minimal Roth conversions.

I’m comfortable with our choice, given that we could enroll in Part B later (albeit with a premium penalty). I suspect that Part B will become required in the foreseeable future. Hopefully, we will be grandfathered in or allowed to enroll without the premium penalty.

Good luck.
I find your prediction that part B may become mandatory at some point interesting and not unthinkable.
A friend who retired under TriCare (military) is required to enroll in part B. That was not required in the past.
If only FEHB enrollees knew if the gov't would handle the Part B late enrollment penalty like they apparently are doing for the postal workers under their reform act...

I think droves of people now enrolled in Part B with FEHB would not be on Part B if they knew they could opt in at a future point with no penalty. Seems like that would have been a smart fiscal move by the gov't to keep Medicare costs down but maybe I am looking at it from the wrong angle. The ones I see benefitting most from enrollees being on FEHB and Part B are the insurance companies. My opinion only.
The new rules for postal retirees are probably the canaries in the coal mine for other federal retirees.

The penalty for late enrollment in Part B is undoubtedly driven by the desire to avoid free riders. You don’t want people to delay enrolling in insurance until they have an expensive illness/condition. Insurance works, in terms of financial sustainability, because both the healthy and the sick buy it.
Good point. Makes sense.
tj
Posts: 9366
Joined: Wed Dec 23, 2009 11:10 pm

Re: Increasing Number of FEHB "Advantage" Plans

Post by tj »

Some written accounts of people not having good experience with these:

https://fedretire.net/medicare-advantag ... en-season/
OpenMinded1
Posts: 1576
Joined: Wed Feb 05, 2020 8:27 am

Re: Increasing Number of FEHB "Advantage" Plans

Post by OpenMinded1 »

tj wrote: Sat Mar 25, 2023 10:53 pm Some written accounts of people not having good experience with these:

https://fedretire.net/medicare-advantag ... en-season/
According to the blog accessed via the link:

The issues around these plans deal with coverage and provider availability. You have to use preferred providers in their plans and because the plan becomes your primary provider, you often require pre-approval or authorizations for many procedures.

I'm seriously considering signing up for the MHBP Standard with Aetna Medicare Advantage option. All my nearby doctors and hospitals are in network. The only one that isn't is about 50 miles away in another state. The plan is a combination PPO and Fee plan, not an HMO-type advantage plan. (The HMO-type plans generally have a much narrower network.) MHBP Standard with Aetna Medicare Advantage appears to have a nationwide network. I searched for and found providers in network in other parts of the country.

The prescription co-pays appear to be lower than most FEHB plans, and I won't have to use mail order to get the best prices. (Although they allow mail order if a person wants to use it.) I'm particularly focused on prescriptions because I have to take several brand name meds. One I take will cost $50, and another $60 for a 90-day supply using this plan. Generic prescriptions are $10 for a 90-day supply.

I also noticed that according to Consumer's Checkbook the maximum out-of-pocket is substantially less than for most other FEHB advantage plans, even though the average cost of healthcare per year is about the same as most of the other advantage plans. I think the Aetna Advantage Plan is less.

Other features that piqued my interest: It covers 100 skilled nursing facility days, and will reimburse $75 per month per person to help offset the Medicare part B premium.

Regarding pre-authorization and approval, I haven't gone on Medicare yet, but have grown accustomed to this with non-Medicare advantage plans. So I don't think this is something that is unique to advantage plans. However, I have never had a provider fail to get approval for something. I just got a sleep study and CTScan pre-approved, but it took two to three weeks for each. Maybe advantage plans are more likely to refuse to approve something? Maybe pre-approval isn't necessary with non-advantage FEHB plans after you enroll in Medicare A and B, or maybe you are less likely to fail to get pre-approval?

I would be interested in hearing more on the topic of FEHB Medicare Advantage plans, especially MHBP Standard with Aetna Medicare Advantage.

Added: Consumer's Checkbook lauds them.
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