Federal retirees: What steps need I take to get Medicare?

[Amethyst]

I turn 65 at the end of 2021. Suddenly the mailbox is full of stuff like "Come to this seminar: What to Expect as You Enter Medicare." Makes Medicare sound like an old folks' home, that swallows you up.

As a Federal retiree who already pays FEHB premiums, I realize I can pay a Medicare premium too, and Medicare then becomes my primary insurer. I suppose this is a good thing, although my husband never went on Medicare and goes to the same doctors, etc. that I do. We just pay FEHB co-pays.

Does Medicare only pick up your FEHB co-pays, or do you actually get more medical care/drug coverage with both coverages?

How complicated is it? What exactly do I need to do, to get Medicare? What application do I need to fill out?

Don't wanna respond to one of these mailed ads; they are just looking to take my money.

Thanks,

Amethyst

 

[Redbugdave]

I have BCBS Basic. For Medicare, you have a window of time to enroll. Like 3 months before your 65th birthday, (and some time after, I believe). You just go on-line and sign up through the Social Security website. I get $800 back each year from BCBS for proving I have Medicare and also using BCBS. Just about everything is covered with both. Medicare becomes the primary.

 

[Amethyst]

What is the "everything" that FEHB doesn't already cover? Just co-pays, or do they cover services and Rx that FEHB doesn't?

I have BCBS Basic. For Medicare, you have a window of time to enroll. Like 3 months before your 65th birthday, (and some time after, I believe). You just go on-line and sign up through the Social Security website. I get $800 back each year from BCBS for proving I have Medicare and also using BCBS. Just about everything is covered with both. Medicare becomes the primary.

 

[donheff]

Different strokes for different folks. DW and I have FEHB (GEHA) and Medicare Part A at no charge. We do not have Part B. Part A covers hospital stays, and FEHB covers everything else in the same way it does for employees. Most Feds take (and pay for) Part B. The carriers waive all deductibles and copays if you do. In our case, when DW's RMDs kick in we would pay a boatload for Part B so it didn't seem worthwhile. If you decline Part B you have to specifically advise SSA when you sign up. You will pay a stiff penalty to sign up later if you change your mind.

 

[Amethyst]

Now, that is something I need to look into.

In our case, when DW's RMDs kick in we would pay a boatload for Part B so it didn't seem worthwhile. .

 

[teej1985]

Different strokes for different folks. DW and I have FEHB (GEHA) and Medicare Part A at no charge. We do not have Part B. Part A covers hospital stays, and FEHB covers everything else in the same way it does for employees. Most Feds take (and pay for) Part B. The carriers waive all deductibles and copays if you do. In our case, when DW's RMDs kick in we would pay a boatload for Part B so it didn't seem worthwhile. If you decline Part B you have to specifically advise SSA when you sign up. You will pay a stiff penalty to sign up later if you change your mind.

Only some FEHB plans waive deductibles and co-pays. It's imporant to pick the right FEHB plan when you have medicare. If you're in heavy IRMAA territory, I'd probably pass on Part B.

 

[ABQ2015]

Finding out what exactly Medicare pays for that is not paid by FEHB is not an easy task. From the OPM website:

"Generally, plans under the FEHB Program help pay for the same kind of expenses as Medicare. FEHB plans also provide coverage for emergency care outside of the United States which Medicare doesn't provide. Some FEHB plans also provide coverage for dental and vision care. Medicare covers some orthopedic and prosthetic devices, durable medical equipment, home health care, limited chiropractic services, and some medical supplies, which some FEHB plans may not cover or only partially cover (check your plan brochure for details)."

I signed up for Medicare Part B in 2020 and kept my FEHB. One of my concerns was that if FEHB plans become less attractive at some future date and I want/need to sign up for Medicare Part B or vice versa, I would have to pay a large penalty for Part B or would have lost my FEHB eligibility. I also wanted good health insurance coverage since two of my siblings have died from cancer and there is some family history of strokes.

To partially compensate for the Part B premiums, I changed to a Medicare friendly FEHB plan (Aetna Direct similar to BCBS Basic and a GEHA option) that was $1200/year less than my previous HDHP for Self Only. With Aetna Direct, I do not pay deductibles or co-insurance (except for prescriptions), including out of network, and get a $900/year medical fund which can be used to pay for any out of pocket health expenses and a portion of the Medicare Part B premiums.

I signed up online for Medicare a couple of months before turning 65 which was easy. The hard part was changing my FEHB insurance before the annual open season. Turning age 65 or signing up for Medicare is considered a Qualifying Life Event. This required calling OPM and being on hold for 20-30 minutes. Then I had to call again because I had called too early to make the change in September. But I got the entire $900 medical fund in 2020. I thought it would be prorated.

 

[Osprey]

Consumers’ Checkbook evaluates federal employee health insurance plans and discusses decision regarding Medicare part B. When I have to make this decision, I plan on looking at this resource.

 

[Golden sunsets]

Find out what exactly Medicare pays for that is not paid by FEHB is not an easy task. From the OPM website:

"Generally, plans under the FEHB Program help pay for the same kind of expenses as Medicare. FEHB plans also provide coverage for emergency care outside of the United States which Medicare doesn't provide. Some FEHB plans also provide coverage for dental and vision care. Medicare covers some orthopedic and prosthetic devices, durable medical equipment, home health care, limited chiropractic services, and some medical supplies, which some FEHB plans may not cover or only partially cover (check your plan brochure for details)."

I signed up for Medicare Part B in 2020 and kept my FEHB. One of my concerns was that if FEHB plans become less attractive at some future date and I want/need to sign up for Medicare Part B or vice versa, I would have to pay a large penalty for Part B or would have lost my FEHB eligibility. I also wanted good health insurance coverage since two of my siblings have died from cancer and there is some family history of strokes.

To partially compensate for the Part B premiums, I changed to a Medicare friendly FEHB plan (Aetna Direct similar to BCBS Basic and a GEHA option) that was $1200/year less than my previous HDHP for Self Only. With Aetna Direct, I do not pay deductibles or co-insurance (except for prescriptions) and get a $900/year medical fund which can be used to pay for any out of pocket health expenses and a portion of the Medicare Part B premiums.

I signed up online for Medicare a couple of months before turning 65 which was easy. The hard part was changing my FEHB insurance before the annual open season. Turning age 65 or signing up for Medicare is considered a Qualifying Life Event. This required calling OPM and being on hold for 20-30 minutes. Then I had to call again because I had called too early to make the change in September. But I got the entire $900 medical fund in 2020. I thought it would be prorated.

We also took Medicare Part B and switched to Aetna Direct. For 2 people we get $1,800/year back as a subsidy to partially cover Medicare Part B premiums. But as someone observed above, we are in IRMAA territory for elevated Part B premiums. We have been reluctant to forego Part B because of the stiff penalty if circumstances change. If you won't enter IRMAA territory, then Part B plus either Aetna Direct, or BCBS Basic is the most cost effective. But do check your docs acceptance of these plans. I've never run into a doc who doesn't accept our plan. YMMV.

 

[Amethyst]

What is IRMAA?

Never mind; I looked it up. It appears we'd be affected.

Only some FEHB plans waive deductibles and co-pays. It's imporant to pick the right FEHB plan when you have medicare. If you're in heavy IRMAA territory, I'd probably pass on Part B.

 

[Amethyst]

This looks like the biggie.

Finding out what exactly Medicare pays for that is not paid by FEHB is not an easy task. From the OPM website:

home health care,

 

[donheff]

This looks like the biggie.

Home health Care

I'm not sure home much of this Part B provides. We picked up the Federal Long Term Care Policy so we already have it covered.

 

[Amethyst]

I vaguely recall my mother qualifying for 100 days of HHC under Medicare when she was living at a sibling's home 20-some years ago. (What sticks in my mind, is that she hated it, rejected every aide who came).

That was so long ago, it may not even be the same benefit now.

I'm not sure home much of this Part B provides. We picked up the Federal Long Term Care Policy so we already have it covered.

 

[RAE]

I have BCBS Basic. For Medicare, you have a window of time to enroll. Like 3 months before your 65th birthday, (and some time after, I believe). You just go on-line and sign up through the Social Security website. I get $800 back each year from BCBS for proving I have Medicare and also using BCBS. Just about everything is covered with both. Medicare becomes the primary.

I assume we are talking about Medicare Part B here, which has a monthly cost. Medicare Part A (hospitalization) is free, but you still need to apply for it.


I also have BCBS Basic, and I chose to only get Medicare Part A, after reviewing my options, and considering my health situation, etc. Others may choose to pay for Medicare Part B, which is fine if you think you will need it.

 

[Involuntary Retiree]

I assume we are talking about Medicare Part B here, which has a monthly cost. Medicare Part A (hospitalization) is free, but you still need to apply for it.


I also have BCBS Basic, and I chose to only get Medicare Part A, after reviewing my options, and considering my health situation, etc. Others may choose to pay for Medicare Part B, which is fine if you think you will need it.

But how does one ultimately know? This is a decision I don't have to make for a few years, but, at this point, I'm inclined to have Medicare Part B combined with FEHB coverage because there are no out-of-pocket deductibles or copays at all. However, I've read opinions in favor of federal retirees declining Part B and opining that is a "no brainer" decision. The jury is still out for me in this regard.

 

[ABQ2015]

This is an article from the Consumers' Checkbook site that Osprey mentioned that discusses pros and cons of enrolling in Part B:

https://www.checkbook.org/newhig2/y...itants-enroll-in-medicare-part-b-after-age-65

The bottom line financially is: "However, Medicare Part B will rarely save you nearly as much money as you spend on the Part B premium. This is because the cost sharing for physician visits and tests in almost all FEHB plans is already so low. And as we discuss below, for those who pay more for Part B than the normal premium, it is almost always a bad buy in purely financial terms."

But the article goes on to state some advantages such as more freedom to go outside the FEHB plan network at reduced or no additional cost, protection in case of future cuts to the FEHB Program, etc. and maybe just more "peace of mind."

 

[CRLLS]

This is an article from the Consumers' Checkbook site that Osprey mentioned that discusses pros and cons of enrolling in Part B:

https://www.checkbook.org/newhig2/y...itants-enroll-in-medicare-part-b-after-age-65

The bottom line financially is: "However, Medicare Part B will rarely save you nearly as much money as you spend on the Part B premium. This is because the cost sharing for physician visits and tests in almost all FEHB plans is already so low. And as we discuss below, for those who pay more for Part B than the normal premium, it is almost always a bad buy in purely financial terms."

But the article goes on to state some advantages such as more freedom to go outside the FEHB plan network at reduced or no additional cost, protection in case of future cuts to the FEHB Program, etc. and maybe just more "peace of mind."

I'm am not and was never a federal employee. The highlighted could be said about any insurance plan; health, home, auto etc. If I can comfortably cover the premiums, it is a no brainer to just get the best coverage I can even iif some of it overlaps with another policy.

 

[donheff]

The highlighted could be said about any insurance plan; health, home, auto etc. If I can comfortably cover the premiums, it is a no brainer to just get the best coverage I can even iif some of it overlaps with another policy.

Most feds agree and pop for Part B. But that isn't where my analysis took me. I concluded that I had been happy with my FEHB policy for 30 years and saw no reason why I wouldn't be in retirement. The Part B got us some additional benefits but would cost us a bundle. The worst case scenario wasn't bad so why pop the extra money. Rather than comparing it to auto insurance vs no auto insurance, I would say the better analogy would be paying a lot extra for auto insurance that guarantees no out of pocket expenses.

 

[Amethyst]

Our retirement seminars at work, left huge gaps in this topic. The only thing that sticks with me is being told "After you turn 65, FEHB will only compensate doctors for the amount that Medicare will compensate them, which will limit your choice of doctors" but we are already in a preferred provider plan that accepts both.

But how does one ultimately know? This is a decision I don't have to make for a few years, but, at this point, I'm inclined to have Medicare Part B combined with FEHB coverage because there are no out-of-pocket deductibles or copays at all. However, I've read opinions in favor of federal retirees declining Part B and opining that is a "no brainer" decision. The jury is still out for me in this regard.

 

[donheff]

Our retirement seminars at work, left huge gaps in this topic. The only thing that sticks with me is being told "After you turn 65, FEHB will only compensate doctors for the amount that Medicare will compensate them, which will limit your choice of doctors" but we are already in a preferred provider plan that accepts both.

The doctors are compensated at the Medicare rate but if they are in network they have to take you - part of the deal. So the question is are you happy with your network. To me the biggest benefit with Part B is that BCBS and GEHA will pay for out of network costs for any doc who accepts Medicare. But living in DC I have never had a problem with network coverage.

 

[RAE]

Most feds agree and pop for Part B. But that isn't where my analysis took me. I concluded that I had been happy with my FEHB policy for 30 years and saw no reason why I wouldn't be in retirement. The Part B got us some additional benefits but would cost us a bundle. The worst case scenario wasn't bad so why pop the extra money. Rather than comparing it to auto insurance vs no auto insurance, I would say the better analogy would be paying a lot extra for auto insurance that guarantees no out of pocket expenses.

Yep, I agree with your analysis, Donheff, which is why I made the same decision you did. No Part B for me.

 

[Redbugdave]

I assume we are talking about Medicare Part B here, which has a monthly cost. Medicare Part A (hospitalization) is free, but you still need to apply for it.


I also have BCBS Basic, and I chose to only get Medicare Part A, after reviewing my options, and considering my health situation, etc. Others may choose to pay for Medicare Part B, which is fine if you think you will need it.

Yes...I also have the Medicare Part B and BCBS Basic. That is why I get the $800 refund each year from BCBS. I might also add: If you spouse is under your plan and also has Medicare Part B...that is another $800 into their checking account.

You can read up about it some here, (opens as a PDF):
https://www.fepblue.org/our-plans/m...f?la=en&hash=CF0E3532EE5CED60EA88ECB582A78722

 

[grayv]

fyi, some bcbs plans have an in-network limitation.

https://www.fepblue.org/our-plans/benefits-plan-overview

 

[teej1985]

The doctors are compensated at the Medicare rate but if they are in network they have to take you - part of the deal. So the question is are you happy with your network. To me the biggest benefit with Part B is that BCBS and GEHA will pay for out of network costs for any doc who accepts Medicare. But living in DC I have never had a problem with network coverage.

Only BCBS Standard pays out of network. BCBS Basic and Focus do not. Even if you have Medicare.

 

[RAE]

Only BCBS Standard pays out of network. BCBS Basic and Focus do not. Even if you have Medicare.

I have BCBS Basic coverage, and we have never had a problem finding network coverage anywhere we have been in the USA so far.


BCBS Basic does reimburse you $800 if you have Medicare Part B, but that is less than half what Medicare Part B would cost me each year.