Medicare & FEHB high v. Standard

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PoppyA
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Medicare & FEHB high v. Standard

Post by PoppyA »

Can someone explain to me why you might keep the high plan v. Standard plan when you have Medicare?

Edited: I’m not asking about advantage plans, only traditional FEHB.
Last edited by PoppyA on Wed Oct 30, 2024 3:56 pm, edited 1 time in total.
Tdubs
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Re: Medicare & FEHB high v. Standard

Post by Tdubs »

For the one policy I'm familiar with, the answer is that there is no benefit to a High plan.

2025 will be my first year on Medicare and using an FEHB Advantage plan. I'm leaning toward the United Healthcare Advantage plan. You have to take Medicare Part B while enrolled in one of their regular plans. I called and asked if there were any benefits to taking anything other than their lowest priced plan. The rep told me that once on Medicare there was no benefit to higher cost plans; take the cheapest one. Nothing in the literature told you that.

It may be different outside of Advantage plans.
Swee'pea
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Re: Medicare & FEHB high v. Standard

Post by Swee'pea »

There are a lot of FEHB plans and the 2025 benefit brochures have been published. I believe that most (all?) include a section on how the plan coordinates with Medicare benefits. There are three FEHB BCBS plans - Standard, Basic and Focus. Maybe you are referring to Standard and Basic? It is confusing because the "higher" option is called "standard."

This is a very timely question since the open season runs from Nov 11 thru Dec 9. This the first year I am on Medicare and I am reviewing BCBS Standard and Basic plans. The brochure provides a side by side comparison of the standard and basic plans. Premiums under the Basic plan are cheaper but the full cost of medical services depends on personal circumstances. Topics of interest to me are the 2025 drug lists, coverage of skilled nursing days, coverage in vs out of network, access to the mail order pharmacy, and more. I'll be reading this topic to see other folks experiences and thoughts.

I am not looking at the BCBS Focus plan which is described in a separate brochure.

I haven't come to a decision. Best of luck with your research.
delamer
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Re: Medicare & FEHB high v. Standard

Post by delamer »

My guess is that a lot of people keep the same coverage that they had when they were active employees.

And they don’t do the research to determine if that is a good decision.
One thing that humbles me deeply is to see that human genius has its limits while human stupidity does not. - Alexandre Dumas, fils
stan1
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Re: Medicare & FEHB high v. Standard

Post by stan1 »

PoppyA wrote: Wed Oct 30, 2024 2:58 pm Can someone explain to me why you might keep the high plan v. Standard plan when you have Medicare?

Edited: I’m not asking about advantage plans, only traditional FEHB.
Which plan? FEHB has many different plans such as BCBS, GEHA, etc. and then local plans such as Kaiser HMO in some places.
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retiredjg
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Re: Medicare & FEHB high v. Standard

Post by retiredjg »

Here's an example for BCBS which has "standard" and "basic".

With BCBS Basic as your medicare supplement (Medigap), there are some limitations in payments if you use out of network providers. If you are in an area where almost everybody is in the BCBS network, it does not matter much. And you get $800 a year back from BCBS as a reimbursement for your Medicare premiums.

BCBS Standard costs more and does not have the in network limitations. But they do not give you the $800 a year reimbursement.

Every plan is different. You have to actually do the comparisons.
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

Sometimes the High option has better Rx copays/coinsurance, but I personally have not seen where this is worth a plan premium which can be much higher.

Others have mentioned a difference in Skilled Nursing days, and out of network coverage. If one has non-Medicare family members that can be a factor. It is possible overseas coverage might come into play?

I have been surprised over the years at how many people seem to just stick with what they used while employed, paying sometimes hundreds of dollars more per month rather than select a less expensive plan which--if on Medicare A and B--might work just as well or better than the plan they had while working.

In my opinion, being on Medicare A and B changes the ballgame when choosing an FEHB plan to pair with it. It does take some work to thoroughly read and compare the plans when enrolling in Medicare, and each year thereafter for changes. Maybe each person selects what they are comfortable with and they feel fits their needs best. FEHB has many good plans from which to choose.

Having said that, I do the same thing. I could suspend (not cancel) my FEHB and we could get on a local public Advantage plan by a major leading company, which has all our providers and hospital in it--in fact a very large "Group" and which covers Rx as good as or better than FEHB in most respects, and has a lower catastrophic out of pocket max per year, and seems modeled after an FEHB plan which costs almost $600 per month to use as a secondary. The cost of this local non-FEHB MA plan? $38 each so $76 per month for the two of us. But I don't want to do that. Too many "what ifs."
cowbman
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Re: Medicare & FEHB high v. Standard

Post by cowbman »

Other than reasons listed above, I can't think of a great reason. NALC High is popular with those that don't take part B due to IRMAA.
chemocean
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Re: Medicare & FEHB high v. Standard

Post by chemocean »

stan1 wrote: Wed Oct 30, 2024 6:23 pm
Which plan? FEHB has many different plans such as BCBS, GEHA, etc. and then local plans such as Kaiser HMO in some places.
Kaiser HMO WA several years ago stop allowing you to have Original Medicare as primary and FEHB Kaiser as secondary.
In other words, that was no coordination of benefits between Medicare and FEHB and you were essentially wasting the FEHB premium.

If you have the Kaiser WA standard FEHB options,you needed to chose an Advantage Plan have any reasonable coordination of benefits with Medicare.

If you want coordination of Medicare benefits with Medicare being primary and FEHB as secondary, you needed to chose the high FEHB WA Kaiser option.
Tdubs
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Re: Medicare & FEHB high v. Standard

Post by Tdubs »

tallguy3891 wrote: Wed Oct 30, 2024 8:10 pm Sometimes the High option has better Rx copays/coinsurance, but I personally have not seen where this is worth a plan premium which can be much higher.

Others have mentioned a difference in Skilled Nursing days, and out of network coverage. If one has non-Medicare family members that can be a factor. It is possible overseas coverage might come into play?

I have been surprised over the years at how many people seem to just stick with what they used while employed, paying sometimes hundreds of dollars more per month rather than select a less expensive plan which--if on Medicare A and B--might work just as well or better than the plan they had while working.

In my opinion, being on Medicare A and B changes the ballgame when choosing an FEHB plan to pair with it. It does take some work to thoroughly read and compare the plans when enrolling in Medicare, and each year thereafter for changes. Maybe each person selects what they are comfortable with and they feel fits their needs best. FEHB has many good plans from which to choose.

Having said that, I do the same thing. I could suspend (not cancel) my FEHB and we could get on a local public Advantage plan by a major leading company, which has all our providers and hospital in it--in fact a very large "Group" and which covers Rx as good as or better than FEHB in most respects, and has a lower catastrophic out of pocket max per year, and seems modeled after an FEHB plan which costs almost $600 per month to use as a secondary. The cost of this local non-FEHB MA plan? $38 each so $76 per month for the two of us. But I don't want to do that. Too many "what ifs."
What are the most serious "what ifs?"
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

Tdubs wrote: Wed Oct 30, 2024 10:28 pm
tallguy3891 wrote: Wed Oct 30, 2024 8:10 pm Sometimes the High option has better Rx copays/coinsurance, but I personally have not seen where this is worth a plan premium which can be much higher.

Others have mentioned a difference in Skilled Nursing days, and out of network coverage. If one has non-Medicare family members that can be a factor. It is possible overseas coverage might come into play?

I have been surprised over the years at how many people seem to just stick with what they used while employed, paying sometimes hundreds of dollars more per month rather than select a less expensive plan which--if on Medicare A and B--might work just as well or better than the plan they had while working.

In my opinion, being on Medicare A and B changes the ballgame when choosing an FEHB plan to pair with it. It does take some work to thoroughly read and compare the plans when enrolling in Medicare, and each year thereafter for changes. Maybe each person selects what they are comfortable with and they feel fits their needs best. FEHB has many good plans from which to choose.

Having said that, I do the same thing. I could suspend (not cancel) my FEHB and we could get on a local public Advantage plan by a major leading company, which has all our providers and hospital in it--in fact a very large "Group" and which covers Rx as good as or better than FEHB in most respects, and has a lower catastrophic out of pocket max per year, and seems modeled after an FEHB plan which costs almost $600 per month to use as a secondary. The cost of this local non-FEHB MA plan? $38 each so $76 per month for the two of us. But I don't want to do that. Too many "what ifs."
What are the most serious "what ifs?"
I've thought about it quite a bit. What if the suspend FEHB process got messed up and I could never get back on FEHB (unlikely). What if the plan really isn't that great. My spouse has a lot of health issues so we might end up paying max oop anyway on an MA plan. What if prior authorizations are a constant hassle. And, although our Group is huge, since this MA plan is an HMO, it would limit going anywhere for providers like we can do now.
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

cowbman wrote: Wed Oct 30, 2024 8:57 pm Other than reasons listed above, I can't think of a great reason. NALC High is popular with those that don't take part B due to IRMAA.
NALC High was my favorite choice for a FEHB plan without Part B, until the premium apparently is increasing for 2025 by approx $134 per month for self+family (self+family is actually cheaper than self+one at present).

So, the plan no longer makes financial sense for us at this time. However, we are not subject to IRMAA.

Example:

NALC High will be approx $615.20/mo in 2025. Without Part B we would be paying this and whatever coinsurance for treatment.

However, with our current plan--Aetna Direct--we pay FEHB premium of $356.21 for 2025 + Part B premiums minus the HRA of $150 per month so our net out of pocket each month will be about $585 total each month for self+one, (assuming Part B increases to $185 each), and we have paid zero out of pocket other than Rx for the last 3 years. So, it pays off to have FEHB+Part B in our case.

I have maybe mentioned the above details in part at least in previous threads but am repeating it here for those new to this FEHB/Part B question. It makes sense in my opinion to thoroughly check plan combinations with and without Part B. Situations for people can vary widely.
Last edited by tallguy3891 on Thu Oct 31, 2024 5:05 pm, edited 2 times in total.
Tdubs
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Re: Medicare & FEHB high v. Standard

Post by Tdubs »

tallguy3891 wrote: Wed Oct 30, 2024 11:01 pm
Tdubs wrote: Wed Oct 30, 2024 10:28 pm

What are the most serious "what ifs?"
And, although our Group is huge, since this MA plan is an HMO, it would limit going anywhere for providers like we can do now.
Yes, this is the clincher for me. Spouse has need of very specialized medical centers. None I'd trust in state.
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

Swee'pea wrote: Wed Oct 30, 2024 5:03 pm There are a lot of FEHB plans and the 2025 benefit brochures have been published. I believe that most (all?) include a section on how the plan coordinates with Medicare benefits. There are three FEHB BCBS plans - Standard, Basic and Focus. Maybe you are referring to Standard and Basic? It is confusing because the "higher" option is called "standard."

This is a very timely question since the open season runs from Nov 11 thru Dec 9. This the first year I am on Medicare and I am reviewing BCBS Standard and Basic plans. The brochure provides a side by side comparison of the standard and basic plans. Premiums under the Basic plan are cheaper but the full cost of medical services depends on personal circumstances. Topics of interest to me are the 2025 drug lists, coverage of skilled nursing days, coverage in vs out of network, access to the mail order pharmacy, and more. I'll be reading this topic to see other folks experiences and thoughts.

I am not looking at the BCBS Focus plan which is described in a separate brochure.

I haven't come to a decision. Best of luck with your research.
I'm curious as to why not BCBS Focus?

Cheaper than Basic for self+one and self only even after the Basic reimbursement amount. As of 2025, both Basic and Focus have no Skilled Nursing Days, both have Medicare wraparound, both have no out of network, and both have Rx coverage with a $2000 cap. Focus does have a higher catastrophic limit and would have a higher cost if Medicare hospital days were exhausted. Many Rx are $5. I would personally not use Focus without Part B too. I would use Basic without Part B due to its set copays much of the time (I like that better than a % of an unknown amount), although it would not be my first choice with or without Part B (nor would BCBS Standard or Focus). I think they are all great plans, but other plans work better for our situation at this time. They might work great for others.
Last edited by tallguy3891 on Thu Oct 31, 2024 7:27 pm, edited 1 time in total.
michaelingp
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Re: Medicare & FEHB high v. Standard

Post by michaelingp »

The Consumer Checkbook Guide to Health Plans is the definitive reference for this question. On the issue of Medicare B, their advice (has been for years) is something like, "It depends, but what you don't want to do is pay for a high cost (and high benefit) plan and also pay for Medicare Part B.
cowbman
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Re: Medicare & FEHB high v. Standard

Post by cowbman »

tallguy3891 wrote: Thu Oct 31, 2024 1:51 pm
cowbman wrote: Wed Oct 30, 2024 8:57 pm Other than reasons listed above, I can't think of a great reason. NALC High is popular with those that don't take part B due to IRMAA.
NALC High was my favorite choice for a FEHB plan without Part B, until the premium apparently is increasing for 2025 by approx $134 per month for self+family (self+family is actually cheaper than self+one at present).

So, the plan no longer makes financial sense for us at this time. However, we are not subject to IRMAA.

Example:

NALC High will be approx $615.20/mo in 2025. Without Part B we would be paying this and whatever coinsurance for treatment.

However, with our current plan--Aetna Direct--we pay FEHB premium of $356.21 for 2025 + Part B premiums minus the HRA of $150 per month so our net out of pocket each month will be about $585 total each month for self+one, (assuming Part B increases to $185 each), and we have paid zero out of pocket other than Rx for the last 3 years. So, it pays off to have FEHB+Part B in our case.

I have maybe mentioned the above details in part at least in previous threads but am repeating it here for those new to this FEHB/Part B question. It makes sense in my opinion to thoroughly check plan combinations with and without Part B. Situations for people can vary widely.
Why Aetna Direct? Why not use the Aetna Medicare Advantage? Self+1 is $253.74/month with a $100/month part B credit.
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

cowbman wrote: Thu Oct 31, 2024 8:17 pm
tallguy3891 wrote: Thu Oct 31, 2024 1:51 pm

NALC High was my favorite choice for a FEHB plan without Part B, until the premium apparently is increasing for 2025 by approx $134 per month for self+family (self+family is actually cheaper than self+one at present).

So, the plan no longer makes financial sense for us at this time. However, we are not subject to IRMAA.

Example:

NALC High will be approx $615.20/mo in 2025. Without Part B we would be paying this and whatever coinsurance for treatment.

However, with our current plan--Aetna Direct--we pay FEHB premium of $356.21 for 2025 + Part B premiums minus the HRA of $150 per month so our net out of pocket each month will be about $585 total each month for self+one, (assuming Part B increases to $185 each), and we have paid zero out of pocket other than Rx for the last 3 years. So, it pays off to have FEHB+Part B in our case.

I have maybe mentioned the above details in part at least in previous threads but am repeating it here for those new to this FEHB/Part B question. It makes sense in my opinion to thoroughly check plan combinations with and without Part B. Situations for people can vary widely.
Why Aetna Direct? Why not use the Aetna Medicare Advantage? Self+1 is $253.74/month with a $100/month part B credit.
I was interested when I first saw it. It would be great to have a low premium plus $100 Part B credit each, thus a net of about $53+ per month for self+one. Looking further, none of our providers were in network. Several of the FEHB Advantage plans did not have our providers either but rather state something to the effect that we could use any provider which accepts Medicare and is willing to treat us. I can't wonder every time we need to see a provider whether 1) they will treat us and 2) they will bill on our behalf.

Also, I have decided at this point that Advantage plans are not for us. With Aetna Direct, we get a great premium, a great reimbursement (HRA), and are still in Original Medicare and have a great Part D Rx option. Great combo for us.
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

michaelingp wrote: Thu Oct 31, 2024 6:14 pm The Consumer Checkbook Guide to Health Plans is the definitive reference for this question. On the issue of Medicare B, their advice (has been for years) is something like, "It depends, but what you don't want to do is pay for a high cost (and high benefit) plan and also pay for Medicare Part B.
I've wondered for many years exactly what goes into their recommendations. I find it a very handy tool for information. I do find it interesting that (for 2024) the site listed 7 Medicare Advantage FEHB plans in the top 10 for a self+one with Medicare A and B in my State. From what I've seen posted by FEHB enrollees, the top 10 plans are rarely mentioned from what I've seen.

Also, for 2024, in my State, for self+one without Medicare, I was surprised to see so many plans in the top 10 which apparently don't have Medicare wraparound, don't waive the plan deductible and coinsurance. GEHA Standard, which I've seen repeatedly a favorite for some on FEHB but no Part B, ranked 10th!!! However, I've never seen much if any mention of many of the other top ten rankings for those without Part B. Perhaps I'm missing something.

I personally would not want to be paying for Part B and then have an FEHB plan in which I still had to pay the deductible and copays/coinsurance. I guess there could be reasons but I'm not sure what. However, there are good FEHB plans which do work really well with Medicare and do waive deductibles and coinsurance/copays, although some of them might be more expensive than the others.

Also, while I do think the site does a good job of comparing $ amounts, I think there are other factors one should look at too when choosing a plan, like extra Skilled Nursing Facility days. Many FEHB plans offer none. Several I know of are quite generous.
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pahkcah
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Re: Medicare & FEHB high v. Standard

Post by pahkcah »

tallguy3891 wrote: Fri Nov 01, 2024 4:19 pm
michaelingp wrote: Thu Oct 31, 2024 6:14 pm The Consumer Checkbook Guide to Health Plans is the definitive reference for this question. On the issue of Medicare B, their advice (has been for years) is something like, "It depends, but what you don't want to do is pay for a high cost (and high benefit) plan and also pay for Medicare Part B.
I've wondered for many years exactly what goes into their recommendations. I find it a very handy tool for information. I do find it interesting that (for 2024) the site listed 7 Medicare Advantage FEHB plans in the top 10 for a self+one with Medicare A and B in my State. From what I've seen posted by FEHB enrollees, the top 10 plans are rarely mentioned from what I've seen.

Also, for 2024, in my State, for self+one without Medicare, I was surprised to see so many plans in the top 10 which apparently don't have Medicare wraparound, don't waive the plan deductible and coinsurance. GEHA Standard, which I've seen repeatedly a favorite for some on FEHB but no Part B, ranked 10th!!! However, I've never seen much if any mention of many of the other top ten rankings for those without Part B. Perhaps I'm missing something.

I personally would not want to be paying for Part B and then have an FEHB plan in which I still had to pay the deductible and copays/coinsurance. I guess there could be reasons but I'm not sure what. However, there are good FEHB plans which do work really well with Medicare and do waive deductibles and coinsurance/copays, although some of them might be more expensive than the others.

Also, while I do think the site does a good job of comparing $ amounts, I think there are other factors one should look at too when choosing a plan, like extra Skilled Nursing Facility days. Many FEHB plans offer none. Several I know of are quite generous.
Back when wife and I (both federal retirees) were approaching the time when we needed to make a decision, I checked every resource I could find. I remember the Consumers' Checkbook recommendation was to stick with an FEHB plan and add Medicare Part B, but only if there would be no major impact due to IRMAA, basically going no higher than one of the two lower tiers. The recommendation, from a strictly financial perspective, was to pick up Part B and move to a lower FEHB plan (like BCBS Standard to Basic), which would hopefully cover all costs except prescription co-pays. Again, the one big issue was how high up the IRMAA tiers someone might be.

We picked up Part B and switched from BCBS Standard to Basic. Our only additional costs have been small prescription co-pays. Due to our pensions, we can't avoid IRMAA, but we're not complaining. DW and I both agree quality health care and peace of mind is worth a few extra dollars.
Last edited by pahkcah on Sat Nov 02, 2024 8:28 am, edited 1 time in total.
cowbman
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Re: Medicare & FEHB high v. Standard

Post by cowbman »

tallguy3891 wrote: Thu Oct 31, 2024 9:00 pm
cowbman wrote: Thu Oct 31, 2024 8:17 pm

Why Aetna Direct? Why not use the Aetna Medicare Advantage? Self+1 is $253.74/month with a $100/month part B credit.
I was interested when I first saw it. It would be great to have a low premium plus $100 Part B credit each, thus a net of about $53+ per month for self+one. Looking further, none of our providers were in network. Several of the FEHB Advantage plans did not have our providers either but rather state something to the effect that we could use any provider which accepts Medicare and is willing to treat us. I can't wonder every time we need to see a provider whether 1) they will treat us and 2) they will bill on our behalf.

Also, I have decided at this point that Advantage plans are not for us. With Aetna Direct, we get a great premium, a great reimbursement (HRA), and are still in Original Medicare and have a great Part D Rx option. Great combo for us.
Odd, as the website specifically states the provider needs to take Medicare assignment and bill Aetna. That seems simple enough. I would guess any Medicare provider would be "in-network."
cowbman
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Re: Medicare & FEHB high v. Standard

Post by cowbman »

pahkcah wrote: Fri Nov 01, 2024 4:53 pm
tallguy3891 wrote: Fri Nov 01, 2024 4:19 pm

I've wondered for many years exactly what goes into their recommendations. I find it a very handy tool for information. I do find it interesting that (for 2024) the site listed 7 Medicare Advantage FEHB plans in the top 10 for a self+one with Medicare A and B in my State. From what I've seen posted by FEHB enrollees, the top 10 plans are rarely mentioned from what I've seen.

Also, for 2024, in my State, for self+one without Medicare, I was surprised to see so many plans in the top 10 which apparently don't have Medicare wraparound, don't waive the plan deductible and coinsurance. GEHA Standard, which I've seen repeatedly a favorite for some on FEHB but no Part B, ranked 10th!!! However, I've never seen much if any mention of many of the other top ten rankings for those without Part B. Perhaps I'm missing something.

I personally would not want to be paying for Part B and then have an FEHB plan in which I still had to pay the deductible and copays/coinsurance. I guess there could be reasons but I'm not sure what. However, there are good FEHB plans which do work really well with Medicare and do waive deductibles and coinsurance/copays, although some of them might be more expensive than the others.

Also, while I do think the site does a good job of comparing $ amounts, I think there are other factors one should look at too when choosing a plan, like extra Skilled Nursing Facility days. Many FEHB plans offer none. Several I know of are quite generous.
Back when wife and I (both federal retirees) were approaching the time when we needed to make a decision, I checked every resource I could find. I remember the Consumers' Checkbook recommendation was to stick with an FEHB plan and add Medicare Part B, but only if there would be no major impact due to IRMAA, basically going no higher than one of the two lower tiers. The recommendation, from a strictly financial perspective, was to pick up Part B and move to a lower FEHB plan (like BCBS Standard to Basic), which would hopefully cover all costs except prescription co-pays. Again, the one big issue was how high up the IRMAA tiers someone might be.

We picked up Part B and switched from BCBS Standard to Basic. Our only additional costs have been small prescription co-pays. Due to our pensions, we can't IRMAA, but we're not complaining. DW and I both agree quality health care and peace of mind is worth a few extra dollars.
In general, this is good advice. IRMAA tier 3 and above start to become quite expensive for parts B and/or D.
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

cowbman wrote: Fri Nov 01, 2024 10:47 pm
tallguy3891 wrote: Thu Oct 31, 2024 9:00 pm

I was interested when I first saw it. It would be great to have a low premium plus $100 Part B credit each, thus a net of about $53+ per month for self+one. Looking further, none of our providers were in network. Several of the FEHB Advantage plans did not have our providers either but rather state something to the effect that we could use any provider which accepts Medicare and is willing to treat us. I can't wonder every time we need to see a provider whether 1) they will treat us and 2) they will bill on our behalf.

Also, I have decided at this point that Advantage plans are not for us. With Aetna Direct, we get a great premium, a great reimbursement (HRA), and are still in Original Medicare and have a great Part D Rx option. Great combo for us.
Odd, as the website specifically states the provider needs to take Medicare assignment and bill Aetna. That seems simple enough. I would guess any Medicare provider would be "in-network."
I read it as IF the provider will accept Medicare, is willing to treat, and will bill the plan, not that they MUST or even will do so. Perhaps I'm wrong, but I don't want to hassle wondering every time. That, along with the other concerns I've read about MA plans, makes me hesitant to go that route with all of my spouse's medical needs. My bottom line is I just don't go with any plan which doesn't show our providers in-network on their provider list. They do show many other providers which are in-network, just not ours or our Group or hospital.
Last edited by tallguy3891 on Sat Nov 02, 2024 8:34 pm, edited 1 time in total.
chalet
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Re: Medicare & FEHB high v. Standard

Post by chalet »

PoppyA wrote: Wed Oct 30, 2024 2:58 pm Can someone explain to me why you might keep the high plan v. Standard plan when you have Medicare?

If you have expensive drugs, it could save money.

high single premium: $297 per month

standard single premium: $174 per month.

the difference is $123 per month.

high medicare rebate is $83 per month.

final difference is only $40 per month


Review the RX diffferences. One expensive drug each month could make 'high' the better choice.
cowbman
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Re: Medicare & FEHB high v. Standard

Post by cowbman »

tallguy3891 wrote: Sat Nov 02, 2024 11:07 am
cowbman wrote: Fri Nov 01, 2024 10:47 pm

Odd, as the website specifically states the provider needs to take Medicare assignment and bill Aetna. That seems simple enough. I would guess any Medicare provider would be "in-network."
I read it as IF the provider will accept Medicare, is willing to treat, and will bill the plan, not that they MUST or even will do so. Perhaps I'm wrong, but I don't want to hassle wondering every time. That, along with the other concerns I've read about MA plans, makes me hesitant to go that route with all of my spouse's medical needs. My bottom line is I just don't go with any plan which doesn't show our providers in-network on their provider list. They do show many other providers which are in-network, just not ours or our Group or hospital.
Maybe some smarter than me can address this, but unlike a non-FEHB Medicare Advantage plan (which replaces Medicare and subjects you to the Insurer network rules), when I read this it still appears to me to be more akin to a Medigap plan where it basically picks up the copays that you would be subject to on Parts A or B without a supplement plan. Thus, if the provider accepts/in-network with Medicare, it appears to me to be included. Do we have any BHs with experience on this one?
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

cowbman wrote: Sat Nov 02, 2024 9:33 pm
tallguy3891 wrote: Sat Nov 02, 2024 11:07 am

I read it as IF the provider will accept Medicare, is willing to treat, and will bill the plan, not that they MUST or even will do so. Perhaps I'm wrong, but I don't want to hassle wondering every time. That, along with the other concerns I've read about MA plans, makes me hesitant to go that route with all of my spouse's medical needs. My bottom line is I just don't go with any plan which doesn't show our providers in-network on their provider list. They do show many other providers which are in-network, just not ours or our Group or hospital.
Maybe some smarter than me can address this, but unlike a non-FEHB Medicare Advantage plan (which replaces Medicare and subjects you to the Insurer network rules), when I read this it still appears to me to be more akin to a Medigap plan where it basically picks up the copays that you would be subject to on Parts A or B without a supplement plan. Thus, if the provider accepts/in-network with Medicare, it appears to me to be included. Do we have any BHs with experience on this one?
I don't consider myself smarter than anyone, and you are asking good questions. Medicare Advantage plans are Part C, they are not Original Medicare Parts A and B although one needs to be enrolled in A and B to be in a Medicare Advantage plan, whether in FEHB or not. The company running the Medicare Advantage plan in so many words takes over from Original Medicare; my understanding is one then gets a single id card from the Medicare Advantage plan to show providers.

Medicare Advantage FEHB plans are not generally considered supplement plans. If one is on Original Medicare A and B and also has a regular FEHB plan, that is generally considered to be a secondary insurance.

fedretire.net has a helpful article on this general topic dated 11/02/2024. It is well worth reading in my opinion.
cowbman
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Re: Medicare & FEHB high v. Standard

Post by cowbman »

tallguy3891 wrote: Mon Nov 04, 2024 2:16 pm
cowbman wrote: Sat Nov 02, 2024 9:33 pm

Maybe some smarter than me can address this, but unlike a non-FEHB Medicare Advantage plan (which replaces Medicare and subjects you to the Insurer network rules), when I read this it still appears to me to be more akin to a Medigap plan where it basically picks up the copays that you would be subject to on Parts A or B without a supplement plan. Thus, if the provider accepts/in-network with Medicare, it appears to me to be included. Do we have any BHs with experience on this one?
I don't consider myself smarter than anyone, and you are asking good questions. Medicare Advantage plans are Part C, they are not Original Medicare Parts A and B although one needs to be enrolled in A and B to be in a Medicare Advantage plan, whether in FEHB or not. The company running the Medicare Advantage plan in so many words takes over from Original Medicare; my understanding is one then gets a single id card from the Medicare Advantage plan to show providers.

Medicare Advantage FEHB plans are not generally considered supplement plans. If one is on Original Medicare A and B and also has a regular FEHB plan, that is generally considered to be a secondary insurance.

fedretire.net has a helpful article on this general topic dated 11/02/2024. It is well worth reading in my opinion.
Advantage plans (part C) do not require enrollment in A&B. This is how FEHB Advantage plans differ. Also, part C plans usually have no premium or minimal $20-50/month. The reason many choose advantage plans over traditional (despite more limited networks) is due to the perceived savings.
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

cowbman wrote: Tue Nov 05, 2024 8:54 am
tallguy3891 wrote: Mon Nov 04, 2024 2:16 pm

I don't consider myself smarter than anyone, and you are asking good questions. Medicare Advantage plans are Part C, they are not Original Medicare Parts A and B although one needs to be enrolled in A and B to be in a Medicare Advantage plan, whether in FEHB or not. The company running the Medicare Advantage plan in so many words takes over from Original Medicare; my understanding is one then gets a single id card from the Medicare Advantage plan to show providers.

Medicare Advantage FEHB plans are not generally considered supplement plans. If one is on Original Medicare A and B and also has a regular FEHB plan, that is generally considered to be a secondary insurance.

fedretire.net has a helpful article on this general topic dated 11/02/2024. It is well worth reading in my opinion.
Advantage plans (part C) do not require enrollment in A&B. This is how FEHB Advantage plans differ. Also, part C plans usually have no premium or minimal $20-50/month. The reason many choose advantage plans over traditional (despite more limited networks) is due to the perceived savings.
Enrolling in a Medicare Advantage plan, FEHB or public, requires also being enrolled in Medicare Parts A and B.

See Medicare.gov link:

https://www.medicare.gov/publications/1 ... eriods.pdf
Claudia Whitten
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Re: Medicare & FEHB high v. Standard

Post by Claudia Whitten »

I thought that if you take BCBS basic or standard (or other FEHB plans) as well as Part B, you don't need drug coverage (Part D), and you don't have many other medical expenses. Of course, you then pay two premiums for some overlapping services. If you're in IRMAA territory (category 2 or above), it's worth considering dropping B altogether, I've been told. But then you have to worry whether FEHB will continue and continue to be affordable for retirees. There's no simple answer. :oops:
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

Claudia Whitten wrote: Tue Nov 05, 2024 10:36 am I thought that if you take BCBS basic or standard (or other FEHB plans) as well as Part B, you don't need drug coverage (Part D), and you don't have many other medical expenses. Of course, you then pay two premiums for some overlapping services. If you're in IRMAA territory (category 2 or above), it's worth considering dropping B altogether, I've been told. But then you have to worry whether FEHB will continue and continue to be affordable for retirees. There's no simple answer. :oops:
There are many FEHB plans which work well together with Parts A and B. Section 9 of the FEHB brochures usually states how they work together. It is possible--at this time anyway--to have a combination of FEHB and Parts A and B in which one pays zero or very little as coinsurance/copays for medical treatment.

FEHB plans at this time have their own built-in drug coverage, but many now are also offering Part D options (which now will have the $2000 max cap). Some plans also offer a Health Reimbursement Account which gives a fund to reimburse allowable expenses.

IRMAA can be a factor in whether some people choose to remain in Part B. Some do, some do not.

In addition, some FEHB plans are now offering Medicare Advantage options too.
Claudia Whitten
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Re: Medicare & FEHB high v. Standard

Post by Claudia Whitten »

tallguy3891 wrote: Tue Nov 05, 2024 11:31 am
Claudia Whitten wrote: Tue Nov 05, 2024 10:36 am I thought that if you take BCBS basic or standard (or other FEHB plans) as well as Part B, you don't need drug coverage (Part D), and you don't have many other medical expenses. Of course, you then pay two premiums for some overlapping services. If you're in IRMAA territory (category 2 or above), it's worth considering dropping B altogether, I've been told. But then you have to worry whether FEHB will continue and continue to be affordable for retirees. There's no simple answer. :oops:
There are many FEHB plans which work well together with Parts A and B. Section 9 of the FEHB brochures usually states how they work together. It is possible--at this time anyway--to have a combination of FEHB and Parts A and B in which one pays zero or very little as coinsurance/copays for medical treatment.

FEHB plans at this time have their own built-in drug coverage, but many now are also offering Part D options (which now will have the $2000 max cap). Some plans also offer a Health Reimbursement Account which gives a fund to reimburse allowable expenses.

IRMAA can be a factor in whether some people choose to remain in Part B. Some do, some do not.

In addition, some FEHB plans are now offering Medicare Advantage options too.
This is all ridiculously complicated.
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

Claudia Whitten wrote: Wed Nov 06, 2024 2:32 pm
tallguy3891 wrote: Tue Nov 05, 2024 11:31 am

There are many FEHB plans which work well together with Parts A and B. Section 9 of the FEHB brochures usually states how they work together. It is possible--at this time anyway--to have a combination of FEHB and Parts A and B in which one pays zero or very little as coinsurance/copays for medical treatment.

FEHB plans at this time have their own built-in drug coverage, but many now are also offering Part D options (which now will have the $2000 max cap). Some plans also offer a Health Reimbursement Account which gives a fund to reimburse allowable expenses.

IRMAA can be a factor in whether some people choose to remain in Part B. Some do, some do not.

In addition, some FEHB plans are now offering Medicare Advantage options too.
This is all ridiculously complicated.
If you have any questions, please post. I think there are some people on the group who are familiar with FEHB and Medicare and could perhaps offer some comments or direct to appropriate sources for information.
Claudia Whitten
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Re: Medicare & FEHB high v. Standard

Post by Claudia Whitten »

tallguy3891 wrote: Wed Nov 06, 2024 8:45 pm
Claudia Whitten wrote: Wed Nov 06, 2024 2:32 pm

This is all ridiculously complicated.
If you have any questions, please post. I think there are some people on the group who are familiar with FEHB and Medicare and could perhaps offer some comments or direct to appropriate sources for information.
Thank you.

1. A&B plus FEHB BCBS Basic or Standard. Do I need more than that? If so, what? And why?
2. A&B in IRMAA bracket 2. Drop B and just do BCBS Standard? Downside?
3. BCBS Basic or Standard in retirement abroad: Is one better than the other?
4. GEHA abroad rather than BCBS? Any differences from those who have experience?

Thank you.
ChrisC
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Re: Medicare & FEHB high v. Standard

Post by ChrisC »

Let me piggyback with a question I have about possibly changing health insurance enrollment for my wife. I have GEHA standard plus 1, with Medicare A only. My wife has Medicare A and B. After my wife has been solicited the last few years for GEHA-FEHB United HealthCare Medicare Advantage plan, we called the GEHA customer service number on the recent flyer sent to us because the benefits seemed very good for her and we didn’t seem a drop in medical provider coverage. We’ll be at IRMAA 4 for 2025.

The CSR for this FEHB sponsored Advantage plan told us that my wife can enroll in this plan even though she’s not the primary on the GEHA FEHB enrollment. The plan would reimburse Part B premiums at $75 per month, but you’d have to enroll in Medicare Part D, which the IRMAA charge for her in 2025 is $74 a month. (We anticipate that IRMAA might drop down to tier 2 for us as we phase out of doing Roth conversions after 2026.) There is a late penalty enrollment for Part D but Medicare.gov says if you previously were enrolled in a comparable prescription benefit plan the late enrollment penalty would not apply. We're wondering if my wife's prescription benefit coverage under my GEHA standard plus 1 would allow her to avoid the late enrollment penalty for Part D if she elected coverage for this Advantage Plan. Anyone have any experience with this situation? Also, it appears that you can disenroll in a Medicare Advantage Plan and go back on original Medicare A and B -- my BIL did this a few years ago after he had erroneously enrolled in an Advantage Plan listening to Joe Namath on TV -- but what happens to your Part D enrollment if you were in an Advantage Plan with a Part requirement -- does that just go away?
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

Claudia Whitten wrote: Thu Nov 07, 2024 5:20 am
tallguy3891 wrote: Wed Nov 06, 2024 8:45 pm

If you have any questions, please post. I think there are some people on the group who are familiar with FEHB and Medicare and could perhaps offer some comments or direct to appropriate sources for information.
Thank you.

1. A&B plus FEHB BCBS Basic or Standard. Do I need more than that? If so, what? And why?
2. A&B in IRMAA bracket 2. Drop B and just do BCBS Standard? Downside?
3. BCBS Basic or Standard in retirement abroad: Is one better than the other?
4. GEHA abroad rather than BCBS? Any differences from those who have experience?

Thank you.
1. BCBS Std and Basic are both excellent plans in my opinion and they work well with Medicare. They do, at this time, have higher premiums than many FEHB plans which also work well with Medicare. With Standard, one gets an extra 10 days of covered Skilled Nursing Facility days paid after the initial zero coinsurance Medicare 20 days. Basic gives no extra days as of this time. Standard has some lower Rx costs. BCBS site has a very nice calculator which one can put in the med and see which plan is lower cost, and also if the newer Part D option is "better."

Basic does not usually cover out of network providers. Basic gives some Part B reimbursement money.

2. Dropping Part B is a personal decision. One can find out what the % coinsurance would be for treatments for any FEHB plan by looking at the plan brochures at OPM.gov. Very handy. Some people like the Basic plan which has many set copays so they know up front what a treatment will cost. There are several other plans which are lower premiums and apparently work just as well but it is important I think to make sure one's providers are all in the plan. BCBS Std and Basic are extremely popular plans so I'm guessing there are reasons for that. I was on both in the past and both worked great but once on Medicare I knew for our situation there were other plans which would work too.

Downsides? Depends. Some people like having FEHB with Parts A and B Medicare so they know the combo covers all or almost all of their cost. Without Part B, there could be having to pay a copay or coinsurance for each treatment throughout the year. Also, of course, if one drops Part B and goes back on it later, the 10% penalty per 12 months comes into play. If I were considering dropping Part B I would ask myself two questions: 1) I would just assume every year the rest of my and my spouse's lives we would pay the max catastrophic out of pocket and plan accordingly, and so, do I have the means to do so? 2) Do I want to make payments out of pocket throughout the year if necessary and is that a hassle to me?

3. Perhaps others can comment on any difference for overseas coverage between Std and Basic, but one can also call the plan and they should be able to give details?

4. No experience, but again, one can call the plans and read the brochures for details. Look in the brochure index for pages for overseas coverage.

As an aside, over the years I have repeatedly seen mentioned FEHB plans BCBS Std, BCBS Basic, NALC High, MHBP Standard, GEHA High and Standard, and Aetna Direct as plans which work well with Medicare A and B. There are others too. I personally would only use Aetna Direct with BOTH parts A and B. The others could be used with only Part A only. The only way to know which ones best fit one's own situation is in my opinion to research thoroughly the plans and call the plans with questions but feel free to ask here too.
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

ChrisC wrote: Thu Nov 07, 2024 11:01 am Let me piggyback with a question I have about possibly changing health insurance enrollment for my wife. I have GEHA standard plus 1, with Medicare A only. My wife has Medicare A and B. After my wife has been solicited the last few years for GEHA-FEHB United HealthCare Medicare Advantage plan, we called the GEHA customer service number on the recent flyer sent to us because the benefits seemed very good for her and we didn’t seem a drop in medical provider coverage. We’ll be at IRMAA 4 for 2025.

The CSR for this FEHB sponsored Advantage plan told us that my wife can enroll in this plan even though she’s not the primary on the GEHA FEHB enrollment. The plan would reimburse Part B premiums at $75 per month, but you’d have to enroll in Medicare Part D, which the IRMAA charge for her in 2025 is $74 a month. (We anticipate that IRMAA might drop down to tier 2 for us as we phase out of doing Roth conversions after 2026.) There is a late penalty enrollment for Part D but Medicare.gov says if you previously were enrolled in a comparable prescription benefit plan the late enrollment penalty would not apply. We're wondering if my wife's prescription benefit coverage under my GEHA standard plus 1 would allow her to avoid the late enrollment penalty for Part D if she elected coverage for this Advantage Plan. Anyone have any experience with this situation? Also, it appears that you can disenroll in a Medicare Advantage Plan and go back on original Medicare A and B -- my BIL did this a few years ago after he had erroneously enrolled in an Advantage Plan listening to Joe Namath on TV -- but what happens to your Part D enrollment if you were in an Advantage Plan with a Part requirement -- does that just go away?
Being on GEHA Medicare Advantage option does not mean having to do an additional enrollment in Part D---rather, since one enrolls in the Advantage option, one is automatically in the Part D of that Advantage plan. However, if IRMAA applies there would be the higher premium which I believe is deducted from Social Security benefits (like Part B is) or if no Social Security, billed.

If one has been on FEHB with the plan Rx, that is apparently considered creditable coverage so there should be no late enrollment penalty for Part D. When I opted into my plan Part D option this year, there was no late enrollment penalty for Part D because I had been covered all along under the regular Rx option of the plan.

My understanding is one can go back to the regular plan if one does not like the Advantage plan option. That would mean reverting to the regular FEHB plan and its Rx coverage (however, one could also revert to the regular plan and also choose the new GEHA regular plan Part D option, which is not the same as the Advantage Part D exactly). HOWEVER, I have recently read some issues with getting reverted to a particular regular plan as far as how long it took and the process. I have also read that some plans allow reverting the next month, and in one plan at least not being able to revert until the next year. A call to the plan could help verify this.
Last edited by tallguy3891 on Thu Nov 07, 2024 1:58 pm, edited 2 times in total.
Topic Author
PoppyA
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Re: Medicare & FEHB high v. Standard

Post by PoppyA »

Where can I look to see a listing of how many skilled nursing days the FEHB plans provide? Do I have to visit each site separately &/or compare them all against each other? That’s a lot of work…
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

PoppyA wrote: Thu Nov 07, 2024 1:16 pm Where can I look to see a listing of how many skilled nursing days the FEHB plans provide? Do I have to visit each site separately &/or compare them all against each other? That’s a lot of work…
It is usually in Section 5 of each brochure at OPM.gov--all the 2025 brochures are there--or can be found in the index under Skilled Nursing Facility or Extended Care benefits.

Be careful to read thoroughly because sometimes the SNF benefit days apply differently if an employee versus those on Medicare. In other words, it might state that it gives 30 days for SNF, but if on Medicare and Medicare covers the first 20 in full, then there are only the additional 10 to TOTAL 30 days. Or, it might state that if on Medicare, those days aren't given at all.

https://www.opm.gov/healthcare-insuranc ... ion/plans/
Claudia Whitten
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Re: Medicare & FEHB high v. Standard

Post by Claudia Whitten »

tallguy3891 wrote: Thu Nov 07, 2024 12:53 pm I personally would only use Aetna Direct with BOTH parts A and B. The others could be used with only Part A only. The only way to know which ones best fit one's own situation is in my opinion to research thoroughly the plans and call the plans with questions but feel free to ask here too.
Thank you *very* much. Why would you personally only use Aetna Direct?
User avatar
retiredjg
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Re: Medicare & FEHB high v. Standard

Post by retiredjg »

Claudia Whitten wrote: Thu Nov 07, 2024 2:12 pm
tallguy3891 wrote: Thu Nov 07, 2024 12:53 pm I personally would only use Aetna Direct with BOTH parts A and B. The others could be used with only Part A only. The only way to know which ones best fit one's own situation is in my opinion to research thoroughly the plans and call the plans with questions but feel free to ask here too.
Thank you *very* much. Why would you personally only use Aetna Direct?
I think he meant to say if he used Aetna Direct, it would be with both A and B, not just A.
ChrisC
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Re: Medicare & FEHB high v. Standard

Post by ChrisC »

tallguy3891 wrote: Thu Nov 07, 2024 1:08 pm
ChrisC wrote: Thu Nov 07, 2024 11:01 am Let me piggyback with a question I have about possibly changing health insurance enrollment for my wife. I have GEHA standard plus 1, with Medicare A only. My wife has Medicare A and B. After my wife has been solicited the last few years for GEHA-FEHB United HealthCare Medicare Advantage plan, we called the GEHA customer service number on the recent flyer sent to us because the benefits seemed very good for her and we didn’t seem a drop in medical provider coverage. We’ll be at IRMAA 4 for 2025.

The CSR for this FEHB sponsored Advantage plan told us that my wife can enroll in this plan even though she’s not the primary on the GEHA FEHB enrollment. The plan would reimburse Part B premiums at $75 per month, but you’d have to enroll in Medicare Part D, which the IRMAA charge for her in 2025 is $74 a month. (We anticipate that IRMAA might drop down to tier 2 for us as we phase out of doing Roth conversions after 2026.) There is a late penalty enrollment for Part D but Medicare.gov says if you previously were enrolled in a comparable prescription benefit plan the late enrollment penalty would not apply. We're wondering if my wife's prescription benefit coverage under my GEHA standard plus 1 would allow her to avoid the late enrollment penalty for Part D if she elected coverage for this Advantage Plan. Anyone have any experience with this situation? Also, it appears that you can disenroll in a Medicare Advantage Plan and go back on original Medicare A and B -- my BIL did this a few years ago after he had erroneously enrolled in an Advantage Plan listening to Joe Namath on TV -- but what happens to your Part D enrollment if you were in an Advantage Plan with a Part requirement -- does that just go away?
Being on GEHA Medicare Advantage option does not mean having to do an additional enrollment in Part D---rather, since one enrolls in the Advantage option, one is automatically in the Part D of that Advantage plan. However, if IRMAA applies there would be the higher premium which I believe is deducted from Social Security benefits (like Part B is) or if no Social Security, billed.

If one has been on FEHB with the plan Rx, that is apparently considered creditable coverage so there should be no late enrollment penalty for Part D. When I opted into my plan Part D option this year, there was no late enrollment penalty for Part D because I had been covered all along under the regular Rx option of the plan.

My understanding is one can go back to the regular plan if one does not like the Advantage plan option. That would mean reverting to the regular FEHB plan and its Rx coverage (however, one could also revert to the regular plan and also choose the new GEHA regular plan Part D option, which is not the same as the Advantage Part D exactly). HOWEVER, I have recently read some issues with getting reverted to a particular regular plan as far as how long it took and the process. I have also read that some plans allow reverting the next month, and one at least not being able to revert until the next year. A call to the plan could help verify this.
Thanks for the information about creditable service -- are you self-only insured? My wife, as a dependent on my GEHA standard plus 1 plan is listed with GEHA Standard with Medicare A and B. If she went back to Medicare A and B she would not be choosing another FEHB plan, she would be disenrolled in the Advantage plan and listed as a dependent with GEHA Standard and placed back in original Medicare Parts A and B. She would be using whatever plan I'm taking with FEHB as her secondary insurance with original Medicare as primary.
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

Claudia Whitten wrote: Thu Nov 07, 2024 2:12 pm
tallguy3891 wrote: Thu Nov 07, 2024 12:53 pm I personally would only use Aetna Direct with BOTH parts A and B. The others could be used with only Part A only. The only way to know which ones best fit one's own situation is in my opinion to research thoroughly the plans and call the plans with questions but feel free to ask here too.
Thank you *very* much. Why would you personally only use Aetna Direct?
Yes, thank you retiredjg, I meant if I was going to select Aetna Direct, I would only do so if I had both Medicare A and B. I believe it was designed to work best that way, and in fact we have had it that way for several years now. It has been great for our situation.
tallguy3891
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Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

ChrisC wrote: Thu Nov 07, 2024 2:34 pm
tallguy3891 wrote: Thu Nov 07, 2024 1:08 pm

Being on GEHA Medicare Advantage option does not mean having to do an additional enrollment in Part D---rather, since one enrolls in the Advantage option, one is automatically in the Part D of that Advantage plan. However, if IRMAA applies there would be the higher premium which I believe is deducted from Social Security benefits (like Part B is) or if no Social Security, billed.

If one has been on FEHB with the plan Rx, that is apparently considered creditable coverage so there should be no late enrollment penalty for Part D. When I opted into my plan Part D option this year, there was no late enrollment penalty for Part D because I had been covered all along under the regular Rx option of the plan.

My understanding is one can go back to the regular plan if one does not like the Advantage plan option. That would mean reverting to the regular FEHB plan and its Rx coverage (however, one could also revert to the regular plan and also choose the new GEHA regular plan Part D option, which is not the same as the Advantage Part D exactly). HOWEVER, I have recently read some issues with getting reverted to a particular regular plan as far as how long it took and the process. I have also read that some plans allow reverting the next month, and one at least not being able to revert until the next year. A call to the plan could help verify this.
Thanks for the information about creditable service -- are you self-only insured? My wife, as a dependent on my GEHA standard plus 1 plan is listed with GEHA Standard with Medicare A and B. If she went back to Medicare A and B she would not be choosing another FEHB plan, she would be disenrolled in the Advantage plan and listed as a dependent with GEHA Standard and placed back in original Medicare Parts A and B. She would be using whatever plan I'm taking with FEHB as her secondary insurance with original Medicare as primary.
I am self+one enrollment. I believe the rest of your statement is correct. Either one or both can go into or out of the Advantage plan if they are on Parts A and B (which is not the situation at this time for yourself).

If I may ask, why did you choose to not take Part B and what benefit do you see to your spouse opting into the GEHA Advantage plan? Sorry if we already spoke about this in the past. So many threads!

fedretire.net has some info by Dennis Damp about the MA options for FEHB.
ChrisC
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Re: Medicare & FEHB high v. Standard

Post by ChrisC »

tallguy3891 wrote: Thu Nov 07, 2024 3:07 pm
ChrisC wrote: Thu Nov 07, 2024 2:34 pm

Thanks for the information about creditable service -- are you self-only insured? My wife, as a dependent on my GEHA standard plus 1 plan is listed with GEHA Standard with Medicare A and B. If she went back to Medicare A and B she would not be choosing another FEHB plan, she would be disenrolled in the Advantage plan and listed as a dependent with GEHA Standard and placed back in original Medicare Parts A and B. She would be using whatever plan I'm taking with FEHB as her secondary insurance with original Medicare as primary.
I am self+one enrollment. I believe the rest of your statement is correct. Either one or both can go into or out of the Advantage plan if they are on Parts A and B (which is not the situation at this time for yourself).

If I may ask, why did you choose to not take Part B and what benefit do you see to your spouse opting into the GEHA Advantage plan? Sorry if we already spoke about this in the past. So many threads!

fedretire.net has some info by Dennis Damp about the MA options for FEHB.
GEHA standard has met my health insurance coverage needs. So far with the exception of this year, since I've been Medicare eligible, the Part B premiums I would have paid would exceed the benefit of having both GEHA standard and Part B. And this year, I would have paid around $5.5K for Part B enrollment and my OOP maximum under GEHA standard, which I met this year, was $6.5K so I would have saved $1000 with dual enrollment. My wife might drop Part B but she became Medicare eligible 2 years before me and enrolled in it that time. We thought it prudent to enroll her in Part B because she was having several surgeries back then. Part B for her hasn't been cost effective for us because of the IRMAA levels we face. Next year, her Part B annual premium will likely be $6.7K.

If she stays with Part B, there's quite a few benefits she likes under the Advantage Plan, like the dental benefits (we get 3-4 dental cleanings/preventive visits each year and my primary dental insurance covers 2 and GEHA standard covers the other 2 at 50%, whereas Advantage covers 2 completely -- and it stacks up on my primary dental well), vision is a bit better, we have a gym membership (senior couple of $75 monthly, and Advantage would cover her membership), the other benefits are detailed in this year's brochure: https://retiree.uhc.com/content/dam/ret ... -16614.pdf And there are generous SNF benefits under this Advantage plan beyond the coverage one would get under original Medicare, such as 100 days of free SNF care.

Here are the general additional benefits of this Plan: https://retiree.uhc.com/content/dam/ret ... e-plan.pdf
tallguy3891
Posts: 991
Joined: Sat Jul 03, 2021 10:47 am

Re: Medicare & FEHB high v. Standard

Post by tallguy3891 »

ChrisC wrote: Thu Nov 07, 2024 4:57 pm
tallguy3891 wrote: Thu Nov 07, 2024 3:07 pm

I am self+one enrollment. I believe the rest of your statement is correct. Either one or both can go into or out of the Advantage plan if they are on Parts A and B (which is not the situation at this time for yourself).

If I may ask, why did you choose to not take Part B and what benefit do you see to your spouse opting into the GEHA Advantage plan? Sorry if we already spoke about this in the past. So many threads!

fedretire.net has some info by Dennis Damp about the MA options for FEHB.
GEHA standard has met my health insurance coverage needs. So far with the exception of this year, since I've been Medicare eligible, the Part B premiums I would have paid would exceed the benefit of having both GEHA standard and Part B. And this year, I would have paid around $5.5K for Part B enrollment and my OOP maximum under GEHA standard, which I met this year, was $6.5K so I would have saved $1000 with dual enrollment. My wife might drop Part B but she became Medicare eligible 2 years before me and enrolled in it that time. We thought it prudent to enroll her in Part B because she was having several surgeries back then. Part B for her hasn't been cost effective for us because of the IRMAA levels we face. Next year, her Part B annual premium will likely be $6.7K.

If she stays with Part B, there's quite a few benefits she likes under the Advantage Plan, like the dental benefits (we get 3-4 dental cleanings/preventive visits each year and my primary dental insurance covers 2 and GEHA standard covers the other 2 at 50%, whereas Advantage covers 2 completely -- and it stacks up on my primary dental well), vision is a bit better, we have a gym membership (senior couple of $75 monthly, and Advantage would cover her membership), the other benefits are detailed in this year's brochure: https://retiree.uhc.com/content/dam/ret ... -16614.pdf And there are generous SNF benefits under this Advantage plan beyond the coverage one would get under original Medicare, such as 100 days of free SNF care.

Here are the general additional benefits of this Plan: https://retiree.uhc.com/content/dam/ret ... e-plan.pdf
Ah, yes, IRMAA!!! I doubt I would have Part B either if IRMAA would be approx the same as Part B premiums.

As far as those 100 days of SNF under the Advantage option, that would be great if the plan does approve them. That seems to be one of the questions involving prior authorizations under Advantage plans in general, and which I gather is a concern of FEHB people too about these newer Advantage options. Hopefully time will tell how good they are.
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