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FEHB and Medicare
Old 10-17-2017, 05:14 AM   #1
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FEHB and Medicare

Good Morning -

I am a (happily) retired federal worker on FERS. My DW is about to turn 65 so we are at the Medicare decision point. We currently have BC/BS Standard.

I have read a lot of online experiences about FEHB and Medicare and been great source of information.

Right now my plan is to sign DW up for Part A. The question is what to do about Part B. In its simplest terms I thought it be basically a comparison of estimated Part B yearly premium expense (I estimate about $1800) compared to current or expected BC/BS copays/out of pocket expenses for my DW. The assumption if we pay for DW on Part B as primary, then BCBS would be secondary and take care of all the copays,... versus stay solely on BCBS and we continue the copays.

Now the complication. Most of her doctors are with a group and they say they are Medicare Non-Par Status. From reading the fine print this means that they have a Limiting Charge of 115% of Medicare allowable charge.

So, in my small brain, I think this means that Medicare Part B and BCBS would only cover the 100% portion and we still get stuck with the 15%.

For instance, say dr visit was $100 Medicare Allowable Charge. Medicare pays $80 (80%), BCBC pays $20, and we are left with a $15 charge. Am I reading this correctly?

Cause if this the case seems to me I am paying BCBS premiums and still getting stuck with copays,... cause of the Non Par 115% Allowable Charge. Then why pick up Medicare Part B. Maybe time for new medical doctors group.

Appreciate anyone advise on folks who have dealt with this Non Par status.

Thanks
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Old 10-17-2017, 06:28 AM   #2
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I don't know what all this non par stuff is. For DW and myself I went with Medicare Part A only because we would have to pay a lot for Part B and the copays and deductibles won't come close to making up for it.The way I looked at it is that I was happy with my health plan while working so I may as well stick with it in retirement. I did do quite a bit of research on the topic 5 years ago when I was making the decision for myself. People whose opinions I respect advocated that decision (including the author of the Consumer's Checkbook guide to FEHB plans who gave a talk on the subject). The dollars clearly worked out on the Part A side only. About the only factor that gave me pause is that I need to stick with my FEHB network to get the best costs. But GEHA and BCBS will cover the extra costs for out of network providers if you take Part B so your options are wider. I live in DC where doctors participating in FEHB plans are abundant so that hasn't been a problem.

Naturally, I second guess my decision all the time. I believe about 70% of Fed retirees go with Part B - do they see something I don't? Each year the Part B costs go up 10% so it becomes more and more costly to change your decision as years go by. Could Congress cripple the FEHB for retirees and, if so, would they give us a penalty free opportunity to sign up for B? Either way you will probably be in good shape.
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Old 10-17-2017, 06:30 AM   #3
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A participating provider always accepts assignment of payment. A non-participating provider can either accept assignment (5% of them) or not accept assignment (95% of them). When the group said they are non-par they probably meant they do not accept claim assignment making you responsible for the "Part B excess" charge. From OPM:

Quote:
Will My FEHB Fee-For-Service Plan Cover All My Out-Of Pocket Costs Not Covered by Medicare?

Not always. A fee-for-service plan's payment is typically based on allowable charges, not billed charges. In some cases, Medicare's payment and the plan's payment combined will not cover the full cost.

Your out-of-pocket costs for Part B services will depend on whether your doctor accepts Medicare assignment. When your doctor accepts assignment, you can be billed only for the difference between the Medicare-approved amount and the combined payments made by Medicare and your FEHB plan.

When your doctor doesn't accept assignment, you can be billed up to the difference between 115 percent of the Medicare approved amount (limiting charge) and the combined payments made by Medicare and your FEHB plan.

Source: https://www.opm.gov/healthcare-insur...fehb-benefits/
Quote:
Non-Participating (NON-PAR)

If you choose not to become a participating provider in the Medicare program, you may choose either to accept or not accept assignment on Medicare claims.

If you choose not to participate in the Medicare program AND do not accept assignment on your claims, the maximum amount you may charge is 115 percent of the approved fee schedule amount for non-participating providers. This amounts to only 9.25 percent more than the fee schedule amount for participating providers (115% x 95%). So in the following example, a non-participating provider would only receive $9.25 more than the participating provider would.

Reference: https://www.cahabagba.com/part-b/enr...pating-part-b/
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Old 10-17-2017, 06:51 AM   #4
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About the only factor that gave me pause is that I need to stick with my FEHB network to get the best costs. But GEHA and BCBS will cover the extra costs for out of network providers if you take Part B so your options are wider.

This may be big if you travel. Or if the network or benefit changes. I have the VA and it's a no-brainer that I take medicare part B when the time comes.
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Old 10-17-2017, 06:54 AM   #5
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Originally Posted by donheff View Post
Naturally, I second guess my decision all the time. I believe about 70% of Fed retirees go with Part B - do they see something I don't? Each year the Part B costs go up 10% so it becomes more and more costly to change your decision as years go by. Could Congress cripple the FEHB for retirees and, if so, would they give us a penalty free opportunity to sign up for B? Either way you will probably be in good shape.
I am starting Medicare in December, and I decided to go with Part B. Primarily because I didn't want to run afoul of the Part B late enrollment penalty should Congress wreck the FEHB or some other unforeseeable thing happen. To partially mitigate the Part B premiums, I changed my FEHB to a cheaper one (GEHA Standard) than I had previously. And GEHA (among some other plans) waives copays and deductibles if I have Part B.

edit: FYI: when looking at what to do at 65 I noticed the Aetna Direct FEHB plan that could have worked better with Part B if my spouse and I were both on Medicare. We are not, so I passed it by. I'm not endorsing this, but I thought it was an interesting and unique approach if both spouses were on Medicare. http://www.aetnafeds.com/aetna-direct.php
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Old 10-17-2017, 07:39 AM   #6
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DH and I are both over 65, on Medicare A&B and downgraded to FEHB BCBS Basic once we were both 65. We looked very carefully at Aetna Direct last year and decided to wait a year. I spoke with a retired fed coworker who did make the switch last year and he has had a good experience, so we will switch this year. Not only are the premiums less and all co-pays and deductibles wAived(except prescription copays), but the company gives you $900 per person per year in an HSA, which can be claimed in January and used to offset Medicare premiums. This account reduces overall healthcare costs pretty significantly. One caveat, however: your Dr's must accept Medicare assignment. That point is key. We have never experienced any DR's who don't, but the OP would not be a good candidate for this plan


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Old 10-17-2017, 07:43 AM   #7
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We have BCBS Basic and receive no such benefits. Our copays are substantial. Are the benefits reserved for people who also have Medicare?

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Originally Posted by Golden sunsets View Post
DH and I are both over 65, on Medicare A&B and downgraded to FEHB BCBS Basic once we were both 65. ...Not only are the premiums less and all co-pays and deductibles wAived(except prescription copays), but the company gives you $900 per person per year in an HSA, which can be claimed in January and used to offset Medicare premiums.
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Old 10-17-2017, 07:49 AM   #8
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This may be big if you travel. Or if the network or benefit changes. I have the VA and it's a no-brainer that I take medicare part B when the time comes.
I don't have Part B and have no problem with travel (FEHB covers overseas medical). I got billed by a hospital in France for a busted shoulder and GEHA picked it up.
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Old 10-17-2017, 08:01 AM   #9
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Quote:
Originally Posted by Golden sunsets View Post
DH and I are both over 65, on Medicare A&B and downgraded to FEHB BCBS Basic once we were both 65. We looked very carefully at Aetna Direct last year and decided to wait a year. I spoke with a retired fed coworker who did make the switch last year and he has had a good experience, so we will switch this year. Not only are the premiums less and all co-pays and deductibles wAived(except prescription copays), but the company gives you $900 per person per year in an HSA, which can be claimed in January and used to offset Medicare premiums. This account reduces overall healthcare costs pretty significantly. One caveat, however: your Dr's must accept Medicare assignment. That point is key. We have never experienced any DR's who don't, but the OP would not be a good candidate for this plan


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Huh? I thought over 65 and Medicare eligible meant no HSA contributions allowed.
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Old 10-17-2017, 08:51 AM   #10
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Huh? I thought over 65 and Medicare eligible meant no HSA contributions allowed.
You are correct about HSA and medicare. Apparently the vehicle for people over 65 on medicare is an Health Reimbursement Arrangement (HRA). https://www.opm.gov/healthcare-insur...t-arrangement/

Also, I found this 'Federal Soup' forum on the Aetna Direct Plan https://forum.federalsoup.com/defaul...240#post825762
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Old 10-17-2017, 09:00 AM   #11
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We have BCBS Basic and receive no such benefits. Our copays are substantial. Are the benefits reserved for people who also have Medicare?
Yes, some FEHB plans waive the copays and deductibles if a person has BOTH medicare part A & B. Because FEHB plans do not reduce their rates when they become secondary to Medicare. I suppose this is a way to keep people from cancelling their FEHB and going to an advantage plan.

And anecdotally, I have had a Financial planner and a Blue Cross representative tell me that if a person does not pick up medicare, than their FEHB plan sticks to the same limits as Medicare after 65, not the previous limits they covered when younger. Which is bad, because the premium is the same higher rate as when working.
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Old 10-17-2017, 10:55 AM   #12
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Naturally, I second guess my decision all the time. I believe about 70% of Fed retirees go with Part B - do they see something I don't?
My wife is on Part A and B, with secondary coverage under my FEHB plan with GEHA-HDHP/Self Plus 1. I'm not yet eligible for Medicare so I continue funding my family HSA. We decided to enroll my wife in Part A and B even though we're paying higher Part B premiums -- we decided this because in the unlikely event my wife and I get divorced after 41 years of marriage, she would not be covered under FEHB. I'm still debating whether to enroll in Medicare Parts A and B next year when I become eligible as it would render me ineligible for HDHP/HSA plans, but with my current HDHP enrollment and wife's Medicare Part B enrollment some of the financial sting with overlapping FEHB/Medicare coverage is abated because Medicare Part B essentially covers stuff (after the deductible) GEHA-HDHP plan doesn't cover (before the much higher deductible). If I do enroll in Medicare next year, I'll probably take Aetna Direct or BCBS Basic, Plus 1.

My MIL and BIL had FEHB and Medicare with crazy medical bills last few years and it probably worked out better for them to rely on dual coverage than just FEHB plans (even though there is stop-gap catastrophic coverage limits). The ease in which coverage and payments occur when double covered is not insignificant and brings a lot of peace of mind -- I know this as I had to manage MIL's and BIL's medical and financial care last 18 months.


One other thing, if you retire and later obtain SS disability benefits (which happened with my BIL) then you get automatically enrolled in Medicare A and B after 2 years of receiving SS disability payments even if you're under 65. My BIL, a FERS retiree, was Federal Law Enforcement, retired in 2010, two years later, he was formally diagnosed with MS and soon afterwards became eligible for SS disability payments -- he's been on Medicare Part A and B, since 2014 and he's several years short of 65.
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Old 10-17-2017, 11:09 AM   #13
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I am a Fed retiree and have medicare A & B. For many years I had GEHA and because I had B there were no co-pays of any type. Kaiser NW has a FEHB Medicare Advantage option where they rebate, for all practical purposes, your part B deduction. Information about that option was buried deep in their booklet. You need to go into their member services office to fill out the paperwork to exercise that option. So few Fed Kaiser retirees noticed that provision I found only one member services rep (likely a manager) who knew about it so bring in the booklet and do that before the first of the year.

In my service area Kaiser also has a dental program which isn't available through FEHB dental offerings. Kaiser has their own dental clinics in my area but I think we are the only region where that is true. Otherwise it is the typical dental insurance offering. I love my Kaiser dentist (figuratively).
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Old 10-17-2017, 11:59 AM   #14
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We decided to enroll my wife in Part A and B even though we're paying higher Part B premiums -- we decided this because in the unlikely event my wife and I get divorced after 41 years of marriage, she would not be covered under FEHB.
41 years. I thik your wife would be able to continue FEHB and get a portion of your annuity under the spouse equity provision:

"To be eligible, you must have been covered as a family member under your spouse's FEHB Program enrollment at least one day during the 18 months prior to divorce and you must have future entitlement to receive a portion of your spouse's retirement annuity or a survivor annuity. Also, if you remarry prior to age 55 you will lose this coverage."
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Old 10-17-2017, 12:17 PM   #15
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41 years. I thik your wife would be able to continue FEHB and get a portion of your annuity under the spouse equity provision:

"To be eligible, you must have been covered as a family member under your spouse's FEHB Program enrollment at least one day during the 18 months prior to divorce and you must have future entitlement to receive a portion of your spouse's retirement annuity or a survivor annuity. Also, if you remarry prior to age 55 you will lose this coverage."
Thanks for pointing that out. My wife has a survivor's benefit with my annuity. But a former spouse would pay the full freight for FEHB coverage, which could be more expensive than Part B (and a Medicare Advantage or Medicare Supplement Plan). As OPM states:

"Former spouse enrollees must pay the full premium for the plan they select (that is, both the employee and Government shares of the premium)."
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Old 10-17-2017, 02:08 PM   #16
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Previously BCBS had a very informative brochure "2016 Medicare & Blue" with a footnote that implied that BCBS would cover the limiting charge. If your physician does not accept Medicare assignment, they may charge 15% more than the Medicare allowance. This is called the limiting charge. Under Basic Option, the physician must also be a preferred network provider.

From the BCBS FEHB brochure Section 9 about page 147 on the OPM website:

"If you are covered by Medicare Part B and it is primary, your out-of-pocket costs for services that both Medicare Part B and we cover depend on whether your physician accepts Medicare assignment for the claim.
• If your physician accepts Medicare assignment, then you pay nothing for covered charges (see note below for Basic Option).
• If your physician does not accept Medicare assignment, then you pay the difference between the “limiting charge” or the physician’s charge (whichever is less) and our payment combined with Medicare’s payment (see note below for Basic Option).

Note: Under Basic Option, you must see Preferred providers in order to receive benefits. See page 20 for the exceptions to this requirement.

It is important to know that a physician who does not accept Medicare assignment may not bill you for more than 115% of the amount Medicare bases its payment on, called the “limiting charge.” The Medicare Summary Notice (MSN) form that you receive from Medicare will have more information about the limiting charge. If your physician tries to collect more than allowed by law, ask the physician to reduce the charges. If the physician does not, report the physician to the Medicare carrier that sent you the MSN form. Call us if you need further assistance."

I'm not exactly sure how to interpret the above, it seems to be saying that BCBS will not pay the limiting charge but is not that clear. This topic is of interest to me because I am three years away from Medicare and read stories of doctors who will not accept new Medicare patients, especially in the west coast states where the Medicare allowances do not cover the cost of the healthcare. Assume this situation will worsen as the bulk of the baby boomers reach age 65.
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Old 10-17-2017, 02:20 PM   #17
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Note for reference plan F in Medigap does cover the 15% up charge allowed. (I think plan G does also)
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Old 10-17-2017, 05:13 PM   #18
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Oh my head hurts from this!!

Having a doctor who accepts Medicare assignments, that's pretty straight forward. We pay for Part B (around $1600 a year) in turn have no copayments anymore.

It's our situation where our doctors don't accept Medicare assignments that's bewildering.

I looked at a recent EOB. Submitted Charge $300, Plan Allowance $29, FEHB paid $25, we paid $4.

So what I think happens now is that under Medicare B as primary/FEHB as secondary, and doctor is Non-Par Status, the submitted charge gets tacked on an additional 15% or $45 that Medicare or FEHB won't pay. So for having Medicare coverage I now have a $45 "co-payment", along with a Part B $134 a month premium payment, and continuing FEHB premiums. So either pay $4 copay for current plan or $45 copay plus $134 x 12 annual Part B premium.

Am I totally lost or is the system totally lost??
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Old 10-17-2017, 05:43 PM   #19
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I’m a bit lost too. I was always vaguely satisfied with my health coverage. Not thrilled but OK with the deductibles and copays. My impression was that as long as I stay in network participating physicians will have to accept what the plan authorizes and this has seemed to obtain so far. I don’t inquire whether they accept Medicare I just ask if they are in the GEHA network. I assumed that would still be the case if I was on Part B but some of the comments here have my head spinning about that and whether it will even work for me without B. Whatever, time will tell I guess.
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Old 10-17-2017, 06:35 PM   #20
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I am very interested in this also. I have BC/BS Standard Self + 1. My DH has Medicare Part A and Part B. I will go on Medicare 3/1/18 and plan on having Parts A and B. I would like to change from BC/BS Standard to something less expensive. I doubt that I will do it this year, since I will not have medicare for Jan and Feb. It just seems to me that our FEHB should decrease a small amount, since Medicare is now primary and they do not have to pay as much.
My friend, whose DH is on Medicare and has Part A, B and D, can't believe how much we will be paying out for FEHB plus Medicare for both of us. She tells me that between Medicare and his Medigap, it pays for most of his cost. They do get in the Medicare donut hole, because of his prescriptions. Her DH and I are both on Xarelto, which is very expensive. She asks me why we don't drop FEHB and just have Medicare and a Medicap plan, which would be cheaper. I told her that I do not ever plan to drop my FEHB and don't know anyone who has, but could not give her a good reason. I would like to get our costs down though.
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