Claims Experience - Medicare Primary, FEHB 2ndary Insurance

[Amethyst]

Mr. A. is about to move onto Medicare as his primary insurer, with FEHB as secondary. I'd like to hear from other Federal retirees who have gone this route. What has been your experience with submitting and tracking claims?

I am worried. To date, my only experience with 2 insurances has been with dental insurance (FEHB BCBS is primary; Humana dental is secondary). It has been uniformly awful - no matter how often I explain the situation to my dental office, they invariably screw it up and I end up getting collection letters.

They will submit to BCBS, which pays nothing for dental, and then omit to send the BCBS denial to Humana for payment.

Or they bill Humana directly, and then blame me when Humana refuses to reimburse without proof that BCBS was contacted first.

I don't think the average doctor's office or hospital is likely to be any more competent than my dental office. Therefore, I'm really concerned about the potential for screw-ups with Medicare and FEHB, especially now we're starting to use our health insurance quite a bit.

Amethyst

 

[aja8888]

1. What is FEHB?

2. Medicare works well with a supplemental insurance plan.

3. Medicare - no dental or hearing aid coverage.

4. Be absolutely sure you VERIFY that doctors and other providers accept Medicare as the primary insurance.

5. Medicare is good once you know the in's and out's.

 

[Amethyst]

I'm sorry, I should have expanded FEHB = Federal Employees Health Benefits. It's shorthand for the group of insurers which Federal employees can use, and can carry into retirement.

A.

 

[aja8888]

I'm sorry, I should have expanded FEHB = Federal Employees Health Benefits. It's shorthand for the group of insurers which Federal employees can use, and can carry into retirement.

A.

Does this work as a typical supplement policy to Medicare?

As if Medicare pays first then uncovered charges from Medicare are submitted to the FEHB for review and hopefully payment? (I am not or have been a federal employee).

 

[Amethyst]

I don't know anything about Medicare, although I guess we'd better learn fast! Yes, FEHB becomes the "supplemental" or "secondary" insurance for Medicare.

Amethyst

Does this work as a typical supplement policy to Medicare?

As if Medicare pays first then uncovered charges from Medicare are submitted to the FEHB for review and hopefully payment? (I am not or have been a federal employee).

 

[aja8888]

I don't know anything about Medicare, although I guess we'd better learn fast! Yes, FEHB becomes the "supplemental" or "secondary" insurance for Medicare.

Amethyst

I would suggest you really take the time to get very knowledgeable on Medicare and how it works. I can't stress this enough.

DW and I have been on it for almost 5 years and DW has a severe case of COPD and has been hospitalized several times over the last few years. We have been trough the process and it can be a nightmare, especially dealing with hospitals.

I would suggest you get to understand the medicare deductibles, limits on stays in facilities, things not covered, etc. It's complicated, and if you don't know the facts, you can drop a lot of money in a hurry.

What I don't know (at all) is the FEHB coverage you have. It is paramount you find out what they pay for after Medicare stops paying. For instance, will it pay the hospital entry fee deductible of $1100+ for each visit within a specified period (it's not annual). That's the KEY, seeing what FEHB picks up.

Medicare has a good website and if you can find the publication "Medicare and You", I would start there.

 

[donheff]

Amethyst - it sounds like you are taking Medicare Part B for non-hospital coverage and are using FEHB as a supplemental. If so it will probably work flawlessly. The carriers so appreciate the costs you are saving them that they will work tirelessly to please you. I, and a fair proportion of others, skip the part B and use FEHB alone. Our coverage (and deductibles) are the same as they were before Medicare. So far it is working fine for me although some doctors expect that anyone on Medicare will have Part B and keep wanting to submit non-hospital bills to the government.

 

[Brat]

FEHB retiree here. Many would say don't bother with Part B, I disagree because GEHA (for one) insurance waves co-pays when you have Part B. I found it a wash and if at a later date he suspends FEHB to go to a Medicare Advantage Plan you won't have any surcharges.

When Medicare becomes primary some internal medicine doc's won't accept you as a new patient because Medicare's reimbursement rates are low and they limit the % of Medicare patients. If they are a preferred provider on your FEHB policy that might make a difference.

I haven't had any issue with hospitals/specialists as they were all preferred providers on my health plan. Maybe my lack of co-pays were a factor as they knew they would be paid the entirety of the Medicare/contract rate.

 

[Moemg]

I have Medicare & Federal Blue Cross & Blue Shield . It has never been a problem . Blue Cross & Blue Shield pick up all my co-pays & whatever Medicare does not pay . No billing problems at all . I recently had a lot of expensive testing & everything was covered .

 

[W2R]

Amethyst, I was worried too, before Medicare kicked in. However, like the others posting here I have been happy with Medicare Part B and BCBS Standard. I am so impressed and amazed with how easy all this has been.

It is especially nice to discover that none of my doctors or labs have had any issues with the fact that I am a Medicare patient with Medicare being primary. I guess that is because I have BCBS too, secondary. Anyway, they do all the billing and I just get paperwork in the mail saying nothing is due. So far so good. Too bad I still have to pay the same amount for prescriptions.

 

[aja8888]

Amethyst, I was worried too, before Medicare kicked in. However, like the others posting here I have been happy with Medicare Part B and BCBS Standard. I am so impressed and amazed with how easy all this has been.

It is especially nice to discover that none of my doctors or labs have had any issues with the fact that I am a Medicare patient with Medicare being primary. I guess that is because I have BCBS too, secondary. Anyway, they do all the billing and I just get paperwork in the mail saying nothing is due. So far so good. Too bad I still have to pay the same amount for prescriptions.

I don't know anything about government coverage so I am curious as to what the BCBS supplemental costs you? And for prescriptions, is Medicare Part D (prescription coverage) available to you?

As a comparison, I pay ~$104 monthly for Medicare, $220 monthly for Plan F Supplemental (policy with American Republic) and $28 monthly for Part D. DW pays same amounts as me. Our supplemental is the Holy Grail of those plans (most expensive).

 

[W2R]

I don't know anything about government coverage so I am curious as to what the BCBS supplemental costs you? And for prescriptions, is Medicare Part D (prescription coverage) available to you?

As a comparison, I pay ~$104 monthly for Medicare, $220 monthly for Plan F Supplemental (policy with American Republic) and $28 monthly for Part D. DW pays same amounts as me. Our supplemental is the Holy Grail of those plans (most expensive).

$190.28 for BCBS Standard
$104.90 for Medicare Part B

BCBS recommended not getting part D, so I didn't. Of course I could if I wanted to, but BCBS already pays a percentage of prescriptions (the same percentage as it did when I was younger, working, not on Medicare, and so on).

BCBS Standard is the expensive "Cadillac" level of federal health insurance that has caused some contraversy. There are cheaper plans, such as BCBS Basic that many switch to when they get Medicare. I didn't, my choice.

 

[aja8888]

$190.28 for BCBS Standard
$104.90 for Medicare Part B

BCBS recommended not getting part D, so I didn't. Of course I could if I wanted to, but BCBS already pays a percentage of prescriptions (the same percentage as it did when I was younger, working, not on Medicare, and so on).

BCBS Standard is the expensive "Cadillac" level of federal health insurance that has caused some contraversy. There are cheaper plans, such as BCBS Basic that many switch to when they get Medicare. I didn't, my choice.

Thanks, traditional supplemental policies do not cover prescriptions so we have to use Part D, even though it's not great.

 

[Dreamer]

I have FEHB and my DH as Medicare. It has worked flawlessly for him. I have BC/BS Standard and he does not have to pay any copays either. I am friends with many older retirees, and this is what the majority of them have also.

Ajaa8888, I have the family plan for BCBS Standard and I pay $444.12 per month for it and DH pays $104.90 per month for Medicare. When I am eligible for Medicare I will also pay $104.90 per month. The cost of the BCBS does not go down when it is becomes secondary.

 

[Brat]

Indeed but the fact that there are no co-pays when you have Medicare B offsets the expense. Next open season compare your BC/BS to GEHA Standard. I found the latter better.

Bills are first sent to Medicare who pays their piece, they send the balance to the secondary insurer. There is some paperwork every year to make sure that Medicare has the correct secondary insurance information.

Claims handling was never an issue but do eyeball Medicare's statements. My Mother had a name sake who happened to use the same physician in Honolulu. Her physician's office mixed up the Medicare #s. What is funny is that they both lived in Portland and snow birded in Hawaii, although the other patient was about 15 years younger. I can see how there was billing confusion. I contacted Medicare and a couple months later they called back and thanked me for helping them straighten it out. Mom was a FEHB insured, the other patient retired from the City of Portland. There would have been a difference in the secondary insurance.

Because you are in DC you might also look at Kaiser's Medicare Advantage program. I suspended my FEHB to enroll in Kaiser NW's Medicare Advantage. In our situation I am the insured with DH the dependent. I know I could go back to FEHB but I am not sure if I could bring DH back too. He said he would be happy to stick with Kaiser. We were on Kaiser for 20+ years before moving out of their service area so he knows the drill. If you haven't had Kaiser coverage in the past it might be too much of an adjustment for you, and as FEHB family plans go it is very expensive so there are both financial and lifestyle issues to consider.

 

[JakeBrake]

This thread brings back memories. My mother was the widow of a retired federal employee. She died in 2007. I had to handle all her business for her last 10 years. She had traditional Medicare plus part B. Her supplemental coverage was provided by APWU (American Postal Workers Union).

At the time I was almost envious at how much better her claims were handled than my claims through MegaCorp employee insurance.

Now, I'm on traditional Medicare plus part B with MegaCorp retiree supplemental. Since I've been on Medicare, I've had a couple of major claims involving hospitalization, surgery, physical therapy, and long ambulance rides. So far, I've been satisfied with the way Medicare has handled.

 

[iac1003]

I think it works really well when Medicare is primary and FEHB is secondary. And when I was in private practice I was paid very promptly by both.

When I worked at the VA Hospital however my DH was on my FEHB plan and his Medicare was secondary. He had an emergency hospitalization for pulmonary emboli in 2011and they still haven't figured it out. We owe the hospital a $250 deductible but they keep sending it to Medicare, where it's not covered, and then continue to send us EOBs saying we owe nothing.

DH now has Medicare A, B, D and an F supplement. Much easier.

 

[Nightengale212]

That is too bad you have issues regarding dental claims. I am still employed and have standard FEHB medical coverage and dental through Metropolitan. I see both a dentist and periodontist, and both offices know to first submit my claims to FEHB who sends these offices whatever payment they will cover, and then these offices send the statement to Metropolitan who will pay their portion of the bill. In the 12 or so years I have had two coverages never had a problem. You may want to track the claims yourself via having an online account with FEHB and your dental provider so you will know first hand hand who was paid and when.

 

[friar1610]

My experience is not with the exact situation you describe but rather with the military side of a Federal supplemental policy. That is, I have Medicare (parts A and B) as my primary insurance and Tricare for Life as the supplementary policy. (Tricare is the Federal plan for members of active duty personnel and for military retirees and their families; Tricare for Life is the version of Tricare that kicks in after one becomes Medicare-eligible.) This combination has worked flawlessly. The health care providers submit the claims to Medicare; Medicare, after processing them, forwards them to Tricare and Tricare picks up what Medicare doesn't pay (subject, of course, to annual deductibles.)