Big News For Those On FEHB BCBS And Other Plans

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Swansea
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Swansea »

I saw a letter from BCBS envelope market Medicare on USPS informed delivery for 10/30. I never received it.
For those who also received a letter around that time, did it indicate your opt out status or anything else of importance?
Thanks
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tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

CraigBinFL wrote: Thu Nov 09, 2023 3:14 pm Received my notice from BCBS on 10/28. Came here looking for the drawbacks since the notice only touts the benefits. Didn't see any as I scrolled through the comments, so I'll pass on my findings.

BCBS already has the 2024 drug prices loaded for comparison between the plans and FEP-MPDP. We don't have a lot of drug costs, so there weren't too many to check. Slight decreases for my Rxs, none for my wife's. One, Armour Thyroid isn't covered at all under FEP-MPDP, so that will result in a much larger payout for us.

Called their help line & pried loose another drawback. Per OPM, FEP enrollees can take participate in "patient assistance" and "pharmacy incentive" programs. MPDP and Medicare D prohibit participation. (Somehow the incentives are seen as violations of the False Claims Act)

We've declined for now, but I'd still like to know any other drawbacks anyone else has identified.
These "assistance" and "incentive" programs are different from offers like GoodRx coupons, is that correct?

https://www.goodrx.com/corporate/busine ... e-medicare
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tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

Swansea wrote: Thu Nov 09, 2023 3:57 pm I saw a letter from BCBS envelope market Medicare on USPS informed delivery for 10/30. I never received it.
For those who also received a letter around that time, did it indicate your opt out status or anything else of importance?
Thanks
If you go to your BCBS FEP site (you can set up your account if it's like it used to be), is there a place you can view/reprint documents/letters sent to you? Or, BCBS may be able to send you an email with attachment?
barber
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by barber »

My spouse called today to opt out and the rep asked is your husband going to also? I had to also talk with the rep to verify I was opting out.
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HueyLD
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by HueyLD »

Swansea wrote: Thu Nov 09, 2023 3:57 pm I saw a letter from BCBS envelope market Medicare on USPS informed delivery for 10/30. I never received it.
For those who also received a letter around that time, did it indicate your opt out status or anything else of importance?
Thanks
The postal service has been inconsistent. The Fepblue sent individual letters dated 10/16/23 to my spouse and me and one letter arrived on 10/24 but the other took another 10 days to arrive.

However, the letters confirming each op-out were received on the same date.
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pahkcah
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by pahkcah »

tallguy3891 wrote: Wed Nov 08, 2023 6:48 pm
pahkcah wrote: Wed Nov 08, 2023 6:15 pm Thanks to everyone for the ongoing conversation concerning this topic!

DW and I are both retired Federal employees with Medicare Parts A & B and BCBS Basic. After looking at the new option and comparing the formularies for both plans, we decided to opt out. Our analysis was that if someone had expensive prescription needs, the new cap under MPDP could be a really great benefit. As we are using generics that are all Tier 1 drugs under the existing BCBS Basic plan, we see no need to switch. One really odd data point was that under the MPDP formulary one of my prescriptions, a generic with 20 mg dosage, was listed as a Tier 4, while the same generic drug in a 40 mg dosage was listed as Tier 1. Huh? It doesn’t make sense.

Another reason we decided to stay with BCBS Basic for our drug plan is that we are subject to IRMAA as a result of having two CSRS pensions, and it’s only going to get worse when we start taking RMDs.

I opted out by calling the number provided and following the automated directions, which required me to state my FEHB subscriber number and birth date. My wife tried to do the same, but for some reason the “system” could not recognize her subscriber number. She was, however, immediately connected to a representative who took action to opt her out. As others have mentioned, we were told that a confirmation letter would be mailed out in 7 to 10 days.
If you don't mind sharing, why have you decided to remain on Basic when on Medicare A&B? I know many people choose to do this. I do realize the situation is different cost-wise for couples who can each choose the self only rate rather than self+one. I was on Standard for a very long time and then Basic and found them great, but am wondering if I am missing something since so many seem to like that combo (Basic + Medicare). There are other plans which are cheaper, offer higher reimbursement amounts, possibly better Rx coverage, have widespread providers available, and offer extra Skilled Nursing facility days. I feel like maybe I am missing something but after thorough comparisons I still don't see it. I can also see BCBS Basic and NALC High as excellent choices, especially with Part A and not Part B, but I would find your comments very helpful and very much appreciate it.
Okay, this might sound like heresy on this site, but the bottom line is that we are willing to pay more for the peace of mind having BCBS Basic provides, rather than trying to save a few dollars. We had BCBS Standard as well for many years until Medicare kicked in. I spent months comparing costs and features (using Consumers' Checkbook and lots of other sources of information) with other FEHB plans prior to starting Medicare, but finally decided the risk of choosing another provider was not worth any potential savings or additional benefits. We have never had a problem finding top quality medical professionals under either of the BCBS plans. I guess I'd compare the decision to buying a Toyota product versus a Kia 20-25 years ago. Sure, we might have paid more for a Toyota, but we never worried about anything going wrong with a Toyota. Same applies to our medical provider.
CharacterCounts
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by CharacterCounts »

Don't recall seeing any comments about Part D coverage for meds if needed while traveling overseas. Not 100% sure, but don't think they would be covered.
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tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

pahkcah wrote: Thu Nov 09, 2023 5:35 pm
tallguy3891 wrote: Wed Nov 08, 2023 6:48 pm
pahkcah wrote: Wed Nov 08, 2023 6:15 pm Thanks to everyone for the ongoing conversation concerning this topic!

DW and I are both retired Federal employees with Medicare Parts A & B and BCBS Basic. After looking at the new option and comparing the formularies for both plans, we decided to opt out. Our analysis was that if someone had expensive prescription needs, the new cap under MPDP could be a really great benefit. As we are using generics that are all Tier 1 drugs under the existing BCBS Basic plan, we see no need to switch. One really odd data point was that under the MPDP formulary one of my prescriptions, a generic with 20 mg dosage, was listed as a Tier 4, while the same generic drug in a 40 mg dosage was listed as Tier 1. Huh? It doesn’t make sense.

Another reason we decided to stay with BCBS Basic for our drug plan is that we are subject to IRMAA as a result of having two CSRS pensions, and it’s only going to get worse when we start taking RMDs.

I opted out by calling the number provided and following the automated directions, which required me to state my FEHB subscriber number and birth date. My wife tried to do the same, but for some reason the “system” could not recognize her subscriber number. She was, however, immediately connected to a representative who took action to opt her out. As others have mentioned, we were told that a confirmation letter would be mailed out in 7 to 10 days.
If you don't mind sharing, why have you decided to remain on Basic when on Medicare A&B? I know many people choose to do this. I do realize the situation is different cost-wise for couples who can each choose the self only rate rather than self+one. I was on Standard for a very long time and then Basic and found them great, but am wondering if I am missing something since so many seem to like that combo (Basic + Medicare). There are other plans which are cheaper, offer higher reimbursement amounts, possibly better Rx coverage, have widespread providers available, and offer extra Skilled Nursing facility days. I feel like maybe I am missing something but after thorough comparisons I still don't see it. I can also see BCBS Basic and NALC High as excellent choices, especially with Part A and not Part B, but I would find your comments very helpful and very much appreciate it.
Okay, this might sound like heresy on this site, but the bottom line is that we are willing to pay more for the peace of mind having BCBS Basic provides, rather than trying to save a few dollars. We had BCBS Standard as well for many years until Medicare kicked in. I spent months comparing costs and features (using Consumers' Checkbook and lots of other sources of information) with other FEHB plans prior to starting Medicare, but finally decided the risk of choosing another provider was not worth any potential savings or additional benefits. We have never had a problem finding top quality medical professionals under either of the BCBS plans. I guess I'd compare the decision to buying a Toyota product versus a Kia 20-25 years ago. Sure, we might have paid more for a Toyota, but we never worried about anything going wrong with a Toyota. Same applies to our medical provider.
Nothing wrong with that at all!!! Thanks for sharing your comments. Much appreciated.
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tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

CharacterCounts wrote: Thu Nov 09, 2023 6:53 pm Don't recall seeing any comments about Part D coverage for meds if needed while traveling overseas. Not 100% sure, but don't think they would be covered.
You make an excellent point, especially since so many do travel overseas. This is well worth researching for one's particular plan.

Thanks for pointing this out.
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retiredjg
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by retiredjg »

CharacterCounts wrote: Thu Nov 09, 2023 6:53 pm Don't recall seeing any comments about Part D coverage for meds if needed while traveling overseas. Not 100% sure, but don't think they would be covered.
This is a good question.

Medicare does not cover traveling overseas. Would this sort of hybrid FEHB/Medicare Part D thingy cover Rx when overseas? Might be a good reason to opt out until that is known.

Or switch back before going overseas.
HeelaMonster
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by HeelaMonster »

pahkcah wrote: Thu Nov 09, 2023 5:35 pm
tallguy3891 wrote: Wed Nov 08, 2023 6:48 pm If you don't mind sharing, why have you decided to remain on Basic when on Medicare A&B? I know many people choose to do this. I do realize the situation is different cost-wise for couples who can each choose the self only rate rather than self+one. I was on Standard for a very long time and then Basic and found them great, but am wondering if I am missing something since so many seem to like that combo (Basic + Medicare). There are other plans which are cheaper, offer higher reimbursement amounts, possibly better Rx coverage, have widespread providers available, and offer extra Skilled Nursing facility days. I feel like maybe I am missing something but after thorough comparisons I still don't see it. I can also see BCBS Basic and NALC High as excellent choices, especially with Part A and not Part B, but I would find your comments very helpful and very much appreciate it.
Okay, this might sound like heresy on this site, but the bottom line is that we are willing to pay more for the peace of mind having BCBS Basic provides, rather than trying to save a few dollars. We had BCBS Standard as well for many years until Medicare kicked in. I spent months comparing costs and features (using Consumers' Checkbook and lots of other sources of information) with other FEHB plans prior to starting Medicare, but finally decided the risk of choosing another provider was not worth any potential savings or additional benefits. We have never had a problem finding top quality medical professionals under either of the BCBS plans. I guess I'd compare the decision to buying a Toyota product versus a Kia 20-25 years ago. Sure, we might have paid more for a Toyota, but we never worried about anything going wrong with a Toyota. Same applies to our medical provider.
To that, I would add a reminder that BCBS reimburses $800 with proof that you are also paying for Medicare Part B... so it's not as if you are actually paying full-freight for both plans.
Swansea
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Swansea »

tallguy3891 wrote: Thu Nov 09, 2023 4:24 pm
Swansea wrote: Thu Nov 09, 2023 3:57 pm I saw a letter from BCBS envelope market Medicare on USPS informed delivery for 10/30. I never received it.
For those who also received a letter around that time, did it indicate your opt out status or anything else of importance?
Thanks
If you go to your BCBS FEP site (you can set up your account if it's like it used to be), is there a place you can view/reprint documents/letters sent to you? Or, BCBS may be able to send you an email with attachment?
I emailed them a request for a copy and was informed they could not provide one. Suggested I call a particular number for the information. That was the contact which entered my membership number and said I was not in the system.
I speculate that maybe since I do not have Medicare B, I am not subject to being opted in?
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HueyLD
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by HueyLD »

Swansea wrote: Fri Nov 10, 2023 5:04 am
tallguy3891 wrote: Thu Nov 09, 2023 4:24 pm
Swansea wrote: Thu Nov 09, 2023 3:57 pm I saw a letter from BCBS envelope market Medicare on USPS informed delivery for 10/30. I never received it.
For those who also received a letter around that time, did it indicate your opt out status or anything else of importance?
Thanks
If you go to your BCBS FEP site (you can set up your account if it's like it used to be), is there a place you can view/reprint documents/letters sent to you? Or, BCBS may be able to send you an email with attachment?
I emailed them a request for a copy and was informed they could not provide one. Suggested I call a particular number for the information. That was the contact which entered my membership number and said I was not in the system.
I speculate that maybe since I do not have Medicare B, I am not subject to being opted in?
I have no idea why fepblue provides contradictory information on their MPDP program.

On their MPDP guide https://www.fepblue.org/-/media/FEPBlue ... active.pdf , they indicate “Part A and/or Part B” on page 3 but “Part A and Part B” on page 8.

My best guess is that you need to have both A&B in order to be automatically enrolled in MPDP.
Swansea
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Swansea »

HueyLD wrote: Fri Nov 10, 2023 6:26 am
Swansea wrote: Fri Nov 10, 2023 5:04 am
tallguy3891 wrote: Thu Nov 09, 2023 4:24 pm
Swansea wrote: Thu Nov 09, 2023 3:57 pm I saw a letter from BCBS envelope market Medicare on USPS informed delivery for 10/30. I never received it.
For those who also received a letter around that time, did it indicate your opt out status or anything else of importance?
Thanks
If you go to your BCBS FEP site (you can set up your account if it's like it used to be), is there a place you can view/reprint documents/letters sent to you? Or, BCBS may be able to send you an email with attachment?
I emailed them a request for a copy and was informed they could not provide one. Suggested I call a particular number for the information. That was the contact which entered my membership number and said I was not in the system.
I speculate that maybe since I do not have Medicare B, I am not subject to being opted in?
I have no idea why fepblue provides contradictory information on their MPDP program.

On their MPDP guide https://www.fepblue.org/-/media/FEPBlue ... active.pdf , they indicate “Part A and/or Part B” on page 3 but “Part A and Part B” on page 8.

My best guess is that you need to have both A&B in order to be automatically enrolled in MPDP.
A good job of discovery, thanks.
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HueyLD
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by HueyLD »

The fepblue will have a webinar this morning and the new MPDP is the topic.

I will ask the question of A and/or B. In addition, I will try to ask about overseas medicine coverage under the combo of MPDP/FEHB.
BigJohn
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by BigJohn »

Swansea wrote: Fri Nov 10, 2023 5:04 am
tallguy3891 wrote: Thu Nov 09, 2023 4:24 pm
Swansea wrote: Thu Nov 09, 2023 3:57 pm I saw a letter from BCBS envelope market Medicare on USPS informed delivery for 10/30. I never received it.
For those who also received a letter around that time, did it indicate your opt out status or anything else of importance?
Thanks
If you go to your BCBS FEP site (you can set up your account if it's like it used to be), is there a place you can view/reprint documents/letters sent to you? Or, BCBS may be able to send you an email with attachment?
I emailed them a request for a copy and was informed they could not provide one. Suggested I call a particular number for the information. That was the contact which entered my membership number and said I was not in the system.
I speculate that maybe since I do not have Medicare B, I am not subject to being opted in?
I’ve got a friend going through this that had the same experience. She’s called twice and gotten the same answer… if you don’t have Medicare B, you are not in the system because you are not eligible for MPDP, no opt out necessary.
"The greatest enemy of a good plan is the dream of a perfect plan" - Carl Von Clausewitz
Swansea
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Swansea »

BigJohn wrote: Fri Nov 10, 2023 7:56 pm
Swansea wrote: Fri Nov 10, 2023 5:04 am
tallguy3891 wrote: Thu Nov 09, 2023 4:24 pm
Swansea wrote: Thu Nov 09, 2023 3:57 pm I saw a letter from BCBS envelope market Medicare on USPS informed delivery for 10/30. I never received it.
For those who also received a letter around that time, did it indicate your opt out status or anything else of importance?
Thanks
If you go to your BCBS FEP site (you can set up your account if it's like it used to be), is there a place you can view/reprint documents/letters sent to you? Or, BCBS may be able to send you an email with attachment?
I emailed them a request for a copy and was informed they could not provide one. Suggested I call a particular number for the information. That was the contact which entered my membership number and said I was not in the system.
I speculate that maybe since I do not have Medicare B, I am not subject to being opted in?
I’ve got a friend going through this that had the same experience. She’s called twice and gotten the same answer… if you don’t have Medicare B, you are not in the system because you are not eligible for MPDP, no opt out necessary.
Good to know. Wish BCBS had handled this better.
HeelaMonster
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by HeelaMonster »

OpenMinded1 wrote: Thu Nov 09, 2023 10:05 am
UpperNwGuy wrote: Tue Nov 07, 2023 11:09 am The letter I received from BCBS gave me a deadline of Nov 11 to opt out either by phone or by mail. I'm surprised that they're forcing me to make this decision so far in advance of the end of Open Season. I'm also surprised that they don't have a means to opt out in their website.

Have any forum members opted out? If so, did you do it by phone? Was there any push back by the customer service representative?
FYI. Your statement about a Nov 11 deadline resulted in me checking the deadline for the plan I have - MHBP Standard. Unfortunately, I misplaced the letter they sent me. Anyway, the deadline for opting out of part D with MHBP Standard is the end of the year - Dec. 31 according to the rep I chatted with online. I'm surprised I have that long to opt out.

Maybe you would be able to opt out again after a short blackout period after the Nov. 11 deadline, and not have to wait until next open season.
FWIW, the BCBS automated service line (888-338-7737) stated that members who did not opt-out within the initial 26 day window COULD STILL CANCEL AT ANY TIME after that, once enrolled in MPDP. If that is truly the case (there do seem to be lots of mixed signals in their messaging!), the advertised deadlines may not actually be... deadlines?
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TimeRunner
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by TimeRunner »

The universe is telling you to wait a year and see how it shakes out.... :wink:
One cannot enlighten the unconscious. | "All I need are some tasty waves, a cool buzz, and I'm fine." -Jeff Spicoli
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tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

HueyLD wrote: Fri Nov 10, 2023 8:03 am The fepblue will have a webinar this morning and the new MPDP is the topic.

I will ask the question of A and/or B. In addition, I will try to ask about overseas medicine coverage under the combo of MPDP/FEHB.
If you were able to participate in the webinar, did they have any info which stood out, including answers to your questions?
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HueyLD
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by HueyLD »

tallguy3891 wrote: Mon Nov 13, 2023 10:05 am
HueyLD wrote: Fri Nov 10, 2023 8:03 am The fepblue will have a webinar this morning and the new MPDP is the topic.

I will ask the question of A and/or B. In addition, I will try to ask about overseas medicine coverage under the combo of MPDP/FEHB.
If you were able to participate in the webinar, did they have any info which stood out, including answers to your questions?
I tried not to post negative experience, but the webinar was pretty much worthless. The presenter simply read from their MPDP brochure and could not answer most of the questions, including some basic questions.

So, I went back to read the (OPM) insurance contract and fepblue’s MPDP brochure and I think I can answer my own questions now.
Richard8655
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Richard8655 »

I churned quite a bit about whether to take Part B, but in the end decided to. I realized (per Consumer's Checkbook) that if we're not chronically sick and have no ongoing medical issues, Part B would be more expensive over the long run. But the pressure was on to avoid the annual 10% penalty in deciding this in the first year. But I think we'd have been just as content if we had chosen only FEHB. I think eliminating the worry (and billing) of copays for everything helped in the decision. And the $800 per person annual subsidy also.
cjohnston2
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by cjohnston2 »

Per Consumer Checkbook the three downsides of the Medicare Part D prescription drug program in BCBS or other coverage (MHBP) are:

1. If you are subject to IRMAA, you have to pay IRMAA for your MHBP part D prescription coverage.
2. You cannot use prescription drug discount cards from drug manufacturers. When you have Part D coverage, you lose access to drug manufacturer discount programs.
3. If you spend time overseas, the new program will not provide prescription drug coverage while you are overseas. BCBS states "Members enrolled in the FEP Medicare Prescription Drug Program have no coverage for drugs obtained and/or purchased overseas."

We will be opting out for these reasons and because are current drug costs are very low and won't change with the new program. BCBS has said on the phone that we can opt in and out from year to year so we change in the future if our prescription drug situation changes.
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by bsteiner »

Richard8655 wrote: Mon Nov 13, 2023 2:48 pm I churned quite a bit about whether to take Part B, but in the end decided to. I realized (per Consumer's Checkbook) that if we're not chronically sick and have no ongoing medical issues, Part B would be more expensive over the long run. But the pressure was on to avoid the annual 10% penalty in deciding this in the first year. But I think we'd have been just as content if we had chosen only FEHB. I think eliminating the worry (and billing) of copays for everything helped in the decision. And the $800 per person annual subsidy also.
Does the 10% (per year) penalty apply if you have FEHB as a retiree?

Is it different for the retiree and for the retiree's spouse?
Richard8655
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Richard8655 »

bsteiner wrote: Thu Nov 16, 2023 4:39 pm
Richard8655 wrote: Mon Nov 13, 2023 2:48 pm I churned quite a bit about whether to take Part B, but in the end decided to. I realized (per Consumer's Checkbook) that if we're not chronically sick and have no ongoing medical issues, Part B would be more expensive over the long run. But the pressure was on to avoid the annual 10% penalty in deciding this in the first year. But I think we'd have been just as content if we had chosen only FEHB. I think eliminating the worry (and billing) of copays for everything helped in the decision. And the $800 per person annual subsidy also.
Does the 10% (per year) penalty apply if you have FEHB as a retiree?

Is it different for the retiree and for the retiree's spouse?
Yes, the 10% annual penalty for delaying Part B would apply whether one already has FEHB or not. The penalty is a Medicare rule applying to all Medicare recipients regardless of their having any other health insurance. It would also apply to spouse. But just to be clear, it's a 10% penalty on the Medicare premium not the FEHB premium.
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by bsteiner »

Richard8655 wrote: Thu Nov 16, 2023 4:49 pm
bsteiner wrote: Thu Nov 16, 2023 4:39 pm
Richard8655 wrote: Mon Nov 13, 2023 2:48 pm I churned quite a bit about whether to take Part B, but in the end decided to. I realized (per Consumer's Checkbook) that if we're not chronically sick and have no ongoing medical issues, Part B would be more expensive over the long run. But the pressure was on to avoid the annual 10% penalty in deciding this in the first year. But I think we'd have been just as content if we had chosen only FEHB. I think eliminating the worry (and billing) of copays for everything helped in the decision. And the $800 per person annual subsidy also.
Does the 10% (per year) penalty apply if you have FEHB as a retiree?

Is it different for the retiree and for the retiree's spouse?
Yes, the 10% annual penalty for delaying Part B would apply whether one already has FEHB or not. The penalty is a Medicare rule applying to all Medicare recipients regardless of their having any other health insurance. It would also apply to spouse. But just to be clear, it's a 10% penalty on the Medicare premium not the FEHB premium.
Also on the IRMAA portion or just the (much smaller in the case I have in mind) base premium?
ChrisC
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by ChrisC »

bsteiner wrote: Thu Nov 16, 2023 7:51 pm
Richard8655 wrote: Thu Nov 16, 2023 4:49 pm
bsteiner wrote: Thu Nov 16, 2023 4:39 pm
Richard8655 wrote: Mon Nov 13, 2023 2:48 pm I churned quite a bit about whether to take Part B, but in the end decided to. I realized (per Consumer's Checkbook) that if we're not chronically sick and have no ongoing medical issues, Part B would be more expensive over the long run. But the pressure was on to avoid the annual 10% penalty in deciding this in the first year. But I think we'd have been just as content if we had chosen only FEHB. I think eliminating the worry (and billing) of copays for everything helped in the decision. And the $800 per person annual subsidy also.
Does the 10% (per year) penalty apply if you have FEHB as a retiree?

Is it different for the retiree and for the retiree's spouse?
Yes, the 10% annual penalty for delaying Part B would apply whether one already has FEHB or not. The penalty is a Medicare rule applying to all Medicare recipients regardless of their having any other health insurance. It would also apply to spouse. But just to be clear, it's a 10% penalty on the Medicare premium not the FEHB premium.
Also on the IRMAA portion or just the (much smaller in the case I have in mind) base premium?
https://www.medicare.gov/basics/costs/m ... -penalties

Looks like the penalty is applied only to the base premium.
CharacterCounts
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by CharacterCounts »

I have FEPBLUE and opted out of Part D via phone a few weeks ago. Does anyone know if the opt out will be confirmed via letter etc.
Edit - Now see in earlier post that others rec'd acknowledgment of opt out via mail.
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Info_Hound »

I received in the mail a 'Welcome' letter on 12/4 to the plan. Problem is, I had chosen to opt out on November 6th via the automated phone process. Called them at an ungodly early hour the next morning to correct the problem. (I do not live on the east coast)

Seems they had not gotten around to sending notices to all the opt outs (I am guessing via the auto option) so the default was a Welcome letter instead. In my records it was noted I had opted out and I should receive opt out notification 'in the next couple of days.'

I hope my surprise was a one off, but keep an eye on the mail.
Soaky
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Soaky »

CharacterCounts wrote: Wed Nov 29, 2023 9:51 pm I have FEPBLUE and opted out of Part D via phone a few weeks ago. Does anyone know if the opt out will be confirmed via letter etc.
Edit - Now see in earlier post that others rec'd acknowledgment of opt out via mail.
Yes, at least I did. I called Nov 17 to opt out and got a letter a couple of weeks later saying they received my request to opt out and processed my request ( their letter was dated the next day - Nov 18).
CharacterCounts
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by CharacterCounts »

I also rec'd a welcome letter after opting out via automated phone method. Subsequently confirmed via phone that I had in fact been opted out. Still haven't rec'd promised letter confirming. Same situation for my wife.
UpperNwGuy
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by UpperNwGuy »

CharacterCounts wrote: Wed Dec 06, 2023 10:02 pm I also rec'd a welcome letter after opting out via automated phone method. Subsequently confirmed via phone that I had in fact been opted out. Still haven't rec'd promised letter confirming. Same situation for my wife.
I opted out using the automated phone method on Nov 7. On Nov 25 I received a letter welcoming me to Part D. I called on Nov 27 and found out that they had no record of me opting out. They let me opt out while talking to the agent. I am worried that my opt out is still not guaranteed and that I might soon be seeing a bill for the Part D IRMAA.

I cannot imagine a more convoluted process for introducing the Part D alternative to BCBS members. Shame on you, BSCS!
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AstroJohn
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by AstroJohn »

Received all my material today, and after a careful reading decided to opt out--IRMAA issue. Automated phone procedure failed. Then went the agent route. She got the information for both me and my DW, but I have zero confidence that it is going through. What a mess!
AnnaMaria
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by AnnaMaria »

We first tried to opt out on the phone. That didn't work so we chose to opt out by filling out the form and mailing it in. My husband received the opt out letter. I received the 'Welcome' to the plan letter. Called today and automated phone procedure failed (R# not recognized and its off hours). I'm mailing and calling tomorrow.
rdamery
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by rdamery »

I am on Medicare and my wife is not (not until 2025). If I opt in to the new plan, will my wife's prescription drug costs still be covered under our BCBS Basic plan. If I do opt out, I assume my prescription drug plan currently in affect with BCBS will still apply?

Thanks for the info!
michaelingp
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by michaelingp »

I see a lot of opt outs here. I decided I'd try MPDP for one year and see, but now I'm wondering. The "benefits" according to BCBS are "lower out of pocket costs for higher cost drugs". I should have paid more attention, since it looks like considerably higher out of pocket costs for lower-cost drugs (which is mostly what I buy). The thing is, most of the time I can't figure out what I'm going to be charged in the old system. For example, for one blood pressure med I take, CVS bills $143.99 for 90 days script, BCBS pays $0, and my OOP is $3.05. That doesn't correspond with any benefit listing. So, I figured the only way to compare with the new system is to try it, keep good records and go back if it makes sense. The problem, of course, is that they may change what there is to go back to. Fortunately, it's not going to break the bank either way.
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tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

michaelingp wrote: Fri Dec 29, 2023 4:28 pm I see a lot of opt outs here. I decided I'd try MPDP for one year and see, but now I'm wondering. The "benefits" according to BCBS are "lower out of pocket costs for higher cost drugs". I should have paid more attention, since it looks like considerably higher out of pocket costs for lower-cost drugs (which is mostly what I buy). The thing is, most of the time I can't figure out what I'm going to be charged in the old system. For example, for one blood pressure med I take, CVS bills $143.99 for 90 days script, BCBS pays $0, and my OOP is $3.05. That doesn't correspond with any benefit listing. So, I figured the only way to compare with the new system is to try it, keep good records and go back if it makes sense. The problem, of course, is that they may change what there is to go back to. Fortunately, it's not going to break the bank either way.
A few things--apparently one can opt out of it at any time during the year and revert to the regular option, and I believe the plan states if the actual cost of the Rx is less than the stated cost sharing amount, one pays the lesser amount. Check brochure Section 5 on Prescriptions for this. Also, their site has a place where one can plug in the med and it will give the cost to pay for the regular plan Rx (Standard, Basic, Focus) AND the Part D option to compare. Very handy.
chalet
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by chalet »

michaelingp wrote: Fri Dec 29, 2023 4:28 pm So, I figured the only way to compare with the new system is to try it,

let us know how the medication management works for you.

https://www.fepblue.org/medicarerx/medication-therapy
Rtdcvlserpent
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Rtdcvlserpent »

chalet wrote: Sun Oct 01, 2023 5:31 pm
HoneyBee wrote: Sun Oct 01, 2023 5:14 pm I have Part B and the FEHB BCBS Basic plan and I am having a hard time figuring out what BCBS is doing and the motive.
the coming Part D changes may have FEHB providers concerned.

a combination of high deductible G medigap and a capped Part D plan...... could be competitive with a BCBS plan.

assuming A and B primary in both cases.
I'm on that "exciting new" MPDP plan through BCBS FEP. My Rx costs so far per have tripled or quadrupled since 01/01/2024. My Trulicity is nearly $70/mo., up from $25/mo.; my wife's Vraylar went from $15/mo. to $64/mo. And my insulin is $52/mo, not the Medicare cap of $35.
Yeah, watching the defibrillator activate when I was at the cash register was "exciting" and "new". I'm on Medicare as primary, and kept my BCBS program when I retired at 55. Now I'm paying 700+/mo. for essentially a BCBS MA program. I'll be going back to the old Rx option.
chalet
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by chalet »

Rtdcvlserpent wrote: Thu Jan 25, 2024 12:30 pm
I'm on that "exciting new" MPDP plan through BCBS FEP.

were there any additional conversations, like with a bcbs pharmacist?
Rtdcvlserpent
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by Rtdcvlserpent »

That will be happening since we've started getting Rxs this year. I asked the BCBS rep prior to the startup and got a few answers, but not price answers. Was told I could switch back easily, though. I was on BCBS MA for a trial period, and was in the hole after the first three months. Went back to my preretirement program then because of the drug costs. [Unnecessary comment removed by moderator oldcomputerguy]
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retiredjg
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by retiredjg »

Rtdcvlserpent wrote: Thu Jan 25, 2024 12:30 pm
chalet wrote: Sun Oct 01, 2023 5:31 pm
HoneyBee wrote: Sun Oct 01, 2023 5:14 pm I have Part B and the FEHB BCBS Basic plan and I am having a hard time figuring out what BCBS is doing and the motive.
the coming Part D changes may have FEHB providers concerned.

a combination of high deductible G medigap and a capped Part D plan...... could be competitive with a BCBS plan.

assuming A and B primary in both cases.
I'm on that "exciting new" MPDP plan through BCBS FEP. My Rx costs so far per have tripled or quadrupled since 01/01/2024. My Trulicity is nearly $70/mo., up from $25/mo.; my wife's Vraylar went from $15/mo. to $64/mo. And my insulin is $52/mo, not the Medicare cap of $35.
Yeah, watching the defibrillator activate when I was at the cash register was "exciting" and "new". I'm on Medicare as primary, and kept my BCBS program when I retired at 55. Now I'm paying 700+/mo. for essentially a BCBS MA program. I'll be going back to the old Rx option.
Did you happen to look up the cost of the drugs before signing on? It is not supposed to work the way you have described so I wonder if there is some mistake. Most Rx's should cost a bit less. Surely there are some exceptions, but 3 out of 3 does not sound like how I expected it to go.

But yes, you can switch to the old way anytime. Or so we read earlier.

Let us know how this works out please. And welcome to the forum. :happy
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tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

Rtdcvlserpent wrote: Thu Jan 25, 2024 12:30 pm
chalet wrote: Sun Oct 01, 2023 5:31 pm
HoneyBee wrote: Sun Oct 01, 2023 5:14 pm I have Part B and the FEHB BCBS Basic plan and I am having a hard time figuring out what BCBS is doing and the motive.
the coming Part D changes may have FEHB providers concerned.

a combination of high deductible G medigap and a capped Part D plan...... could be competitive with a BCBS plan.

assuming A and B primary in both cases.
I'm on that "exciting new" MPDP plan through BCBS FEP. My Rx costs so far per have tripled or quadrupled since 01/01/2024. My Trulicity is nearly $70/mo., up from $25/mo.; my wife's Vraylar went from $15/mo. to $64/mo. And my insulin is $52/mo, not the Medicare cap of $35.
Yeah, watching the defibrillator activate when I was at the cash register was "exciting" and "new". I'm on Medicare as primary, and kept my BCBS program when I retired at 55. Now I'm paying 700+/mo. for essentially a BCBS MA program. I'll be going back to the old Rx option.
The OPM site can redirect one to the BCBS site where one can plug in the particular meds and see the pricing for each med. This is a very useful tool to see what the cost will be for the "regular" plan Rx cost versus the new MPDP cost, 90 days versus 30 days, etc.

If one is on Medicare Part B (make sure the Pharmacy and insurance plan knows), sometimes the Rx is cheaper.

Getting a 90 day/mail order supply is oftentimes cheaper also. This can be a big saver.

Rx costs sometimes change from time to time so the coinsurance/copay does too, and different pharmacies could have a different cost.

Some meds have a way to get help with costs from the maker in certain situations.

Doctors can sometimes prescribe other meds of the same type but this is a personal matter for discussion between anyone and their doctor and we are not allowed to discuss specifics here.
jstat
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by jstat »

I didn't realize this wonderful new plan would result in me being enrolled in Medicare Part D. Where does BC/BS indicate you must be enrolled in Medicare Part D to use the plan? Do they discuss the cost of Medicare part D coverage anywhere? It appeared to be a modified version BC/BS existing drug coverage for the same cost, but seems to actually be a higher cost drug plan with maybe better benefits.

It may be a good plan, but it seems like a con job by BC/BS. Am I missing something?
Topic Author
tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

jstat wrote: Sun Feb 11, 2024 3:18 pm I didn't realize this wonderful new plan would result in me being enrolled in Medicare Part D. Where does BC/BS indicate you must be enrolled in Medicare Part D to use the plan? Do they discuss the cost of Medicare part D coverage anywhere? It appeared to be a modified version BC/BS existing drug coverage for the same cost, but seems to actually be a higher cost drug plan with maybe better benefits.

It may be a good plan, but it seems like a con job by BC/BS. Am I missing something?
The brochure for 2024 states at the beginning of Section 5F that it is Medicare Part D and gives the details about it.

It is not something where one has to enroll themself in Part D, but rather that anyone fitting the Medicare parameters would be automatically enrolled (opted into) the option. Letters were sent out to notify people that this was happening for 2024 and gave the info about opting out if preferred. So, it was something one had to choose to opt out of rather than into, which (opting out) would keep the person in the "regular" Rx option of BCBS.

One major change was the lower yearly out of pocket maximum for those in the new MPDP (Medicare Prescription Drug Plan), i.e., Part D. This could be very helpful in situations requiring costly Specialty meds.

Supposedly one can call BCBS and opt back into the "regular" Rx at any time, but can only reenroll in the Part D option during Open Season.

As far as a cost comparison between the regular option and the new Part D option, there is a tool on the BCBS site which allows one to put in their specific meds and see a cost comparison between Standard, Basic, Focus, and the Part D plan. This could be different for each person depending on their meds, and is well worth doing in my opinion. In our situation, we are no longer on BCBS, but we opted into the Part D option for our plan (Aetna Direct) and most of the meds are cheaper, some free, but a couple my spouse takes are a little more expensive. However, I am glad we are in it, because she now has to use a Specialty med and the yearly max is capped at $2000 out of pocket, which will be met by June. Rx the rest of the year will supposedly then be zero out of pocket. In addition, we are reimbursed $1800 per year from the plan health fund so it made sense to opt in.
tj
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tj »

tallguy3891 wrote: Sun Feb 11, 2024 4:12 pm
jstat wrote: Sun Feb 11, 2024 3:18 pm I didn't realize this wonderful new plan would result in me being enrolled in Medicare Part D. Where does BC/BS indicate you must be enrolled in Medicare Part D to use the plan? Do they discuss the cost of Medicare part D coverage anywhere? It appeared to be a modified version BC/BS existing drug coverage for the same cost, but seems to actually be a higher cost drug plan with maybe better benefits.

It may be a good plan, but it seems like a con job by BC/BS. Am I missing something?
The brochure for 2024 states at the beginning of Section 5F that it is Medicare Part D and gives the details about it.

It is not something where one has to enroll themself in Part D, but rather that anyone fitting the Medicare parameters would be automatically enrolled (opted into) the option. Letters were sent out to notify people that this was happening for 2024 and gave the info about opting out if preferred. So, it was something one had to choose to opt out of rather than into, which (opting out) would keep the person in the "regular" Rx option of BCBS.

One major change was the lower yearly out of pocket maximum for those in the new MPDP (Medicare Prescription Drug Plan), i.e., Part D. This could be very helpful in situations requiring costly Specialty meds.

Supposedly one can call BCBS and opt back into the "regular" Rx at any time, but can only reenroll in the Part D option during Open Season.

As far as a cost comparison between the regular option and the new Part D option, there is a tool on the BCBS site which allows one to put in their specific meds and see a cost comparison between Standard, Basic, Focus, and the Part D plan. This could be different for each person depending on their meds, and is well worth doing in my opinion. In our situation, we are no longer on BCBS, but we opted into the Part D option for our plan (Aetna Direct) and most of the meds are cheaper, some free, but a couple my spouse takes are a little more expensive. However, I am glad we are in it, because she now has to use a Specialty med and the yearly max is capped at $2000 out of pocket, which will be met by June. Rx the rest of the year will supposedly then be zero out of pocket. In addition, we are reimbursed $1800 per year from the plan health fund so it made sense to opt in.
The 2000 max is for both of you combined or 2000 for each person?
jstat
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by jstat »

tallguy3891 wrote: Sun Feb 11, 2024 4:12 pm
jstat wrote: Sun Feb 11, 2024 3:18 pm I didn't realize this wonderful new plan would result in me being enrolled in Medicare Part D. Where does BC/BS indicate you must be enrolled in Medicare Part D to use the plan? Do they discuss the cost of Medicare part D coverage anywhere? It appeared to be a modified version BC/BS existing drug coverage for the same cost, but seems to actually be a higher cost drug plan with maybe better benefits.

It may be a good plan, but it seems like a con job by BC/BS. Am I missing something?
The brochure for 2024 states at the beginning of Section 5F that it is Medicare Part D and gives the details about it.

It is not something where one has to enroll themself in Part D, but rather that anyone fitting the Medicare parameters would be automatically enrolled (opted into) the option. Letters were sent out to notify people that this was happening for 2024 and gave the info about opting out if preferred. So, it was something one had to choose to opt out of rather than into, which (opting out) would keep the person in the "regular" Rx option of BCBS.

One major change was the lower yearly out of pocket maximum for those in the new MPDP (Medicare Prescription Drug Plan), i.e., Part D. This could be very helpful in situations requiring costly Specialty meds.

Supposedly one can call BCBS and opt back into the "regular" Rx at any time, but can only reenroll in the Part D option during Open Season.

As far as a cost comparison between the regular option and the new Part D option, there is a tool on the BCBS site which allows one to put in their specific meds and see a cost comparison between Standard, Basic, Focus, and the Part D plan. This could be different for each person depending on their meds, and is well worth doing in my opinion. In our situation, we are no longer on BCBS, but we opted into the Part D option for our plan (Aetna Direct) and most of the meds are cheaper, some free, but a couple my spouse takes are a little more expensive. However, I am glad we are in it, because she now has to use a Specialty med and the yearly max is capped at $2000 out of pocket, which will be met by June. Rx the rest of the year will supposedly then be zero out of pocket. In addition, we are reimbursed $1800 per year from the plan health fund so it made sense to opt in.
The initial letter dated 11/27/23 only said it was for people on Medicare, and said nothing about automatically being enrolled into part D. It would have been easy to make it clear from the beginning in all communications. Just seems like a crummy way to do business. That said, it may well be good plan for me, just one that has an unexpected additional cost that was obscured (poorly explained? completely hidden?) when first presented..
blueheaven
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by blueheaven »

I was automatically enrolled in this and had it reversed. I am relatively healthy and only have one low cost prescription. The move to medicare part D was going to cost me more each month because it works like part B in that high income medicare recipients are also charged extra for part D.
Last edited by blueheaven on Sun Feb 11, 2024 5:16 pm, edited 1 time in total.
tj
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tj »

jstat wrote: Sun Feb 11, 2024 5:11 pm
tallguy3891 wrote: Sun Feb 11, 2024 4:12 pm
jstat wrote: Sun Feb 11, 2024 3:18 pm I didn't realize this wonderful new plan would result in me being enrolled in Medicare Part D. Where does BC/BS indicate you must be enrolled in Medicare Part D to use the plan? Do they discuss the cost of Medicare part D coverage anywhere? It appeared to be a modified version BC/BS existing drug coverage for the same cost, but seems to actually be a higher cost drug plan with maybe better benefits.

It may be a good plan, but it seems like a con job by BC/BS. Am I missing something?
The brochure for 2024 states at the beginning of Section 5F that it is Medicare Part D and gives the details about it.

It is not something where one has to enroll themself in Part D, but rather that anyone fitting the Medicare parameters would be automatically enrolled (opted into) the option. Letters were sent out to notify people that this was happening for 2024 and gave the info about opting out if preferred. So, it was something one had to choose to opt out of rather than into, which (opting out) would keep the person in the "regular" Rx option of BCBS.

One major change was the lower yearly out of pocket maximum for those in the new MPDP (Medicare Prescription Drug Plan), i.e., Part D. This could be very helpful in situations requiring costly Specialty meds.

Supposedly one can call BCBS and opt back into the "regular" Rx at any time, but can only reenroll in the Part D option during Open Season.

As far as a cost comparison between the regular option and the new Part D option, there is a tool on the BCBS site which allows one to put in their specific meds and see a cost comparison between Standard, Basic, Focus, and the Part D plan. This could be different for each person depending on their meds, and is well worth doing in my opinion. In our situation, we are no longer on BCBS, but we opted into the Part D option for our plan (Aetna Direct) and most of the meds are cheaper, some free, but a couple my spouse takes are a little more expensive. However, I am glad we are in it, because she now has to use a Specialty med and the yearly max is capped at $2000 out of pocket, which will be met by June. Rx the rest of the year will supposedly then be zero out of pocket. In addition, we are reimbursed $1800 per year from the plan health fund so it made sense to opt in.
The initial letter dated 11/27/23 only said it was for people on Medicare, and said nothing about automatically being enrolled into part D. It would have been easy to make it clear from the beginning in all communications. Just seems like a crummy way to do business. That said, it may well be good plan for me, just one that has an unexpected additional cost that was obscured (poorly explained? completely hidden?) when first presented..
It is only for people on medicare, or at least people Medicare age. They aren't going to enroll someone under 65 in it.
Topic Author
tallguy3891
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Re: Big News For Those On FEHB BCBS And Other Plans

Post by tallguy3891 »

tj wrote: Sun Feb 11, 2024 4:28 pm
tallguy3891 wrote: Sun Feb 11, 2024 4:12 pm
jstat wrote: Sun Feb 11, 2024 3:18 pm I didn't realize this wonderful new plan would result in me being enrolled in Medicare Part D. Where does BC/BS indicate you must be enrolled in Medicare Part D to use the plan? Do they discuss the cost of Medicare part D coverage anywhere? It appeared to be a modified version BC/BS existing drug coverage for the same cost, but seems to actually be a higher cost drug plan with maybe better benefits.

It may be a good plan, but it seems like a con job by BC/BS. Am I missing something?
The brochure for 2024 states at the beginning of Section 5F that it is Medicare Part D and gives the details about it.

It is not something where one has to enroll themself in Part D, but rather that anyone fitting the Medicare parameters would be automatically enrolled (opted into) the option. Letters were sent out to notify people that this was happening for 2024 and gave the info about opting out if preferred. So, it was something one had to choose to opt out of rather than into, which (opting out) would keep the person in the "regular" Rx option of BCBS.

One major change was the lower yearly out of pocket maximum for those in the new MPDP (Medicare Prescription Drug Plan), i.e., Part D. This could be very helpful in situations requiring costly Specialty meds.

Supposedly one can call BCBS and opt back into the "regular" Rx at any time, but can only reenroll in the Part D option during Open Season.

As far as a cost comparison between the regular option and the new Part D option, there is a tool on the BCBS site which allows one to put in their specific meds and see a cost comparison between Standard, Basic, Focus, and the Part D plan. This could be different for each person depending on their meds, and is well worth doing in my opinion. In our situation, we are no longer on BCBS, but we opted into the Part D option for our plan (Aetna Direct) and most of the meds are cheaper, some free, but a couple my spouse takes are a little more expensive. However, I am glad we are in it, because she now has to use a Specialty med and the yearly max is capped at $2000 out of pocket, which will be met by June. Rx the rest of the year will supposedly then be zero out of pocket. In addition, we are reimbursed $1800 per year from the plan health fund so it made sense to opt in.
The 2000 max is for both of you combined or 2000 for each person?
$2000 each, but in the regular Rx plan, the catastrophic yearly max is $6000 each as part of the overall max, so a great deal.
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