Federal retiree health insurance

[Brat]

Kaiser health insurance, drilling down on the details.

The local Kaiser plans are Kaiser NW. They have a Medicare Advantage offering available to all who have Medicare A & B with a + option which includes dental, hearing aids, and glasses benefits.

The Federal Kaiser NW has several enrollment types and for those who choose Standard and High options and have Medicare A & B they have a Senior Advantage contract where you are reimbursed for what you pay for Medicare B (up to $175). Senior Advantage folks can purchase their dental insurance. This insurance does not include a hearing aid benefit, glasses are covered in the medical policy.

My husband has been on the Medicare Advantage + contract. He uses and purchased his hearing aids at Kaiser. This year that will cost $88/mo

My estimate of his share of the FEHB Kaiser Senior Advantage insurance, including dental, will be $93/mo ---- without access to Kaiser's hearing aid sales staff.

As much as I would like him to have access to FEHB in the future I wonder if it makes financial sense. He is happy with Kaiser and they have given him great care.

Opinions folks...

[W2R]

Quote:

Originally Posted by Brat As much as I would like him to have access to FEHB in the future I wonder if it makes financial sense. He is happy with Kaiser and they have given him great care. Opinions folks...

My opinion is probably useless, but here are my thoughts.

We don't have Kaiser in New Orleans, but we have another Medicare Advantage plan here that is very popular and cheap. Frank is not a retired fed and he is on a bare bones budget in retirement, so he went with that one (we are not married). His doctors and labs are all accepted by that plan.

I am doing FEHB with BCBS Standard (secondary to Medicare). This plan is expensive and I pay much more than he does. I don't care because I can afford it and the difference in price does not affect my lifestyle at all.

I do not pay a cent for appointments, labs, surgeries, or anything else medical, except for my share of prescription expenses. I love not having a deductible or co-pay (both of which Frank has), although overall I am probably paying more for these little luxuries than I am saving when you consider the difference in premiums. Still, it's a great feeling to be told on the way out the door after a medical appointment or procedure, that I don't owe a cent.

Hopefully my FEHB plan is more stable than F's plan. I don't ever want to spend any time looking for another one. That's worth a lot to me. If his plan ever craters, he wouldn't mind reading about other plans and choosing another one. But to me, that would be sheer h*ll and it is worth some $$ to never have to do that again. On the other hand, Kaiser has been around since dirt was young and is probably pretty stable too. I like their wellness-based approach although I don't know how well they perform if a person has something serious and expensive, like terminal cancer or some such thing. You would know more about that than me.

My father has been dead for 40 years; he was a surgeon and his opinion was that any really good doctor would have his own practice, rather than working at Kaiser, because he would make more money with his own practice. I have no idea whether that statement has any validity or if he was full of baloney, but just thought I'd mention it so you could decide what you think about that.

So, to summarize my opinion - - neither is the best choice for everyone. If you can afford it I prefer FEHB. Others disagree, and maybe you have other ideas of how you want to spend your money.

[steelyman]

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Originally Posted by W2R My opinion is probably useless, but here are my thoughts.

Au contraire, NOLA lady! Your opinions are well regarded in these parts!

[W2R]

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Originally Posted by steelyman Au contraire, NOLA lady! Your opinions are well regarded in these parts!

Wow!!!! You just made my day!

[Brat]

Yes, Kaiser has been around since 1945-. We raised our kids on Kaiser, left only because we moved out of their service area. Moved back about 10 years ago.

My only issue with Kaiser after our return was the availability of dermatologists and the inability of my PCP to cure a skin condition - not serious but on my face. Moved to GEHA, found a dermatologist who cured the skin condition. I probably could have seen that dermatologist and paid full fee just to fix that issue while on Kaiser. Too late smart, as my Mother would say.

GEHA is great insurance BUT that puts the responsibility on the insured to find a physician who takes Medicare B as primary.

In our area, Kaiser receives lots of health care professional applications. They are very picky. Kaiser offers good schedules, physicians can have a family life. That isn't to say that at times they ask a lot but that is true of every practice.

We have a friend who was in private practice. His bookkeeper bankrupted the practice so he joined one of the local medical groups and did OK but he was basically salaried. My uncle was a physician & surgeon in Eugene. When he retired my aunt discovered that he spent all he earned. Physicians are rarely good at business. Add that to the cost of malpractice insurance. There is a reason why physicians practice in groups.

If I took the time to compare the FEHB Kaiser plan to the Medicare Advantage plan I would probably find that the FEHB plan has better hospital benefits, for example. Years ago I did a spreadsheet and found that the differences were usually cost neutral if you used the benefit. The one thing I know is that my husband will need to replace those hearing aids in a year or two so he would miss that benefit.

As we all look forward to Covid19 vaccine I am confident that Kaiser will use data to distribute what they receive. If they call we will raise an arm.

[Golden sunsets]

Quote:

Originally Posted by W2R My opinion is probably useless, but here are my thoughts. We don't have Kaiser in New Orleans, but we have another Medicare Advantage plan here that is very popular and cheap. Frank is not a retired fed and he is on a bare bones budget in retirement, so he went with that one (we are not married). His doctors and labs are all accepted by that plan. I am doing FEHB with BCBS Standard (secondary to Medicare). This plan is expensive and I pay much more than he does. I don't care because I can afford it and the difference in price does not affect my lifestyle at all. I do not pay a cent for appointments, labs, surgeries, or anything else medical, except for my share of prescription expenses. I love not having a deductible or co-pay (both of which Frank has), although overall I am probably paying more for these little luxuries than I am saving when you consider the difference in premiums. Still, it's a great feeling to be told on the way out the door after a medical appointment or procedure, that I don't owe a cent. Hopefully my FEHB plan is more stable than F's plan. I don't ever want to spend any time looking for another one. That's worth a lot to me. If his plan ever craters, he wouldn't mind reading about other plans and choosing another one. But to me, that would be sheer h*ll and it is worth some $$ to never have to do that again. On the other hand, Kaiser has been around since dirt was young and is probably pretty stable too. I like their wellness-based approach although I don't know how well they perform if a person has something serious and expensive, like terminal cancer or some such thing. You would know more about that than me. My father has been dead for 40 years; he was a surgeon and his opinion was that any really good doctor would have his own practice, rather than working at Kaiser, because he would make more money with his own practice. I have no idea whether that statement has any validity or if he was full of baloney, but just thought I'd mention it so you could decide what you think about that. So, to summarize my opinion - - neither is the best choice for everyone. If you can afford it I prefer FEHB. Others disagree, and maybe you have other ideas of how you want to spend your money.

W2R; Have you checked out Aetna Direct as an FEHB option? Even BCBS Basic would be less expensive than BCBS Standard with equal coverage, but both pale by comparison to Aetna Direct. On Aetna Direct, because Medicare A&B are primary, we pay zero for deductibles and co-pays, and pay $2 for a 90 day supply of generic drugs plus we receive a $900 subsidy per person per year to offset Medicare premiums. The BCBS standard premium for a single(104) is $267.48 for 2021. BCBS Basic single is $170.31. We initially switched from Standard to Basic after turning 65 and we never had any costs other than prescription copays once we switched to basic. Then along came Aetna Direct(N61) a few years later. We switched and have never regretted it. The single premium for 2021 is $153.96 less the $900 Annual reimbursement, or $75/mo equals a net monthly payment of $78.96/mo, or a savings of $2,262 annually for exactly the same coverage. Most of our federal retiree colleagues have switched to Aetna Direct and have had no issues. You will find the option under HMO plans by State. Keep in mind that once on Medicare there are no restrictions on doctor networks as long as the Dr accepts Medicare. Check it out.

[W2R]

Quote:

Originally Posted by Golden sunsets Have you checked out Aetna Direct as an FEHB option? Even BCBS Basic would be less expensive than BCBS Standard with equal coverage, but both pale by comparison to Aetna Direct. On Aetna Direct, because Medicare A&B are primary, we pay zero for deductibles and co-pays, and pay $2 for a 90 day supply of generic drugs plus we receive a $900 subsidy per person per year to offset Medicare premiums. The BCBS standard premium for a single(104) is $267.48 for 2021. BCBS Basic single is $170.31. We initially switched from Standard to Basic after turning 65 and we never had any costs other than prescription copays once we switched to basic. Then along came Aetna Direct(N61) a few years later. We switched and have never regretted it. The single premium for 2021 is $153.96 less the $900 Annual reimbursement, or $75/mo equals a net monthly payment of $78.96/mo, or a savings of $2,262 annually for exactly the same coverage. Most of our federal retiree colleagues have switched to Aetna Direct and have had no issues. You will find the option under HMO plans by State. Keep in mind that once on Medicare there are no restrictions on doctor networks as long as the Dr accepts Medicare. Check it out.

I know I am unusually adverse to doing this sort of thing... so it's truly hard/impossible for most people to grasp, but the last thing I want to do with my precious time left on this earth is to read and compare health insurance policies! Frankly I'd rather jump off a cliff, after drinking six gallons of cyanide, chopping off all my limbs, rolling in a mountain of fire ants, and setting my hair afire while listening to ear splitting rap music. Besides, I have ZERO desire to switch from my present policy, which I am used to and find totally satisfactory and frankly the premiums are peanuts to me. I went through the torture of checking out all options when I enrolled, saw HUGE differences in the coverage that you do not see, and that's all that I am going to do on this front. Doing it again would be beating my head against the wall for no reason. Thanks for the advice but I'm not interested.

This is not the "W2R wants critiques of her health insurance decisions" thread; this is the "Brat wants to know if her DH should go FEHB or not" thread.

[Golden sunsets]

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Originally Posted by W2R I know I am unusually adverse to doing this sort of thing... so it's truly hard/impossible for most people to grasp, but the last thing I want to do with my precious time left on this earth is to read and compare health insurance policies! Frankly I'd rather jump off a cliff, after drinking six gallons of cyanide, chopping off all my limbs, rolling in a mountain of fire ants, and setting my hair afire while listening to ear splitting rap music. Besides, I have ZERO desire to switch from my present policy, which I am used to and find totally satisfactory and frankly the premiums are peanuts to me. I went through the torture of checking out all options when I enrolled, saw HUGE differences in the coverage that you do not see, and that's all that I am going to do on this front. Doing it again would be beating my head against the wall for no reason. Thanks for the advice but I'm not interested. This is not the "W2R wants critiques of her health insurance decisions" thread; this is the "Brat wants to know if her DH should go FEHB or not" thread.

Wow. Well if a $2200/yr savings is not worth 2 hours of using the comparison tool to see the benefits of a change, then I guess there isn't much that would sway you. I don't think that it's rocket science to come to a conclusion each November. Our savings is double what yours would be as Self plus 1, so over $4400/yr. which over time does add up. But to each his own. C'est la vie.

[W2R]

Quote:

Originally Posted by Golden sunsets Wow. Well if a $2200/yr savings is not worth 2 hours of using the comparison tool to see the benefits of a change, then I guess there isn't much that would sway you. I don't think that it's rocket science to come to a conclusion each November. Our savings is double what yours would be as Self plus 1, so over $4400/yr. which over time does add up. But to each his own. C'est la vie.

I know. Hard to imagine that others might have different reasons for making their health insurance choices, especially when they haven't told you a thing about it and don't plan to. Do you have anything to convey to Brat, who is looking for opinions and advice?

[grayv]

did you include the deductibles/copays/max-out-of-pocket when you were comparing the costs?

[Gumby]

Quote:

Originally Posted by Golden sunsets Wow. Well if a $2200/yr savings is not worth 2 hours of using the comparison tool to see the benefits of a change, then I guess there isn't much that would sway you. I don't think that it's rocket science to come to a conclusion each November. Our savings is double what yours would be as Self plus 1, so over $4400/yr. which over time does add up. But to each his own. C'est la vie.

I, for one, value simplicity and continuity in my life. Given my assets, I have no need and no desire to maximize every last penny. If I were cutting it closer to the bone, I might be concerned. I suspect W2R shares my views.

[Dreamer]

Golden Sunsets: I don't want to derail this thread, but thanks for the info on this insurance and your experience with BC/BS Basic. I am going to be looking at the different plans this weekend.

Brat: I am sorry, but I don't have any advice for you. Good luck.

[Brat]

I gave this as an example of the importance of taking a close look at seemingly identical offerings. DH has said he wants to stay on the Kaiser Medicare Advantage + plan he has so now I need to change my FEHB from family to self only.

Sigh....

[Golden sunsets]

Quote:

Originally Posted by W2R I know. Hard to imagine that others might have different reasons for making their health insurance choices, especially when they haven't told you a thing about it and don't plan to. Do you have anything to convey to Brat, who is looking for opinions and advice?

I know nothing about Kaiser, so no advice. It certainly is true that your providers have to accept Medicare, for Aetna Direct to waive all co-pays and deductibles. In my area, all of our providers accept Medicare, so it isn't an issue. If that weren't true, then the benefits of Aetna Direct's coverage would not be as clear-cut. I think I mentioned that fact in my description of the advantages of the plan.

[Golden sunsets]

Quote:

Originally Posted by grayv did you include the deductibles/copays/max-out-of-pocket when you were comparing the costs?

If your question is directed to me, the answer is yes. There are no deductibles and there are no co-pays for in network providers, (all providers are in network as long as you have Medicare B and your docs and providers accept Medicare). Prescriptions, have co-pays and those co-pays at least for us beat BCBS plan co-pays. All of my and DH's co-pays are either 0 or $2 for a 90 day supply. Statins have a 0 copay. My oop for prescriptions this year is $32.00. Meds that are not generic, but Preferred brand name have a copay of 30%, with a max of $100 for a 90 day supply, and nonbrand name drugs have a copay of 50%, with a max of $200 for a 90 day supply. The drug formulary is on line and easy to use to check out what your med copays would be. Max out of pocket is $6,000 pp, but doesn't affect us due to our limited prescription copays. Aetna's customer service is top notch and their reimbursement of the $1,800 subsidy occurs within a couple of weeks of filing the claim. The FEHB codes for Aetna Direct are N61, N62 AND N63.

NOTE: I would never suggest that any federal retiree annuitant switch plans to Aetna or any other plan without doing their own analysis and OPM provides many tools to make the comparison if not easy, then at least fairly transparent.