Which FEHB Plan Did You Choose And Why?

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Topic Author
tallguy3891
Posts: 801
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Re: Which FEHB Plan Did You Choose And Why?

Post by tallguy3891 »

ChrisC wrote: Mon Jun 10, 2024 3:52 pm
tj wrote: Mon Jun 10, 2024 3:24 pm
tallguy3891 wrote: Mon Jun 10, 2024 3:16 pm
44west wrote: Mon Jun 10, 2024 1:00 pm Thanks for the info. Am I correct in understanding that the $1000 per person HRA for retirees would automatically be applied to the first bills owed (or does one pay it and have to request to be reimbursed)? THEN, one has to pay the (currently) remaining $600 of the $1600 deductible out of pocket, then when the deductible is satisfied one pays the 5%?

When you start the HRA ( mine in Feb.) they put 2000.00 family into your account. When the medical provider submits the bill GEHA pays them direct. My 2000.00 HRA was prorated because January they funded my HSA for that month. The unused 2000.00 HRA rolls into the following year providing you stay with them.
Once you use up the 2000.00 HRA you pay full negotiate prices until you meet the 3200.00 family deductible, so 1200.00. After that it’s 5% of negotiated billing.
I can see where it would be an option for some people. The concern I would have with it if not enrolled in Part B would be the same concern I check into with any FEHB plan without also having Part B; that is, "hospital observation care"-- when not officially admitted to a hospital, but they keep a person for a few days. In that case my understanding is the Medicare allowance limits do not apply and the hospital charges what they charge. I have no way to know how much, nor what the plan allowance of any particular FEHB plan would be (?), but I do seem to remember I have seen bills for my spouse for tens of thousands of dollars per day. I would not want to have to pay 5%, or 15%, or 30% of that amount multiple times a year.

That leads me to believe, in our situation, that I would have to assume paying the catastrophic max out of pocket every year. Why would I risk that when I can enroll in Part B, have total wraparound with my FEHB plan, pay zero out of pocket per year, and the current cost for Part B premiums is about one third less for the both of us than just the catastrophic out of pocket for a HDHP for one of us?

So, to me, a HDHP sounds maybe ok for a younger person, still an employee, but using it with Part A only seems risky to me at a retiree age. If anyone reads carefully what I have just said they might understand why I was surprised by Consumers' Checkbook recommending GEHA HDHP as #1 without Part B (but with Part A only) in our area for our situation. If anyone can clarify it for me I would appreciate it.

Some people get hit with massive IRMAA such that paying the deductible + coinsurance is going to be cheaper than paying Part B + IRMAA.
Raises hand. Last 8 years, wife's Part B + IRMAA exceeds any deductible and coinsurance (out-of-pocket) that would have been covered solely by almost any FEHB plan, by a huge factor. I'm not enrolled in Part B so don't have Part B and IRMAA charges -- for this year I hit the catastrophic limit under GEHA standard, plus 1, of $6500 on May 2nd, which is the first time out of 6 years on Medicare (just Part A) that my out-of pocket costs exceeded the amount I would have paid for Part B and IRMAA.

I agree it's risky to use an HDHP with only Part A -- I didn't do it and I thought the coverage under GEHA standard, plus 1, was significantly better than the coverage I previously had under GEHA- HDHP for me with only Part A and for my wife with Part A and B.
Your comment reminds me that there are also apparently people who, even though they will have Part B IRMAA the rest of their lives which will likely exceed the FEHB plan catastrophic out of pocket yearly max, they enroll in Part B anyway. I think I have read a couple times it is less hassle than ever having to pay any copay or coinsurance or deductible out of pocket. Perhaps there are other reasons.
orange96
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Re: Which FEHB Plan Did You Choose And Why?

Post by orange96 »

Almost 50 years with BCBS and presently have BCBS Standard. Been through the routine and the most major of medical situations with spouse. Never a problem and the BCBS FEP customer service is excellent. Walk into a medical provider; show your id card; and have never had a second question about my medical insurance.
ChrisC
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Re: Which FEHB Plan Did You Choose And Why?

Post by ChrisC »

tallguy3891 wrote: Mon Jun 10, 2024 4:50 pm
ChrisC wrote: Mon Jun 10, 2024 3:52 pm
tj wrote: Mon Jun 10, 2024 3:24 pm
tallguy3891 wrote: Mon Jun 10, 2024 3:16 pm
44west wrote: Mon Jun 10, 2024 1:00 pm Thanks for the info. Am I correct in understanding that the $1000 per person HRA for retirees would automatically be applied to the first bills owed (or does one pay it and have to request to be reimbursed)? THEN, one has to pay the (currently) remaining $600 of the $1600 deductible out of pocket, then when the deductible is satisfied one pays the 5%?

When you start the HRA ( mine in Feb.) they put 2000.00 family into your account. When the medical provider submits the bill GEHA pays them direct. My 2000.00 HRA was prorated because January they funded my HSA for that month. The unused 2000.00 HRA rolls into the following year providing you stay with them.
Once you use up the 2000.00 HRA you pay full negotiate prices until you meet the 3200.00 family deductible, so 1200.00. After that it’s 5% of negotiated billing.
I can see where it would be an option for some people. The concern I would have with it if not enrolled in Part B would be the same concern I check into with any FEHB plan without also having Part B; that is, "hospital observation care"-- when not officially admitted to a hospital, but they keep a person for a few days. In that case my understanding is the Medicare allowance limits do not apply and the hospital charges what they charge. I have no way to know how much, nor what the plan allowance of any particular FEHB plan would be (?), but I do seem to remember I have seen bills for my spouse for tens of thousands of dollars per day. I would not want to have to pay 5%, or 15%, or 30% of that amount multiple times a year.

That leads me to believe, in our situation, that I would have to assume paying the catastrophic max out of pocket every year. Why would I risk that when I can enroll in Part B, have total wraparound with my FEHB plan, pay zero out of pocket per year, and the current cost for Part B premiums is about one third less for the both of us than just the catastrophic out of pocket for a HDHP for one of us?

So, to me, a HDHP sounds maybe ok for a younger person, still an employee, but using it with Part A only seems risky to me at a retiree age. If anyone reads carefully what I have just said they might understand why I was surprised by Consumers' Checkbook recommending GEHA HDHP as #1 without Part B (but with Part A only) in our area for our situation. If anyone can clarify it for me I would appreciate it.

Some people get hit with massive IRMAA such that paying the deductible + coinsurance is going to be cheaper than paying Part B + IRMAA.
Raises hand. Last 8 years, wife's Part B + IRMAA exceeds any deductible and coinsurance (out-of-pocket) that would have been covered solely by almost any FEHB plan, by a huge factor. I'm not enrolled in Part B so don't have Part B and IRMAA charges -- for this year I hit the catastrophic limit under GEHA standard, plus 1, of $6500 on May 2nd, which is the first time out of 6 years on Medicare (just Part A) that my out-of pocket costs exceeded the amount I would have paid for Part B and IRMAA.

I agree it's risky to use an HDHP with only Part A -- I didn't do it and I thought the coverage under GEHA standard, plus 1, was significantly better than the coverage I previously had under GEHA- HDHP for me with only Part A and for my wife with Part A and B.
Your comment reminds me that there are also apparently people who, even though they will have Part B IRMAA the rest of their lives which will likely exceed the FEHB plan catastrophic out of pocket yearly max, they enroll in Part B anyway. I think I have read a couple times it is less hassle than ever having to pay any copay or coinsurance or deductible out of pocket. Perhaps there are other reasons.
I can live with the deductible, co-pays and co-insurance — not much of a hassle; you get the EOB and provider’s billing statement and pay. My wife is second guessing paying Part B IRMAA and its coverage for her when GEHA standard only coverage would spare us from IRMAA tier 3 or 4 expense likely to occur for the rest of her life.
44west
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Re: Which FEHB Plan Did You Choose And Why?

Post by 44west »

tallguy3891 wrote: Mon Jun 10, 2024 3:16 pm
44west wrote: Mon Jun 10, 2024 1:00 pm Thanks for the info. Am I correct in understanding that the $1000 per person HRA for retirees would automatically be applied to the first bills owed (or does one pay it and have to request to be reimbursed)? THEN, one has to pay the (currently) remaining $600 of the $1600 deductible out of pocket, then when the deductible is satisfied one pays the 5%?

When you start the HRA ( mine in Feb.) they put 2000.00 family into your account. When the medical provider submits the bill GEHA pays them direct. My 2000.00 HRA was prorated because January they funded my HSA for that month. The unused 2000.00 HRA rolls into the following year providing you stay with them.
Once you use up the 2000.00 HRA you pay full negotiate prices until you meet the 3200.00 family deductible, so 1200.00. After that it’s 5% of negotiated billing.
I can see where it would be an option for some people. The concern I would have with it if not enrolled in Part B would be the same concern I check into with any FEHB plan without also having Part B; that is, "hospital observation care"-- when not officially admitted to a hospital, but they keep a person for a few days. In that case my understanding is the Medicare allowance limits do not apply and the hospital charges what they charge. I have no way to know how much, nor what the plan allowance of any particular FEHB plan would be (?), but I do seem to remember I have seen bills for my spouse for tens of thousands of dollars per day. I would not want to have to pay 5%, or 15%, or 30% of that amount multiple times a year.

That leads me to believe, in our situation, that I would have to assume paying the catastrophic max out of pocket every year. Why would I risk that when I can enroll in Part B, have total wraparound with my FEHB plan, pay zero out of pocket per year, and the current cost for Part B premiums is about one third less for the both of us than just the catastrophic out of pocket for a HDHP for one of us?

So, to me, a HDHP sounds maybe ok for a younger person, still an employee, but using it with Part A only seems risky to me at a retiree age. If anyone reads carefully what I have just said they might understand why I was surprised by Consumers' Checkbook recommending GEHA HDHP as #1 without Part B (but with Part A only) in our area for our situation. If anyone can clarify it for me I would appreciate it.
The hospital observation care that may or may not be covered under the Medicare negotiated pricing whether you have part A or B would still have Geha negotiated pricing with participating facilities/ practitioners which after the deductible is 5% copays. Also my understanding is every open season you can change your plan. I’m not suggesting you do this plan, as we all know everyone has different circumstances. I kept the plan because I’m in a 65 year old transition season and wanted to see how it works.
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TimeRunner
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Re: Which FEHB Plan Did You Choose And Why?

Post by TimeRunner »

I have Part A & B. Spouse not old enough yet for Medicare. We have Self+1 GEHA Standard, which also provides EyeMed vision care coverage. We have BCBS Dental. IRMAA bites, NIIT bites, Roth conversion tax bites - all First World Problems. Happy to have great coverage, no pre-approvals for Medicare approved treatments, no copays or deductibles, no billing hassles. 8-)
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Topic Author
tallguy3891
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Re: Which FEHB Plan Did You Choose And Why?

Post by tallguy3891 »

So many ways to look at this topic of FEHB, whether as an employee or as a retiree, with or without Medicare Part B. I consider it a true blessing to have so many options.
Jeepguy
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Re: Which FEHB Plan Did You Choose And Why?

Post by Jeepguy »

BCBS basic. Have no regrets, not retired yet
Topic Author
tallguy3891
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Re: Which FEHB Plan Did You Choose And Why?

Post by tallguy3891 »

Jeepguy wrote: Mon Jun 10, 2024 7:20 pm BCBS basic. Have no regrets, not retired yet
I decided against Basic in part because it -- at least currently-- offers zero Skilled Nursing/Rehab Facility days (SNF). Without any Medicare that would be out of pocket. A month in a rehab due to an accident could possibly be $12000 out of pocket. I had Basic for a year at one point. Where I live I could have had NALC High for a cheaper premium and had a decent number, in my opinion, of SNF days. All our providers were in-network. And yep, people do NOT have to be postal workers/retirees to use NALC.
MichDad
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Re: Which FEHB Plan Did You Choose And Why?

Post by MichDad »

For the last few years before I retired (in 2018), my wife and I were enrolled in the GEHA HDHP. We invested the maximum amounts into our respective HSAs and haven't yet touched them. At present, our combined HSA balances are >$50,000 and are invested in Fidelity's zero expense US and international equities index funds. I maintain very detailed records of our healthcare expenditures (including dental, prescriptions, devices, and OTC purchases).

In retirement, I enrolled us into the GEHA standard option plan (self + one). We're both over age 65 and have both opted out of Medicare Part B -- in large part because we're making substantial Roth conversions each year and because we live overseas six months each year and therefore are ineligible for Medicare coverage while outside the USA.

Medical and dental expenses are far lower in Europe than in the USA. In addition, we've both found that the quality of dental care here is higher than what we've experienced in the USA.

MichDad
FrugalFed
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Re: Which FEHB Plan Did You Choose And Why?

Post by FrugalFed »

We live down the street from a Kaiser facility, so we've done Kaiser Standard for a long time. It's been great, especially for a family with small children. To have an urgent care nearby you can always get into, or to have the lab downstairs from the doctor's office, is great.

As our kids get older and medical needs for them become mostly annual physicals, we'll probably make the move to HDHP Land like others.
MnD
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Re: Which FEHB Plan Did You Choose And Why?

Post by MnD »

GEHA Standard for decades out of laziness, familiarity and because it always seem to rate fairly highly in the various comparison tools.
And even in a tiny few bad medical years we have not had really big out-of-pocket. A bad medical year is bad enough without that.

I guess if I had a do-over I would have switched to GEHA HDHP when it first came out but oh well......

The only thing that bugs me about GEHA is preauthorizations and sometimes denials which are (in my case) always approved after further expenditures of time and effort by providers and/or myself. I think they just deny things in the hope you won't bother to follow up to get your needed care.
I can't wait for Medicare A&B being primary - mainly for that reason.
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stan1
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Re: Which FEHB Plan Did You Choose And Why?

Post by stan1 »

MnD wrote: Tue Jun 11, 2024 8:20 am The only thing that bugs me about GEHA is preauthorizations and sometimes denials which are (in my case) always approved after further expenditures of time and effort by providers and/or myself. I think they just deny things in the hope you won't bother to follow up to get your needed care.
I can't wait for Medicare A&B being primary - mainly for that reason.
Interesting, and that's what I've never experienced with BCBS. GEHA contracts through UnitedHealthcare.
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Re: Which FEHB Plan Did You Choose And Why?

Post by MnD »

stan1 wrote: Tue Jun 11, 2024 8:31 am
MnD wrote: Tue Jun 11, 2024 8:20 am The only thing that bugs me about GEHA is preauthorizations and sometimes denials which are (in my case) always approved after further expenditures of time and effort by providers and/or myself. I think they just deny things in the hope you won't bother to follow up to get your needed care.
I can't wait for Medicare A&B being primary - mainly for that reason.
Interesting, and that's what I've never experienced with BCBS. GEHA contracts through UnitedHealthcare.
In the FEHB Checkbook they had a table that indicated GEHA has a much higher rate of denials and a much higher rate of reversal of denials than BCBS. So basically they deny more often for things that BCBS approves and then end up approving a lot of the excess denials.

The reversal rate for BCBS denials was much lower which makes sense if they are only denying things that should be denied.
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keystone
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Re: Which FEHB Plan Did You Choose And Why?

Post by keystone »

MnD wrote: Tue Jun 11, 2024 8:20 am
The only thing that bugs me about GEHA is preauthorizations and sometimes denials which are (in my case) always approved after further expenditures of time and effort by providers and/or myself. I think they just deny things in the hope you won't bother to follow up to get your needed care.
I can't wait for Medicare A&B being primary - mainly for that reason.
Interesting, I had a terrible experience last year with GEHA denying an MRI after the fact. It didn't occur to me that this was a thing with GEHA. I had a doctor's order and the MRI provider informed me prior to the appointment that it was authorized by GEHA. Then after the fact I received a denial notice from GEHA's 3rd party eviCore who handles the preauthorizations. I provided all kinds of documentation after the fact and requested an appeal and could not get anywhere. I eventually just gave up since I was still well under my deductible, but it was a bad experience all around. Now I make sure I get a copy of the preauthorization in hand prior to any type of testing.
MnD
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Re: Which FEHB Plan Did You Choose And Why?

Post by MnD »

keystone wrote: Tue Jun 11, 2024 9:23 am
MnD wrote: Tue Jun 11, 2024 8:20 am
The only thing that bugs me about GEHA is preauthorizations and sometimes denials which are (in my case) always approved after further expenditures of time and effort by providers and/or myself. I think they just deny things in the hope you won't bother to follow up to get your needed care.
I can't wait for Medicare A&B being primary - mainly for that reason.
Interesting, I had a terrible experience last year with GEHA denying an MRI after the fact. It didn't occur to me that this was a thing with GEHA. I had a doctor's order and the MRI provider informed me prior to the appointment that it was authorized by GEHA. Then after the fact I received a denial notice from GEHA's 3rd party eviCore who handles the preauthorizations. I provided all kinds of documentation after the fact and requested an appeal and could not get anywhere. I eventually just gave up since I was still well under my deductible, but it was a bad experience all around. Now I make sure I get a copy of the preauthorization in hand prior to any type of testing.
The large majority of my GEHA denials are imaging and other services preauthorized through Evicore. They are the absolute worst.
Four years ago they denied a routine Cologuard screening claim after-the-fact because they classified it as "genetic testing" which should have been preauthorized. Approved after numerous attempts. I'm sure they hoped I just paid it. I'm also sure they are incentivized to deny everything possible.
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delamer
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Re: Which FEHB Plan Did You Choose And Why?

Post by delamer »

MnD wrote: Tue Jun 11, 2024 8:20 am GEHA Standard for decades out of laziness, familiarity and because it always seem to rate fairly highly in the various comparison tools.
And even in a tiny few bad medical years we have not had really big out-of-pocket. A bad medical year is bad enough without that.

I guess if I had a do-over I would have switched to GEHA HDHP when it first came out but oh well......

The only thing that bugs me about GEHA is preauthorizations and sometimes denials which are (in my case) always approved after further expenditures of time and effort by providers and/or myself. I think they just deny things in the hope you won't bother to follow up to get your needed care.
I can't wait for Medicare A&B being primary - mainly for that reason.
We have GEHA standard for many years also, and we’ve only had one initial denial. They wanted me to try a less expensive osteoporosis treatment than my doctor recommended. My understanding is that they will approve the recommended treatment if the less expensive one is not effective.

(Post-65, but no Part B.)

So no complaints here. We’ve been fortunate in that while we both have a couple chronic conditions, they’ve been manageable cost-wise and controllable through medication.
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44west
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Re: Which FEHB Plan Did You Choose And Why?

Post by 44west »

ChrisC wrote: Mon Jun 10, 2024 3:52 pm
tj wrote: Mon Jun 10, 2024 3:24 pm
tallguy3891 wrote: Mon Jun 10, 2024 3:16 pm
44west wrote: Mon Jun 10, 2024 1:00 pm Thanks for the info. Am I correct in understanding that the $1000 per person HRA for retirees would automatically be applied to the first bills owed (or does one pay it and have to request to be reimbursed)? THEN, one has to pay the (currently) remaining $600 of the $1600 deductible out of pocket, then when the deductible is satisfied one pays the 5%?

When you start the HRA ( mine in Feb.) they put 2000.00 family into your account. When the medical provider submits the bill GEHA pays them direct. My 2000.00 HRA was prorated because January they funded my HSA for that month. The unused 2000.00 HRA rolls into the following year providing you stay with them.
Once you use up the 2000.00 HRA you pay full negotiate prices until you meet the 3200.00 family deductible, so 1200.00. After that it’s 5% of negotiated billing.
I can see where it would be an option for some people. The concern I would have with it if not enrolled in Part B would be the same concern I check into with any FEHB plan without also having Part B; that is, "hospital observation care"-- when not officially admitted to a hospital, but they keep a person for a few days. In that case my understanding is the Medicare allowance limits do not apply and the hospital charges what they charge. I have no way to know how much, nor what the plan allowance of any particular FEHB plan would be (?), but I do seem to remember I have seen bills for my spouse for tens of thousands of dollars per day. I would not want to have to pay 5%, or 15%, or 30% of that amount multiple times a year.

That leads me to believe, in our situation, that I would have to assume paying the catastrophic max out of pocket every year. Why would I risk that when I can enroll in Part B, have total wraparound with my FEHB plan, pay zero out of pocket per year, and the current cost for Part B premiums is about one third less for the both of us than just the catastrophic out of pocket for a HDHP for one of us?

So, to me, a HDHP sounds maybe ok for a younger person, still an employee, but using it with Part A only seems risky to me at a retiree age. If anyone reads carefully what I have just said they might understand why I was surprised by Consumers' Checkbook recommending GEHA HDHP as #1 without Part B (but with Part A only) in our area for our situation. If anyone can clarify it for me I would appreciate it.

Some people get hit with massive IRMAA such that paying the deductible + coinsurance is going to be cheaper than paying Part B + IRMAA.
Raises hand. Last 8 years, wife's Part B + IRMAA exceeds any deductible and coinsurance (out-of-pocket) that would have been covered solely by almost any FEHB plan, by a huge factor. I'm not enrolled in Part B so don't have Part B and IRMAA charges -- for this year I hit the catastrophic limit under GEHA standard, plus 1, of $6500 on May 2nd, which is the first time out of 6 years on Medicare (just Part A) that my out-of pocket costs exceeded the amount I would have paid for Part B and IRMAA.

I agree it's risky to use an HDHP with only Part A -- I didn't do it and I thought the coverage under GEHA standard, plus 1, was significantly better than the coverage I previously had under GEHA- HDHP for me with only Part A and for my wife with Part A and B.
I’m interested to know how the Geha HDHP is more risky than the Geha Standard plan while under Medicare. This is the first year (age 65) that I signed up for part A only and my wife will sign up for both Medicare A and B while under the Geha HDHP plan that is HRA driven. Im a long term GEHA HDHP plan holder that will have an HRA this year and didn’t see anything in the FEHB plans that was drastically better so I’m giving it a test run.
Geha HDHP catastrophic 6000.00
Geha HRA contribution -2000.00.
Net out of pocket max. 400000.
This pan is about 6.00 more per month.
After deductible for in network 5% my cost

Geha Standard catastrophic 6500.00
Geha Standard contribution ? O
Net out of pocket 6500.00
After deductible for in network 15% cost to enrolled other than physicians copays.

I haven’t looked thoroughly at the plans so maybe the HDHP doesn’t cover something that standard does? Both plans at 65 gets the medicare physicians negotiated prices as long as you go to a Medicare provider whether or not if you sign up for Medicare. Hospital the same.
stan1
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Re: Which FEHB Plan Did You Choose And Why?

Post by stan1 »

keystone wrote: Tue Jun 11, 2024 9:23 am GEHA's 3rd party eviCore who handles the preauthorizations.
What a horrible name, as in "Evil to the Core". I guess its appropriate for bureaucracy set up to deny claims hoping people don't follow up.
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Re: Which FEHB Plan Did You Choose And Why?

Post by 44west »

delamer wrote: Tue Jun 11, 2024 10:25 am
MnD wrote: Tue Jun 11, 2024 8:20 am GEHA Standard for decades out of laziness, familiarity and because it always seem to rate fairly highly in the various comparison tools.
And even in a tiny few bad medical years we have not had really big out-of-pocket. A bad medical year is bad enough without that.

I guess if I had a do-over I would have switched to GEHA HDHP when it first came out but oh well......

The only thing that bugs me about GEHA is preauthorizations and sometimes denials which are (in my case) always approved after further expenditures of time and effort by providers and/or myself. I think they just deny things in the hope you won't bother to follow up to get your needed care.
I can't wait for Medicare A&B being primary - mainly for that reason.
We have GEHA standard for many years also, and we’ve only had one initial denial. They wanted me to try a less expensive osteoporosis treatment than my doctor recommended. My understanding is that they will approve the recommended treatment if the less expensive one is not effective.

(Post-65, but no Part B.)

So no complaints here. We’ve been fortunate in that while we both have a couple chronic conditions, they’ve been manageable cost-wise and controllable through medication.
I’ve been with GEHA HDHP many years and haven’t had any denials for services or testing. I try my best to make sure I follow the plan guidelines so I don’t run into trouble. Physicians offices usually get the pre authorization if one is needed and if it’s a costly procedure I double check with them to make sure it was done
MnD
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Re: Which FEHB Plan Did You Choose And Why?

Post by MnD »

stan1 wrote: Tue Jun 11, 2024 10:52 am
keystone wrote: Tue Jun 11, 2024 9:23 am GEHA's 3rd party eviCore who handles the preauthorizations.
What a horrible name, as in "Evil to the Core". I guess its appropriate for bureaucracy set up to deny claims hoping people don't follow up.
Evicore is owned by Express Scripts which is owned by Cigna.
If you follow the money a lot of companies making decisions on whether or not you can actually use your health insurance to pay for medical expenses are owned by private for-profit health insurance companies. No conflict of interest there.
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ChrisC
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Re: Which FEHB Plan Did You Choose And Why?

Post by ChrisC »

44west wrote: Tue Jun 11, 2024 10:34 am
ChrisC wrote: Mon Jun 10, 2024 3:52 pm
tj wrote: Mon Jun 10, 2024 3:24 pm
tallguy3891 wrote: Mon Jun 10, 2024 3:16 pm
44west wrote: Mon Jun 10, 2024 1:00 pm Thanks for the info. Am I correct in understanding that the $1000 per person HRA for retirees would automatically be applied to the first bills owed (or does one pay it and have to request to be reimbursed)? THEN, one has to pay the (currently) remaining $600 of the $1600 deductible out of pocket, then when the deductible is satisfied one pays the 5%?

When you start the HRA ( mine in Feb.) they put 2000.00 family into your account. When the medical provider submits the bill GEHA pays them direct. My 2000.00 HRA was prorated because January they funded my HSA for that month. The unused 2000.00 HRA rolls into the following year providing you stay with them.
Once you use up the 2000.00 HRA you pay full negotiate prices until you meet the 3200.00 family deductible, so 1200.00. After that it’s 5% of negotiated billing.
I can see where it would be an option for some people. The concern I would have with it if not enrolled in Part B would be the same concern I check into with any FEHB plan without also having Part B; that is, "hospital observation care"-- when not officially admitted to a hospital, but they keep a person for a few days. In that case my understanding is the Medicare allowance limits do not apply and the hospital charges what they charge. I have no way to know how much, nor what the plan allowance of any particular FEHB plan would be (?), but I do seem to remember I have seen bills for my spouse for tens of thousands of dollars per day. I would not want to have to pay 5%, or 15%, or 30% of that amount multiple times a year.

That leads me to believe, in our situation, that I would have to assume paying the catastrophic max out of pocket every year. Why would I risk that when I can enroll in Part B, have total wraparound with my FEHB plan, pay zero out of pocket per year, and the current cost for Part B premiums is about one third less for the both of us than just the catastrophic out of pocket for a HDHP for one of us?

So, to me, a HDHP sounds maybe ok for a younger person, still an employee, but using it with Part A only seems risky to me at a retiree age. If anyone reads carefully what I have just said they might understand why I was surprised by Consumers' Checkbook recommending GEHA HDHP as #1 without Part B (but with Part A only) in our area for our situation. If anyone can clarify it for me I would appreciate it.

Some people get hit with massive IRMAA such that paying the deductible + coinsurance is going to be cheaper than paying Part B + IRMAA.
Raises hand. Last 8 years, wife's Part B + IRMAA exceeds any deductible and coinsurance (out-of-pocket) that would have been covered solely by almost any FEHB plan, by a huge factor. I'm not enrolled in Part B so don't have Part B and IRMAA charges -- for this year I hit the catastrophic limit under GEHA standard, plus 1, of $6500 on May 2nd, which is the first time out of 6 years on Medicare (just Part A) that my out-of pocket costs exceeded the amount I would have paid for Part B and IRMAA.

I agree it's risky to use an HDHP with only Part A -- I didn't do it and I thought the coverage under GEHA standard, plus 1, was significantly better than the coverage I previously had under GEHA- HDHP for me with only Part A and for my wife with Part A and B.
I’m interested to know how the Geha HDHP is more risky than the Geha Standard plan while under Medicare. This is the first year (age 65) that I signed up for part A only and my wife will sign up for both Medicare A and B while under the Geha HDHP plan that is HRA driven. Im a long term GEHA HDHP plan holder that will have an HRA this year and didn’t see anything in the FEHB plans that was drastically better so I’m giving it a test run.
Geha HDHP catastrophic 6000.00
Geha HRA contribution -2000.00.
Net out of pocket max. 400000.
This pan is about 6.00 more per month.
After deductible for in network 5% my cost

Geha Standard catastrophic 6500.00
Geha Standard contribution ? O
Net out of pocket 6500.00
After deductible for in network 15% cost to enrolled other than physicians copays.

I haven’t looked thoroughly at the plans so maybe the HDHP doesn’t cover something that standard does? Both plans at 65 gets the medicare physicians negotiated prices as long as you go to a Medicare provider whether or not if you sign up for Medicare. Hospital the same.
It's been several years since I looked into this, but I can tell you that with my spouse having Medicare Parts A and B, our coverage under GEHA-HDHP did not operate like a traditional supplemental medical insurance plan, so that co-pays, deductibles, etc under Medicare Part B, for example, were not waived or picked up by the HDHP -- so the coordination of benefits was a bit lacking. With GEHA-Standard, all of her Medicare co-pays, deductibles are picked up by GEHA standard, regardless of whether she meets any deductibles or co-pays under GEHA standard. Moreover, the deductible for each person under GEHA standard is $350 but it's $1600 under the HDHP. One big ticket item for us was coverage for hearing aids -- I have had two sets of hearing aids since retirement. GEHA-HDHP doesn't provide any benefits, while GEHA-Standard with its affiliation with TruHearing provides for a $2500 benefit allowance every 3 years for hearing aids, which I've used twice! https://www.geha.com/savings/hearing-aid-discounts

There is also a big difference on coverage of some specialty drug; maximum payment of $250 or $400 for some drugs under GEHA standard; whereas, it's 25% or 40% on some drugs under the HDHP.
engineerbme
Posts: 94
Joined: Tue Jun 04, 2019 10:12 am

Re: Which FEHB Plan Did You Choose And Why?

Post by engineerbme »

so many people praising GEHA but no one talking about how bad United Healthcare is on the backend with processing claims and customer service; absolutely terrible dealing with delayed claims, and vague EOBs that make no sense what the provider charged besides MEDICAL or LAB; extremely vague

meanwhile with MHBP Standard and AETNA at least everything is transparent and pricing and detailed EOBs help; Customer Service with MHBP is fantastic as well and although GEHA was OK they were slow

oh and when change healthcare was hacked; GEHA basically lost access to all EOBs on their site; in fact to this day I still cannot view any past EOBs because of the cyber attack; no issues with Aetna now though...
UpperNwGuy
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Re: Which FEHB Plan Did You Choose And Why?

Post by UpperNwGuy »

If GEHA is just a front-end for United Healthcare, then what's the point of even having GEHA?
engineerbme
Posts: 94
Joined: Tue Jun 04, 2019 10:12 am

Re: Which FEHB Plan Did You Choose And Why?

Post by engineerbme »

UpperNwGuy wrote: Tue Jun 11, 2024 5:07 pm If GEHA is just a front-end for United Healthcare, then what's the point of even having GEHA?
prob cheaper premium vs UHC outright and also you get GEHA basic dental and vision benefits...
MnD
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Re: Which FEHB Plan Did You Choose And Why?

Post by MnD »

UpperNwGuy wrote: Tue Jun 11, 2024 5:07 pm If GEHA is just a front-end for United Healthcare, then what's the point of even having GEHA?
They do compete their networks periodically and for several states including mine in 2023, my network was AETNA.
It didn't seem any better or worse than United Healthcare.
But all our doctors continued to bill United Healthcare for most of 2023 despite having my new card and network information.
I think it was hard-coded into their billing systems.
They got it changed to AETNA just in time for GEHA to switch back to United.

But that's still a good question. I guess GEHA knows how to work the Federal health system and they just contract out the real work.
And don't forget GEHA stadium in Kansas City. That adds a lot of value for my premium dollars. :annoyed
70/30 AA for life, Global market cap equity. Rebalance if fixed income <25% or >35%. Weighted ER< .10%. 5% of annual portfolio balance SWR, Proportional (to AA) withdrawals.
tj
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Re: Which FEHB Plan Did You Choose And Why?

Post by tj »

engineerbme wrote: Tue Jun 11, 2024 4:18 pm so many people praising GEHA but no one talking about how bad United Healthcare is on the backend with processing claims and customer service; absolutely terrible dealing with delayed claims, and vague EOBs that make no sense what the provider charged besides MEDICAL or LAB; extremely vague

meanwhile with MHBP Standard and AETNA at least everything is transparent and pricing and detailed EOBs help; Customer Service with MHBP is fantastic as well and although GEHA was OK they were slow

oh and when change healthcare was hacked; GEHA basically lost access to all EOBs on their site; in fact to this day I still cannot view any past EOBs because of the cyber attack; no issues with Aetna now though...
The GEHA EOBs were just as generic when they were using Aetna

I've had no issues with GEHA, other than when medical providers send claims to the wrong address.
UpperNwGuy
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Re: Which FEHB Plan Did You Choose And Why?

Post by UpperNwGuy »

The more I learn about GEHA the happier I am to have been with Blue Cross Blue Shield for the last 50 years.
tj
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Re: Which FEHB Plan Did You Choose And Why?

Post by tj »

UpperNwGuy wrote: Tue Jun 11, 2024 5:07 pm If GEHA is just a front-end for United Healthcare, then what's the point of even having GEHA?
The UHC HDHP is not as attractive. It's also a POS, not A PPO, IIRC.
44west
Posts: 35
Joined: Wed Dec 28, 2011 8:02 pm
Location: New Jersey

Re: Which FEHB Plan Did You Choose And Why?

Post by 44west »

As a member of Geha I experienced the United Health care issue early this year when they switched from Aetna in my state and I’m hoping that was just a blip. Everything appears to be working now but I will be keepimg an eye on how this relationship plays out with United going forward.
delamer
Posts: 17791
Joined: Tue Feb 08, 2011 5:13 pm

Re: Which FEHB Plan Did You Choose And Why?

Post by delamer »

engineerbme wrote: Tue Jun 11, 2024 4:18 pm so many people praising GEHA but no one talking about how bad United Healthcare is on the backend with processing claims and customer service; absolutely terrible dealing with delayed claims, and vague EOBs that make no sense what the provider charged besides MEDICAL or LAB; extremely vague

meanwhile with MHBP Standard and AETNA at least everything is transparent and pricing and detailed EOBs help; Customer Service with MHBP is fantastic as well and although GEHA was OK they were slow

oh and when change healthcare was hacked; GEHA basically lost access to all EOBs on their site; in fact to this day I still cannot view any past EOBs because of the cyber attack; no issues with Aetna now though...
All anyone can post is their own experience with GEHA (or other insurers). You may have had problems with their backend processing and service, but I have not. However, I am now getting copies of EOBs by mail that I used to get electronically.

We are all sharing information about various insurers. Other posters will draw their conclusions as to what to take into account.

EDIT: i did not understand that the cyberattack issues were unresolved, in terms of current service. Here’s what GEHA has to say on the matter: https://www.geha.com/en/change-healthcare
Last edited by delamer on Tue Jun 11, 2024 6:03 pm, edited 3 times in total.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
Trapper
Posts: 301
Joined: Sat Oct 04, 2014 8:38 am

Re: Which FEHB Plan Did You Choose And Why?

Post by Trapper »

I have GEHA high deductible and have been happy until this year.
This year has been a disaster. There website has been down for 6 months, customer service has no visibility for member EOB’s. I have just recently received four (duplicate) EOB’s for medical care I received in mid March that shows GEHA paid nothing and customer service says they paid their portion. Unfortunately for me, GEHA has never sent me this EOB and there is no way to see on their website.
Never would have thought this issue would still be a problem after six months.
Maybe they should have spent some of the premiums on IT security rather than a football stadium.
Glad we have the opportunity to change plans every year.
delamer
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Re: Which FEHB Plan Did You Choose And Why?

Post by delamer »

Trapper wrote: Tue Jun 11, 2024 5:50 pm I have GEHA high deductible and have been happy until this year.
This year has been a disaster. There website has been down for 6 months, customer service has no visibility for member EOB’s. I have just recently received four (duplicate) EOB’s for medical care I received in mid March that shows GEHA paid nothing and customer service says they paid their portion. Unfortunately for me, GEHA has never sent me this EOB and there is no way to see on their website.
Never would have thought this issue would still be a problem after six months.
Maybe they should have spent some of the premiums on IT security rather than a football stadium.
Glad we have the opportunity to change plans every year.
Well, I assume this explains why I’ve recently started getting EOBs by mail instead of electronically as previously.

I’m not aware of any problems with my providers receiving their payments though.

Despite my overall satisfaction with GEHA, it is very unsettling to hear that 6 months has gone by with no resolution.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
K2Retire
Posts: 5
Joined: Mon Feb 12, 2024 6:48 pm

Re: Which FEHB Plan Did You Choose And Why?

Post by K2Retire »

Someone mentioned that the GEHA EOB is not very detailed. It's the same for BCBS. Are there any FEHB plans that actually tell you what specific services (billing codes) are being processed? I try to stay on top of my claims and eyeball them for accuracy, but without codes it's pretty difficult. It also doesn't make much sense that they say they promote transparency by allowing you to look up estimated procedure prices, but the claims I see are always wildly off in either direction.
RJC
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Re: Which FEHB Plan Did You Choose And Why?

Post by RJC »

In light of all these issues, would CareFirst BlueChoice HDHP be a better option than GEHA HDHP?

If so, I may switch this year.
mbres60
Posts: 1324
Joined: Tue Jul 03, 2007 1:47 pm

Re: Which FEHB Plan Did You Choose And Why?

Post by mbres60 »

K2Retire wrote: Tue Jun 11, 2024 7:32 pm Someone mentioned that the GEHA EOB is not very detailed. It's the same for BCBS. Are there any FEHB plans that actually tell you what specific services (billing codes) are being processed? I try to stay on top of my claims and eyeball them for accuracy, but without codes it's pretty difficult. It also doesn't make much sense that they say they promote transparency by allowing you to look up estimated procedure prices, but the claims I see are always wildly off in either direction.
I’m pretty sure I see billing codes on my Aetna Direct EOB.
engineerbme
Posts: 94
Joined: Tue Jun 04, 2019 10:12 am

Re: Which FEHB Plan Did You Choose And Why?

Post by engineerbme »

K2Retire wrote: Tue Jun 11, 2024 7:32 pm Someone mentioned that the GEHA EOB is not very detailed. It's the same for BCBS. Are there any FEHB plans that actually tell you what specific services (billing codes) are being processed? I try to stay on top of my claims and eyeball them for accuracy, but without codes it's pretty difficult. It also doesn't make much sense that they say they promote transparency by allowing you to look up estimated procedure prices, but the claims I see are always wildly off in either direction.
Yes Aetna provides cpt codes and description of the line item being billed on all EOBs and claims
Topic Author
tallguy3891
Posts: 801
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Re: Which FEHB Plan Did You Choose And Why?

Post by tallguy3891 »

RJC wrote: Tue Jun 11, 2024 8:22 pm In light of all these issues, would CareFirst BlueChoice HDHP be a better option than GEHA HDHP?

If so, I may switch this year.
Are you referring to the one in the D.C. area? If so, I did a quick look at the brochure and it looked to me like (as of 2024) the HSA amount was less than GEHA HDHP, the catastrophic max was less, the deductible the same, but the premium was higher, it appeared to have copays and coinsurances which were maybe higher than GEHA. GEHA HDHP 5% share seems very nice. However, everyone has different needs, providers, and Rx needs so my opinion is to compare the two brochures very carefully. Of course, all these things can change from year to year so looking at details yearly seems like a good idea.

Others have GEHA HDHP so they probably could see things in the plans I do not.

Consumers' Checkbook is a site which gives a lot of detailed info regarding choices and comparisons. When I looked at it, it showed GEHA HDHP higher on the list than the other plan.
Trapper
Posts: 301
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Re: Which FEHB Plan Did You Choose And Why?

Post by Trapper »

Delamer wrote, "I’m not aware of any problems with my providers receiving their payments though." regarding GEHA high deductable.
The issue with me is my health care provider sending multiple requests for payment to GEHA which are being denied. If they had been paid, why the multiple requests? GEHA said they paid, but there is no EOB accessible showing that. How am I as a policy holder determine where the issue is? The reality is I can't right now because GEHA has allowed this known issue to fester for six months.
How much of this issue is related to their changeover to United Healthcare? Us policy holders are being left in the dark with only platitudes from low level GEHA employees who can't help. One would think GEHA would want to get ahead of this continuing problem. Having customer service tell me that GEHA has been hacked and trying to tell me the problem is the hackers is really ignorant.
MichDad
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Re: Which FEHB Plan Did You Choose And Why?

Post by MichDad »

A couple of years ago, our USA dentist told my wife she needed a crown on a particular tooth. She held off a few weeks and visited another dentist in Europe who made the same recommendation. The European dentist performed the work for about half the price of the USA dentist.

We’ve got GEHA high option dental insurance. We submitted the claim to GEHA. GEHA dental denied the claim stating that the tooth in question couldn’t support a crown. We appealed the decision within GEHA and our appeal was denied. I then, for the first time ever, filed a second appeal, this time to the independent group that handles such appeals. Just to tweak GEHA, I began that appeal with a narrative about how GEHA was spending its insureds’ money on the Kansas City football team’s stadium.

Our second appeal was granted and my wife received reimbursement as per our insurance agreement.

MichDad
GmanJeff
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Re: Which FEHB Plan Did You Choose And Why?

Post by GmanJeff »

Kaiser here, and quite happy with it. I am subject to IRMAA, so do not have Part B; my infrequent co-pays are trivial compared to the certainty of Part B premiums, and the catastrophic limits mean my risk is capped anyway.

Kaiser's one-stop shopping is hugely convenient. All providers are interconnected, all services, e.g., PT, pharmacy, outpatient surgery, radiology, lab, are available on-site, and appointment availability is very good, especially for urgent situations. In-house urgent care means I am able to be seen almost immediately after-hours without needing to resort to public hospital emergency rooms. Specialty physicians, e.g., retinal surgeons, are on-call outside business hours, and are able to respond to rapdily to emergencies. Diagnostic procedures like biopsies, ultrasounds, and others needed to confirm or rule out potentially significant conditions like certain cancers are available quickly; I have known people in other health plans who had to wait weeks for such procedures before conditions could be more fuly investigated investigated and treatment potentially initiated.
delamer
Posts: 17791
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Re: Which FEHB Plan Did You Choose And Why?

Post by delamer »

Trapper wrote: Wed Jun 12, 2024 7:01 am Delamer wrote, "I’m not aware of any problems with my providers receiving their payments though." regarding GEHA high deductable.
The issue with me is my health care provider sending multiple requests for payment to GEHA which are being denied. If they had been paid, why the multiple requests? GEHA said they paid, but there is no EOB accessible showing that. How am I as a policy holder determine where the issue is? The reality is I can't right now because GEHA has allowed this known issue to fester for six months.
How much of this issue is related to their changeover to United Healthcare? Us policy holders are being left in the dark with only platitudes from low level GEHA employees who can't help. One would think GEHA would want to get ahead of this continuing problem. Having customer service tell me that GEHA has been hacked and trying to tell me the problem is the hackers is really ignorant.
Just to be clear, I have GEHA Standard not high deductible. I don’t know if that could account for our different experiences.

And I’m sympathetic to your frustration, and I hope it gets straightened out sooner rather later.

Obviously, there are a range of experiences with GEHA.

I’m reminded of a friend who bought a Honda and ended up with a lemon (some problem with the head gasket). Most of us think of Honda as an exemplar of reliability, but my friend had a very different experience.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
cowbman
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Re: Which FEHB Plan Did You Choose And Why?

Post by cowbman »

keystone wrote: Mon Jun 10, 2024 1:14 pm
cowbman wrote: Sun Jun 09, 2024 7:02 pm
tallguy3891 wrote: Sun Jun 09, 2024 6:55 pm
tj wrote: Sun Jun 09, 2024 6:06 pm
tallguy3891 wrote: Sun Jun 09, 2024 6:00 pm

Interestingly, when I plugged in info (location, age, healthcare usage) into Consumers' Checkbook as to which FEHB plan to use WITHOUT Medicare Part B, it listed GEHA HDHP as #1. I would have never guessed that, have never heard of anyone doing so, and am still trying to figure out the details as to why. My opinions about choice of plans with Part A only would have been NALC High, MHBP Standard, GEHA Standard, BCBS Basic.
makes sense to me. For the same reason GEHA HDHP tends to make a lot of sense for people who are not old enough for medicare...
I don't have experience with a HDHP, but in this case I suspect it is ranked #1 in part due to the low 5% coinsurance on many services? This appears much lower than the usual 10%-30% I see on other FEHB plans. This seems difficult to know, since it is 5% of what? Each plan negotiates their "plan allowance" so how would someone know whether that plan's 5%, 10%, or 30% is more or less than another FEHB plan?

However, the premium for GEHA HDHP isn't that low in my opinion, so I'm wondering how it works out when one has to still use up the HRA first, then have a $3200 deductible for a self+one?
The premium isn't that low, but the HSA benefits when maxed out bring the deductible effectively down to $0 if you are 22% or higher. The dental benefits are pretty strong too. Rx benefits aren't the best, so consider that...
And for someone with pretty low maintenance vision needs, the vision benefit is pretty good covering a chunk of the exam and frame/lense replacement.

My family has been on GEHA HDHP for about 7 years now and I think it's a great option. I would just caution anyone to take a second look if they anticipate any out of network expenses, since GEHA treats the out of network deductible as separate from the in network (ie out of network expenses do not count towards in network and vice versa).
That's fair, but with United as the network, it's pretty comprehensive
44west
Posts: 35
Joined: Wed Dec 28, 2011 8:02 pm
Location: New Jersey

Re: Which FEHB Plan Did You Choose And Why?

Post by 44west »

cowbman wrote: Wed Jun 12, 2024 7:24 pm
keystone wrote: Mon Jun 10, 2024 1:14 pm
cowbman wrote: Sun Jun 09, 2024 7:02 pm
tallguy3891 wrote: Sun Jun 09, 2024 6:55 pm
tj wrote: Sun Jun 09, 2024 6:06 pm

makes sense to me. For the same reason GEHA HDHP tends to make a lot of sense for people who are not old enough for medicare...
I don't have experience with a HDHP, but in this case I suspect it is ranked #1 in part due to the low 5% coinsurance on many services? This appears much lower than the usual 10%-30% I see on other FEHB plans. This seems difficult to know, since it is 5% of what? Each plan negotiates their "plan allowance" so how would someone know whether that plan's 5%, 10%, or 30% is more or less than another FEHB plan?

However, the premium for GEHA HDHP isn't that low in my opinion, so I'm wondering how it works out when one has to still use up the HRA first, then have a $3200 deductible for a self+one?
The premium isn't that low, but the HSA benefits when maxed out bring the deductible effectively down to $0 if you are 22% or higher. The dental benefits are pretty strong too. Rx benefits aren't the best, so consider that...
And for someone with pretty low maintenance vision needs, the vision benefit is pretty good covering a chunk of the exam and frame/lense replacement.

My family has been on GEHA HDHP for about 7 years now and I think it's a great option. I would just caution anyone to take a second look if they anticipate any out of network expenses, since GEHA treats the out of network deductible as separate from the in network (ie out of network expenses do not count towards in network and vice versa).
That's fair, but with United as the network, it's pretty comprehensive
I’ve had a HDHP plan since they were first introduced to the FEHB program many years ago. I have been 100% happy with that decision. It’s worked beautifully when we had many claims that exceeded our deductible and reaped the tax benefits that we gained in our HSA when we’ve had fewer claims.HSA total sits at 150k these days . Self plus 1 or family have a combined 3200.00 deductible and after the Geha tax free 2000 contribution is applied to either the HSA or HRA you have a net 1200.00 out of pocket deductible remaining, after that 5% of their negotiated rate with a catastrophic limit of 6000.00 per person(self +plus ) family I would think would be similar. It’s true that we don’t know what each Insurance company negotiates on services but GEHa uses large network providers so I would think they have some clout on negotiations and would also be in their best interest to do so, the quicker you blow through your deductible the insurance co. Is now on the hook at 95%. Just my opinion and I could be completely wrong about that. It’s worked for me but everyone’s needs and views are different when picking a plan.
Topic Author
tallguy3891
Posts: 801
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Re: Which FEHB Plan Did You Choose And Why?

Post by tallguy3891 »

I don't personally see any way FEHB HDHP plans would work in our situation while having Part B Medicare, but I did take some time to look at the numbers and can see why Consumers' Checkbook ranks some of them so high--particularly GEHA HDHP--for a self or self+one with Part A but WITHOUT Part B.

Of the ones I looked at, GEHA HDHP and MHBP Consumer HDHP were of particular interest, although in my opinion, due to (as of 2024) GEHA HDHP's lower premium, lower deductible and extra Skilled Nursing Days, it fits our situation better. I would still be concerned about 5% of the amount for "Observation Days" in a hospital (5% of what amount?) but at least the catastrophic max could mitigate that.

I had never seriously considered HDHP plans as a retired annuitant, but I can at least see it as a viable choice for us--if we ever dropped Part B--due to that low 5% coinsurance. Of course, that and the deductible could change in the future.
jerryk68
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Re: Which FEHB Plan Did You Choose And Why?

Post by jerryk68 »

Retiree here on BCBS Basis plus one for around $517 per month plus Medicare A and B for around $174 times 2 or $348 a month. What I actually pay for Medicare B is around $108 a month for me and $108 for my spouse because BCBS reimburses $800 per person because we have Medicare B. So my total monthly actual outlay is around $733 which is $517 for BCBS Basic plus one and $216 for Medicare.

Medicare is primary and BCBS is the secondary payer. What Medicare doesn't pay Basic pays. The advantages of Basic w/ B is no copays, deductables, coinsurance or any other fees for service but the facility or doctor must accept BCBS or they won't pay. In my area 99.999% doctors accept BCBS.

Since retiring over 10 years ago we have paid nothing extra even with surgery with an overnight stay at a hospital. Even the drugs were covered for the hospital stay. What I like about it is the decision to seek medical help is not being made because of what it will cost. As I say to my spouse "just go to the doctor, it's free, we already paid."

Another advantage with Basic & B is mail order prescriptions are available. Normally BCBS Standard offers mail order and Basic does not but with Medicare B we are enrolled in mail order. Basically you pay two months worth of copays and get three months worth of pills. There are changes to mail order system coming this year and if I am reading it correctly the maximum out of pocket for copays is $2k yearly.

Another advantage is overseas travel. Medicare is not available overseas but BCBS is available is some areas. Never had a need to use it but at least it's available.

One disadvantage in having Medicare B is IRMAA income limits if you go over the limits your Medicare B costs go up.

Thank You. Just my 2 cents.
Topic Author
tallguy3891
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Re: Which FEHB Plan Did You Choose And Why?

Post by tallguy3891 »

44west wrote: Mon Jun 10, 2024 1:00 pm Thanks for the info. Am I correct in understanding that the $1000 per person HRA for retirees would automatically be applied to the first bills owed (or does one pay it and have to request to be reimbursed)? THEN, one has to pay the (currently) remaining $600 of the $1600 deductible out of pocket, then when the deductible is satisfied one pays the 5%?

When you start the HRA ( mine in Feb.) they put 2000.00 family into your account. When the medical provider submits the bill GEHA pays them direct. My 2000.00 HRA was prorated because January they funded my HSA for that month. The unused 2000.00 HRA rolls into the following year providing you stay with them.
Once you use up the 2000.00 HRA you pay full negotiate prices until you meet the 3200.00 family deductible, so 1200.00. After that it’s 5% of negotiated billing.
I spoke with a rep today. They said bills for providers and Rx would be paid out of pocket up front until the $1600 deductible is met [$3200 for self+one], and I would need to request reimbursement of the $1000 [$2000 self+one] from the HRA. Said provider bills are not automatically deducted from the HRA when provider bills GEHA.

I'm still not sure if this is correct but that is what I was told. UPDATE: Page 39 of the 2024 brochure appears to state that providers are automatically reimbursed from the HRA when a claim is submitted but I don't know if that means a claim submitted by the enrollee or directly by the provider?

This would mean $3200 out of pocket up front for a self+one, constant payments for dr visits and Rx in our situation. Why would I do that every year when my plan now, with Parts A and B Medicare, covers 100% with no deductible, no copay, and no coinsurance, other than a small coinsurance for Rx, which because I opted into the Part D option, has a $2000 max cap on it at present? I don't see it.
Last edited by tallguy3891 on Thu Jun 13, 2024 7:43 pm, edited 1 time in total.
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tallguy3891
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Re: Which FEHB Plan Did You Choose And Why?

Post by tallguy3891 »

Claudia Whitten wrote: Mon Jun 10, 2024 9:23 am
pahkcah wrote: Sun Jun 09, 2024 7:32 pm My wife and I are both retired Federal employees. Once we no longer had a need to cover our children, we switched to individual plans. We were both using FEHB BCBS Standard Option until Medicare kicked in. We stayed with BCBS but switched to BCBS Basic when Medicare became our prime coverage and FEHB became our secondary coverage. This year, BCBS Basic provides a reimbursement of $800 to each of us that helps pay for our Medicare Part B premiums. This is not the least expensive option, but it provides health care that best supports our needs. In our area, every doctor we looked at who accepts Medicare is in-network for BCBS Basic. No need for Part D for us, as the prescription coverage under our FEHB plan is better than using Part D. Due to our CSRS pensions, we will always be subject to some level of IRMAA.
Why do so many people choose FEHB BCBS Basic when Medicare kicks in? That's the option that I hear most often. Have you compared other options/plans and decided that BCBS is best?

And how about Part C with this combo?
I think your question about comparing Basic with other plans is a great one. I have wondered the same thing. Personally, I think people stick with what works for them. I read that only about 5% of people change plans in FEHB each year. I have heard comments in so many words that it worked for them while working, so they will stick with it now. Or for foreign travel coverage, or particular Rx needs, or providers. All good reasons.

The numbers boil down to this for me:

Basic: (Self+one) premium $517.03 + $349.40 for Part B for two = $866.43/mo x12 = $10,397.16 per year minus $1600 reimbursement = $8797.16/yr = $733.10 average per month.

Aetna Direct: (Self+one) premium $352.64 + $349.40 for Part B for two = $702.04/mo x 12 = $8424.48 per year minus $1800 reimbursement = $6624.48/yr = $552.04 average per month.

So, as of 2024, $733.10 minus $552.04 = $181.06 immediate savings per month. Direct has in and out of network coverage, a larger HRA, a lower premium, 60 total days of Skilled Nursing coverage, and an outstanding in my opinion Part D Rx option, although one can remain in the regular option if they choose. For our situation, Aetna Direct with Parts A and B, and using providers who accept Medicare, is better coverage for cheaper cost. FEHB is now secondary for us. Why pay more? Others have other reasons and preferences for their choices.
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