Experiences With FEHB and No Part B

[zl55lz]

I opted not to pick up Part B and I stayed with Basic. I have been on BCBS Basic for almost thirty years and I have only had one doctor not accept it. All hospitals, labs, etc. accepted it.

Since FEHB annuitants 65+ cannot be charged more than the Medicare approved amount (true whether on Part B or not, except I believe for outpatient hospital and non-physician based care charges), have you noticed what the difference is between the regular Basic plan copays shown in the brochure versus what you actually pay?

In other words, if Basic says the set copay will be $100 for something , or $40 or whatever for a dr visit, have you noticed whether actual charges owed differ under Basic without part B?

 

[teej1985]

I believe Basic is the most popular FEHB plan? Maybe with retirees too? It appears to be outstanding coverage, different from most plans due to the set copays/coinsurance (which in my opinion might be its biggest appeal). It did have some significant cost changes this year (2023). Also I would like it better if it offered some Skilled Nursing days, and of course one has to be aware of out of network provider situations. The premium for self+one is heading for $500/mo, but if one doesn't have Part B too, the cost issue is perhaps mitigated for some.

There is also a statement in the Basic coverage to the effect of having to pay 30% of the plan allowance for agents, drugs, and surgical implants but I haven't found out which. Maybe this applies to certain outpatient (surgical or otherwise) situations? I wonder, 30% of what total cost?

Having said that, I recently looked at a publicly offered MA plan in my area which reminded me very much of Basic, has Skilled Nursing Days, a lower catastrophic oop than Basic, and offered about half the sample of common Rx I checked for zero cost, and with FEHB suspended, with a zero MA premium, it would only cost the Part B premiums per month as a basis. However, I would personally not want to do that. In my opinion, if the FEHB premiums keep going up, it could eventually cause some to have to drop their Part B and go with FEHB and Part A only. It sounds like this combo has worked well in your situation.

Basic seems pretty risky with zero out of market coverage. But the No Surprises Act should avoid out of network ER issues.

 

[grayv]

I was looking at BCBS premiums. For a single plan, retired with medicare B primary, the $800 Basic rebate brings the Basic cost down very close to the Focus cost. On a monthly basis, the difference is $4.


A small difference in RX coverage could be the deciding factor.


https://www.fepblue.org/our-plans/compare-plans

 

[zl55lz]

I was looking at BCBS premiums. For a single plan, retired with medicare B primary, the $800 Basic rebate brings the Basic cost down very close to the Focus cost. On a monthly basis, the difference is $4.


A small difference in RX coverage could be the deciding factor.


https://www.fepblue.org/our-plans/compare-plans

Yes, BCBS is excellent in my opinion, and Basic with the Part B rebate brings it down nicely. Be aware that at this time Basic and Focus offers zero days Skilled Nursing Facility days, and does not cover out of network providers except for certain exceptions shown in the brochure. Also, the Basic max out of pocket is $6500/yr compared to Focus being $8500, and the Rx for Basic does appear overall better? The out of network and out of pocket max issues could, however, be somewhat mitigated by being on Original Medicare Parts A and B.

Also, MHBP CDHP has a great premium and gives $1200 per year to single as HRA which effectively reduces the premium down to $70.50 per month as of 2023. However, it looks like there is a yearly deductible of $2000 for Rx only so that could be a factor. I believe it covers out of network as well?

Aetna Direct might interest some too. Good premium. It gives $900 per year as a fund ($1800 self+one) and covers out of network too. Also, when one goes to pick up Rx, the copay is automatically deducted from the fund. We have had Direct with A and B for a couple years and have paid zero out of pocket for anything. Nice. Pick up meds. Zero out of pocket.

Lastly, there is talk of FEHB also offering Part D standalone plans in upcoming years so that could factor into plan selections which might otherwise have been excluded due to Rx situations for regular FEHB plans.

There are other plans as well which have great perks. Well worth researching in my opinion.