Experiences With FEHB and No Part B

[zl55lz]

Just wondered if anyone would share their experiences being on a FEHB plan and choosing to take Part A but not Part B. Specifically, which FEHB plan chosen, why, and how the yearly out of pocket costs without Part B played out over time compared to just paying the Part B premium (non-IRMAA or IRMAA).

 

[donheff]

DW and I are on Part A only with GEHA standard or basic- whatever they call it. We have friends who also skipped Part B but went with BCBS. We ran the numbers years ago and concluded part B wasn’t worthwhile for us. We would have been bumped up by IRMAA from day one and would get slammed when DW’s RMDs kick in. We concluded that if FEHB was fine for workers, why not for retirees. I switched to GEHA decades ago because it was a better deal than BCBS and has virtually the same network in the DC area where I live. BCBS may have broader networks elsewhere.

 

[Lakedog]

DW and I are on Part A only with GEHA standard or basic- whatever they call it. We have friends who also skipped Part B but went with BCBS. We ran the numbers years ago and concluded part B wasn’t worthwhile for us. We would have been bumped up by IRMAA from day one and would get slammed when DW’s RMDs kick in. We concluded that if FEHB was fine for workers, why not for retirees. I switched to GEHA decades ago because it was a better deal than BCBS and has virtually the same network in the DC area where I live. BCBS may have broader networks elsewhere.

I had trouble deciding which way to go when I turned 65 a couple of years ago and ended up going with medicare A and B along with GEHA standard. I am thinking that I might drop Part B once I start RMDs since IRMAA would then be a consideration. Although I have not had to pay anything beyond premiums for health care (other than 50% prev dental) since going on Part B, I think it would have been close to a wash as to total cost. My estimate of what I would have had to pay without Part B was very close to the Part B cost, even with a few skin surgeries during that time.

 

[donheff]

Yes, Lakedog, it can be a tough call. The providers keep adding attractive incentives for us to take Part B because they save a lot if we do. In network reimbursement to out of network providers, partial reimbursement of Part B costs…. The choice for me would still be to skip B but that's not so clear for many. Multiple pensions coupled with big RMDs dictate the decision for DW and me.

 

[zl55lz]

DW and I are on Part A only with GEHA standard or basic- whatever they call it. We have friends who also skipped Part B but went with BCBS. We ran the numbers years ago and concluded part B wasn’t worthwhile for us. We would have been bumped up by IRMAA from day one and would get slammed when DW’s RMDs kick in. We concluded that if FEHB was fine for workers, why not for retirees. I switched to GEHA decades ago because it was a better deal than BCBS and has virtually the same network in the DC area where I live. BCBS may have broader networks elsewhere.

That is an interesting point you make about if FEHB without Part B was good enough while working, why any different in retirement. It is too bad that they add a 10% penalty for Part B for each year not enrolled, and I'm guessing if they did not do so, less than 5% of retirees would take Part B at 65, but would instead wait until their later years. It will be interesting to see if/when they mandate Part B for FEHB retirees like they did for postal retirees, if they will give a grandfather in period and help with IRMAA costs like they apparently did with the postal reform. Also wonder how they will handle those who took Part B but later dropped out and then are mandated to enroll again due to FEHB reform (if it happens, which I personally think is likely at some point, although maybe only for those attaining age 65).

 

[zl55lz]

I had trouble deciding which way to go when I turned 65 a couple of years ago and ended up going with medicare A and B along with GEHA standard. I am thinking that I might drop Part B once I start RMDs since IRMAA would then be a consideration. Although I have not had to pay anything beyond premiums for health care (other than 50% prev dental) since going on Part B, I think it would have been close to a wash as to total cost. My estimate of what I would have had to pay without Part B was very close to the Part B cost, even with a few skin surgeries during that time.

Unfortunately GEHA didn't work for us due to a couple of my wife's Rx--any savings in premium would have been surpassed by Rx coinsurance/copay when compared to BCBS. We did switch to Aetna Direct (with Parts A&B), which as of this time is just a little more premium than GEHA Std, covers Rx extremely well, has more Skilled Nursing days, and also gives $1800 tax free to us every year as a medical fund. We paid not a cent out of pocket the entire year, not even for Rx. Went to pharmacy, no copay/coinsurance, left, no hassle, automatically taken out of medical fund.

 

[donheff]

Unfortunately GEHA didn't work for us due to a couple of my wife's Rx-.

I haven’t found a way to compare on my wife’s Rx’s. GEHA fights her on one but she eventually gets it every year. Then the manufacturer reimburses all but $5 which they tell her they don’t do for people with Medicare.

 

[zl55lz]

One of the questions I've wondered about is the BCBS Standard vs. Basic vs. Focus option for annuitants with Parts A&B Medicare.

The majority of retirees apparently had BCBS while working and maybe keep it into retirement?

The comparison I see is (example of Self+One as of 2023):
Standard $690.84 premium
Basic $472.12
Focus $252.51

The only benefit I see for Standard with A+B is 10 more days per month of Skilled Nursing Facility days covered (after the Medicare fully covered 20 days), and the Specialty Rx looks better than Basic or Focus, and has out of network coverage as well. This costs over $218 per month more than Basic and over $438 per month more than Focus.

Basic looks like better Specialty Rx than Focus, otherwise they both have zero additional SNF days, and both have no out of network coverage (except for some situations). Basic is over $219 per month more than Focus. Focus does have a higher catastrophic oop limit but not sure how much that matters when on Parts A&B. Focus does also have higher costs in some instances after Medicare Part A is exhausted?

So, I can see some situations where one might be better over the others, but I wonder how many people ever really do a cost comparison?

Anyone see anything else I'm missing?

 

[donheff]

If you don’t get out of network coverage with BCBS Basic I can’t see much of a reason to pop for Part B.

 

[Dreamer]

We both have both parts of Medicare and have BCBS Basic. We each receive $800.00 per year back from the Basic, since we have Medicare.

All of our healthcare providers and hospitals are covered. My DH had to go to Urgent Care in OH and NC and they were covered also.

We are allowed to use the CVS Caremark Pharmacy through the mail, which really helps for one of my DH's medications.

The SNF is the only difference that I am aware of, as long as you stay in network.

 

[zl55lz]

If you don’t get out of network coverage with BCBS Basic I can’t see much of a reason to pop for Part B.

Wouldn't it be just the opposite? In other words, since Basic and Focus don't have out of network coverage, then by having Part B one could then at least see any provider who accepts Medicare and have Part B pay the 80%, thereby reducing the "risk" of having an insurance which does not cover out of network providers?

 

[donheff]

Wouldn't it be just the opposite? In other words, since Basic and Focus don't have out of network coverage, then by having Part B one could then at least see any provider who accepts Medicare and have Part B pay the 80%, thereby reducing the "risk" of having an insurance which does not cover out of network providers?

interesting take. I haven’t done the math since I haven’t needed to go out of network but I would guess the out of network reimbursement rate is equal or close to the Part B 80% If so, still no advantage to Part B that would justify the cost (for me with big IRMAA).

 

[Amethyst]

IRMAA kept me from taking Part B. Even with an $800 rebate from BCBS Basic, that's a big extra premium to pay on top of FEHB.

Basic has no deductible, but co-pays can be large, and Rx drugs had better have a generic or you will get soaked. Fortunately I can change FEHB plans at Open Season, if and when my needs change. You never know what's going to happen.

I used to be part of a two-Fed couple, but I'm curious how high-IRMAA couples handle it, where only one was a Fed? Does the one who wasn't in Federal service, ever drop Medicare B and go on the retired person's FEHB as a plus-one? That would save a lot of dough.

 

[RAE]

I decided to continue with BCBS Basic after retirement, and not get Medicare Part B. Extra monthly cost for Part B just didn't seem to be worth it. I had GEHA some years back, but they tried to force my wife to drive 2+ hours to a clinic that was in their coverage network to get treatment for her broken leg that wasn't healing right, and that wasn't going to happen. So we switched to BCBS Basic, and have been generally satisfied, although the premiums have been creeping up quite a bit lately. Anyway, so far so good with BCBS Basic and no Part B.

 

[zl55lz]

IRMAA does seem to throw a wrench in the equation for some. One of the nice things about Basic, even without Part B, is that one knows up front what the copay/coinsurance will usually be, instead of 10%-40% as in some plans. 10%-40% of what amount?

That is why I repeatedly state that if not taking Part B, I would personally heavily consider the catastrophic oop max for a plan. If one sets that amount aside for that purpose each year, whether self only or self+one/family, then Part B importance diminishes in my opinion, although Part B does appear to cover things which FEHB plans might not in certain situations.

It will be interesting for enrollees to see over the next 5 years where the premiums are going for FEHB. Some plans already appear to be pricing themselves out of favor in my opinion, with $40-$50 per month increases each year. At that rate it won't be long before some of them are $1000 a month for self+one, with increased Part B premiums too?

It is too bad that some of the lower cost value plans and such do not appear to work well with Medicare. Plus, the trend seems to be toward offering more Medicare Advantage options for established plans but with no premium reduction (although they do offer reimbursement funds). I personally don't see any new "regular" cheaper plans being offered in the future which will work well with Medicare. My opinion only. I hope I am wrong. BCBS Focus does seem to be a good option with Parts A&B at this point which is very reasonably priced.

Sometimes I wonder about FEHB plans. They used to be considered the gold standard. However, here in my location a regular "public" Advantage plan is offered through BCBS which covers all our providers and hospitals, the Rx coverage is about as good or better than FEHB, the catastrophic max is about half of FEHB, and the copays/coinsurance are mostly zero or a very reasonable cost. All for zero premium per month. Would just pay Part B.

This is why having Aetna Direct plus Medicare is nice, at least for us. After the $1800 tax free fund each year, currently it is like paying a monthly premium of approx $202 (current premium approx $352 minus $150 average fund per month=approx $202).

 

[donheff]

I used to be part of a two-Fed couple, but I'm curious how high-IRMAA couples handle it, where only one was a Fed? Does the one who wasn't in Federal service, ever drop Medicare B and go on the retired person's FEHB as a plus-one? That would save a lot of dough.

DW has been on my plan since we got married. We have a plus 1 GEHA enrollment know which costs somewhere around $400/month. Adding two high cost Part B plans doesn’t make sense for us.

 

[zl55lz]

As an interesting addition to this thread, it is known that FEHB enrollees who are trying to decide about whether to also enroll in Medicare Part B seem to have a concern about the 10% penalty per year added to the premium if they later do enroll.

Many wonder what will happen later if FEHB mandates Part B enrollment. When the Postal Reform Act was passed last year, some of the provisions, if I read it correctly, were that future Postal Employee retirees, starting 1/01/2025, would be required to also enroll in Parts A&B.

For those postal employees already retired with FEHB, the provision would not apply to them.

However, those postal retirees over 65 on FEHB who do want to enroll in Parts A&B, they will have a one-time opportunity to do so and the late enrollment penalty will be waived!!!

I did not see anything about what happens if someone had enrolled in Part B, then dropped it, then wants to enroll again as to whether any late penalty still applies.

This is not to say that if they mandate A&B enrollment in the future for
NON-POSTAL retirees on FEHB that it will have the same rules but hopefully they could offer something similar.

HOWEVER, I personally would NOT count on this! They might never mandate it in the future for non-postal retirees in which case the 10% penalty per year remains.

 

[Dreamer]

I should have included that IRMAA does not apply to us. I might have looked at it differently if it did apply.

 

[ChrisC]

I'm enrolled in GEHA-Standard, plus 1, with no Part B. My wife, the non-Federal annuitant, is enrolled in Part B. Ever since my wife started Part B, in 2016, we've been subject to IRMAA, with pensions and Roth conversions, despite delaying her SS retirement benefits until 2021 (I'm WEP impacted so my modest SS benefits and her spousal benefits from my SS retirement benefits never moved the needle.) We just got our SSA 1099s for 2022 and she paid over $5K in Part B premiums. She had some minor medical issues last year, but we're sure standalone coverage under GEHA standard would have been far cheaper than premiums paid under Part B. She'll always be in IRMAA tier 3, at minimum, going forward, whether filing jointly or singly.

We annually evaluate whether she should dis-enroll in Part B. I'm comfortable with not enrolling in Part B and don't see any current health insurance benefit to have Part B coverage. She enrolled in Part B when first turned eligible for Medicare; and if we were to ever get divorced (unlikely as we've been married for 47 years), she'd lose coverage under my FEHB plan (and I once thought that her FEHB coverage lapsed if I predeceased her -- but OPM clarified that in its literature on survivor FEHB coverage).

I think if you are not subject to IRMAA, Medicare Part B plus BCBS-Basic (or the new FEHB Medicare Advantage Plans standing alone) might be a good deal, if you can stay in BCBS network and are satisfied with the medical providers. My BIL has Part B and BCBS-Basic and the coverage takes care of all his medical needs with debilitating MS and his confinement in an assisted living facility -- we oversee his care and finances -- and he has no out-of-pocket expenses for expensive drug treatments and PT.

 

[Amethyst]

I presume you have made arrangements so that she can continue on your FEHB plan, if she happens to out live you?

DW has been on my plan since we got married. We have a plus 1 GEHA enrollment know which costs somewhere around $400/month. Adding two high cost Part B plans doesn’t make sense for us.

 

[zl55lz]

I'm enrolled in GEHA-Standard, plus 1, with no Part B. My wife, the non-Federal annuitant, is enrolled in Part B. Ever since my wife started Part B, in 2016, we've been subject to IRMAA, with pensions and Roth conversions, despite delaying her SS retirement benefits until 2021 (I'm WEP impacted so my modest SS benefits and her spousal benefits from my SS retirement benefits never moved the needle.) We just got our SSA 1099s for 2022 and she paid over $5K in Part B premiums. She had some minor medical issues last year, but we're sure standalone coverage under GEHA standard would have been far cheaper than premiums paid under Part B. She'll always be in IRMAA tier 3, at minimum, going forward, whether filing jointly or singly.

We annually evaluate whether she should dis-enroll in Part B. I'm comfortable with not enrolling in Part B and don't see any current health insurance benefit to have Part B coverage. She enrolled in Part B when first turned eligible for Medicare; and if we were to ever get divorced (unlikely as we've been married for 47 years), she'd lose coverage under my FEHB plan (and I once thought that her FEHB coverage lapsed if I predeceased her -- but OPM clarified that in its literature on survivor FEHB coverage).

I think if you are not subject to IRMAA, Medicare Part B plus BCBS-Basic (or the new FEHB Medicare Advantage Plans standing alone) might be a good deal, if you can stay in BCBS network and are satisfied with the medical providers. My BIL has Part B and BCBS-Basic and the coverage takes care of all his medical needs with debilitating MS and his confinement in an assisted living facility -- we oversee his care and finances -- and he has no out-of-pocket expenses for expensive drug treatments and PT.

My general rule of thumb personally is if the amount of Part B premiums is close to or more than the FEHB catastrophic out of pocket max for the year, then Part B might not be worth it, although I could see certain situations where having Part B too even with IRMAA could make sense, such as needing the unlimited possible therapy (physical/speech/occupational) sessions now apparently allowed with Part B, whereas FEHB plans usually seem to have a limit. Of course, if one is in a financial position to be under IRMAA, for many people the cost of Part B too does not pose an issue anyway.

NALC High currently has a catastrophic max for self+one ($5000/yr) which for two is less than the Part B premiums it sounds like you pay just for your spouse. I believe if one or both of us were to go without Part B, then NALC High would be my choice. Seems like great coverage and low out of pocket max. In fact, if there was no Part B penalty of 10% per year, I would still not have Part B and would take NALC High.

That said, both of us being on Part B, Aetna Direct works great, especially with the $1800/yr HRA. There is something to be said for the FEHB/Part B combo and not having any out of pocket other than premiums. Very easy and simple.

 

[ChrisC]

My general rule of thumb personally is if the amount of Part B premiums is close to or more than the FEHB catastrophic out of pocket max for the year, then Part B might not be worth it, although I could see certain situations where having Part B too even with IRMAA could make sense, such as needing the unlimited possible therapy (physical/speech/occupational) sessions now apparently allowed with Part B, whereas FEHB plans usually seem to have a limit. Of course, if one is in a financial position to be under IRMAA, for many people the cost of Part B too does not pose an issue anyway.

NALC High currently has a catastrophic max for self+one ($5000/yr) which for two is less than the Part B premiums it sounds like you pay just for your spouse. I believe if one or both of us were to go without Part B, then NALC High would be my choice. Seems like great coverage and low out of pocket max. In fact, if there was no Part B penalty of 10% per year, I would still not have Part B and would take NALC High.

That said, both of us being on Part B, Aetna Direct works great, especially with the $1800/yr HRA. There is something to be said for the FEHB/Part B combo and not having any out of pocket other than premiums. Very easy and simple.

Thanks for suggesting NALC High as something that might be a good fit for someone in our situation. Catastrophic limits are one thing to consider for one or two people going without Part B coverage. In our case, GEHA works for us in light of its reasonable premium charges, modest dental and hearing aid coverage, and decent drug coverage. We can afford the tier 3, IRMAA hit for one or two of us — we just don’t like flushing money down the toilet for unnecessary or overlapping coverage.

 

[Helen]

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.

 

[Amethyst]

My late DH also did not take Part B and was on BCBS Basic, as was/am I. Fortunately, he was rarely ill until his very last days, when he was admitted to the hospital and later died in hospice. Part A picked up almost all those bills (hospice 100% covered).

He did have one lab that wasn't covered, years ago. It was the particular lab that read his Cologuard results (the Cologuard test, itself, was covered). That reading cost us over $700 out of pocket. This taught me a valuable lesson: always ask first if a test interpretation will be covered.

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.

 

[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.

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.