New(er) FEHB Medicare Advantage Plans

[zl55lz]

Anyone have any comments about the Federal Employee Health Benefits (FEHB) Medicare Advantage plan options? They seem to be adding more of these so maybe they are the direction of the future in FEHB? Aetna Adv, NALC, MHBP, and SAMBA now have these in my state.

 

[donheff]

Not a clue. With my pension and DW's pension and SS, when DW's RMDs kick in two years from now IRMAA would burn us badly so no Part B for us. I figure if FEHB was good enough for 30+ years, it will be good enough for a few more.

 

[zl55lz]

Not a clue. With my pension and DW's pension and SS, when DW's RMDs kick in two years from now IRMAA would burn us badly so no Part B for us. I figure if FEHB was good enough for 30+ years, it will be good enough for a few more.

If I may ask, which FEHB plan are you currently using without Part B and why did you choose it? I have looked at NALC High if I ever drop Part B. It has great Skilled Nursing Facility coverage but especially appealing is the very low Catastrophic max and Rx out of pocket max. BCBS Basic seems good too although no extra SNF days at this point.

 

[zl55lz]

I thought I should elaborate a little on my original post. These newer FEHB Medicare Advantage Plans are actual Part C plans, but one remains enrolled in the "regular" FEHB plan and then opts also into the Advantage offering. They so far (in my location) range in premiums from about $275 to over $500 for self+one, the same regular plan premium, there is no additional premium, and the Rx coverage is through Part D. However, these plans appear to be "revved up" compared to Advantage plans for the general public: they don't have the Rx donut hole, have seemingly good Rx copays/coinsurance, have zero out of pocket for almost everything and some other perks, and one can opt out and back to the regular plan. Not sure why they have such widely varying premiums for what appears to be relatively same coverages, although I did see some, in my opinion, small differences. Of course, choosing the option requires being on Medicare A&B.

 

[Golden sunsets]

Have you looked at Aetna Direct in the FEHB list of options? The premium for 2023 is 351.67/mo for Self +1. Then you get back $1800 in an HRA which reduces your Part B premium. No copays, except for meds, which are generally $2 for a 90 day prescription. No donut hole. We've never paid a cent to a provider, other than the Mets copays. There is a catch though. Your providers have to accept Medicare. For us this has never been a problem

 

[donheff]

If I may ask, which FEHB plan are you currently using without Part B and why did you choose it? I have looked at NALC High if I ever drop Part B. It has great Skilled Nursing Facility coverage but especially appealing is the very low Catastrophic max and Rx out of pocket max. BCBS Basic seems good too although no extra SNF days at this point.

I switched from BCBS to GEHA standard about 30 years ago and have stayed with it. The benefits are similar to BCBS and the network is essentially the same in DC where I live. The cost is significantly lower. Before I retired I attended a lecture by the editor of the Consumer Checkbook who wrote the annual guide to FEHB plans. He pointed out that most Feds are better off skipping Part B and when I ran the numbers I agreed. The higher your taxable income the more compelling that choice becomes. The downside is that if you change your mind, the penalty to pick B up later is high. About 2/3 of retirees take B so you are in good company.

 

[zl55lz]

Have you looked at Aetna Direct in the FEHB list of options? The premium for 2023 is 351.67/mo for Self +1. Then you get back $1800 in an HRA which reduces your Part B premium. No copays, except for meds, which are generally $2 for a 90 day prescription. No donut hole. We've never paid a cent to a provider, other than the Mets copays. There is a catch though. Your providers have to accept Medicare. For us this has never been a problem

I have been on Aetna Direct this past year, have found it excellent, and especially like the way the medical fund works with automatic deduction for Rx copays/coinsurance. My spouse is a heavy healthcare user for various serious issues with probably 10 Rx per month yet we paid zero out of pocket this year. Zero, for anything, including Rx.

I was just wondering what others are seeing regarding these newer Advantage plans.

If you don't mind me asking, have you been on Aetna Direct for awhile and what has been your long term experience with hospitals and other major services?

 

[Golden sunsets]

I have been on Aetna Direct this past year, have found it excellent, and especially like the way the medical fund works with automatic deduction for Rx copays/coinsurance. My spouse is a heavy healthcare user for various serious issues with probably 10 Rx per month yet we paid zero out of pocket this year. Zero, for anything, including Rx.

I was just wondering what others are seeing regarding these newer Advantage plans.

If you don't mind me asking, have you been on Aetna Direct for awhile and what has been your long term experience with hospitals and other major services?

We switched in 2018. I think 2017 was the first year that Aetna Direct was offered and is designed specifically for Federal Annuitants, although you can still sign up even if you have not yet retired. I called Aetna at one point trying to understand the difference between Aetna Direct and the Aetna Advantage plan and was told by the Aetna Advisor, that I was better off cost wise in the Direct Plan, which I had surmised. I didn't understand why anyone would choose the Advantage Plan over Direct. Maybe if your providers don't accept Medicare, which is necessary in order to avoid extra costs, than the Advantage Plan might be better, but as I recall the HRA either doesn't exist for the Advantage Plan, or is a considerably lower reimbursement.

We have never incurred a cost for anything since joining Direct. The copays on the meds, $2 each for 90 day scripts or $8/year is covered by the HRA with the remainder, a large sum, effectively reducing our Medicare Costs. We do pay IRMAA, but I am reluctant to drop Part B, to avoid costs, so we just ante up. Direct would not be nearly as cost effective, if we did not have Plan B.

 

[zl55lz]

I switched from BCBS to GEHA standard about 30 years ago and have stayed with it. The benefits are similar to BCBS and the network is essentially the same in DC where I live. The cost is significantly lower. Before I retired I attended a lecture by the editor of the Consumer Checkbook who wrote the annual guide to FEHB plans. He pointed out that most Feds are better off skipping Part B and when I ran the numbers I agreed. The higher your taxable income the more compelling that choice becomes. The downside is that if you change your mind, the penalty to pick B up later is high. About 2/3 of retirees take B so you are in good company.

Now that GEHA Standard offers 50 days of SNF days it is much more appealing. I've heard many good things about it. However, for my wife's Rx needs it doesn't work well, although I have heard GEHA might work well with Part D for just that reason. It would be interesting to know if anyone ever has used the FEHB+Part D combo.

 

[zl55lz]

We switched in 2018. I think 2017 was the first year that Aetna Direct was offered and is designed specifically for Federal Annuitants, although you can still sign up even if you have not yet retired. I called Aetna at one point trying to understand the difference between Aetna Direct and the Aetna Advantage plan and was told by the Aetna Advisor, that I was better off cost wise in the Direct Plan, which I had surmised. I didn't understand why anyone would choose the Advantage Plan over Direct. Maybe if your providers don't accept Medicare, which is necessary in order to avoid extra costs, than the Advantage Plan might be better, but as I recall the HRA either doesn't exist for the Advantage Plan, or is a considerably lower reimbursement.

We have never incurred a cost for anything since joining Direct. The copays on the meds, $2 each for 90 day scripts or $8/year is covered by the HRA with the remainder, a large sum, effectively reducing our Medicare Costs. We do pay IRMAA, but I am reluctant to drop Part B, to avoid costs, so we just ante up. Direct would not be nearly as cost effective, if we did not have Plan B.

Good info to know. The FEHB Aetna Medicare Advantage Plan option now offers a $2400 HRA per year and $275 premium for self+one. However, the Rx plan didn't seem to me as good as Direct. In addition, in my area none of our doctors or our hospital are in-network. Supposedly this doesn't matter if the provider accepts Medicare and is willing to treat, but this sounds too risky for me. How would I ever know in a sudden situation who would? Not something I want to be concerned about. That, and the stories I read about Medicare Advantage plans denying/delaying care make me wonder. Perhaps these FEHB versions are different.

 

[teej1985]

Now that GEHA Standard offers 50 days of SNF days it is much more appealing. I've heard many good things about it. However, for my wife's Rx needs it doesn't work well, although I have heard GEHA might work well with Part D for just that reason. It would be interesting to know if anyone ever has used the FEHB+Part D combo.

GEHA increased SNF days to 50? That's surprising. Did they do this in their other plans also?

 

[Brat]

I have used Kaiser's FEHB version of Medicare Advantage and find it works well. One option is to have Kaiser reimburse my Medicare B premium. Before that I had GEHA, my primary issue is that although it offers a choice of provider that choice alone gets more stressful as I age. Kaiser is not for the timid and it works well if the client uses their online tools. There is no heaven on earth....

My husband opted out of FEHB to the plain vanilla Kaiser Medicare Advantage. He liked the option of signing up for their Dental/optical/hearing aid program which isn't available through FEHB - he is significantly hard of hearing so the $1,000 every three years for hearing aids has significant value to him.

 

[zl55lz]

GEHA increased SNF days to 50? That's surprising. Did they do this in their other plans also?

The 2023 brochures state that FEHB GEHA High, Standard, HDHP, and Elevate Plus plans get the 50 days if the criteria are met, but Elevate does not. That is my understanding.

 

[zl55lz]

I have used Kaiser's FEHB version of Medicare Advantage and find it works well. One option is to have Kaiser reimburse my Medicare B premium. Before that I had GEHA, my primary issue is that although it offers a choice of provider that choice alone gets more stressful as I age. Kaiser is not for the timid and it works well if the client uses their online tools. There is no heaven on earth....

My husband opted out of FEHB to the plain vanilla Kaiser Medicare Advantage. He liked the option of signing up for their Dental/optical/hearing aid program which isn't available through FEHB - he is significantly hard of hearing so the $1,000 every three years for hearing aids has significant value to him.

From what I have heard, it seems Kaiser solves one of the supposed issues with Medicare Advantage plans--since one must use Kaiser, apparently all of their providers are in-network. From what I have read, one of the problems with some other Medicare Advantage plans is that some of one's providers may be in-network, some not, and it has been said more doctors are not taking Advantage plans at all for whatever reason. So being part of Kaiser and having some assurance that whoever one sees is in-network would seem to be helpful.

 

[Irishgirlyc58]

I’m not on Medicare yet but researching as I will be September 2023.
My former local government employer offers a UHC Medicare Advantage plan.
My understanding is that employer group MA are much different than MA you can get in the wild. Most of the negatives you hear about MA are those bought on your own.
The one I’m being offered has no co- pays (except prescriptions)zero out of pocket for in and out of network.
Provider just needs to accept Medicare and the plan. I don’t see that as being any different than what I have now.
Also no donut hole for prescriptions. Prescription’s have an additional coverage listing, no tier 5-they only go up to 4.
Of course they cover some services not covered by original Medicare.

I’m still doing my research and have a few questions to ask them but I’m leaning towards taking this plan.

I had Kaiser for years through my employer but I don’t live in a Kaiser covered area so I had to give it up. I would totally go for a Kaiser MA plan if I could. It beats the heck out of this ridiculous game these insurance providers play.

 

[zl55lz]

I’m not on Medicare yet but researching as I will be September 2023.
My former local government employer offers a UHC Medicare Advantage plan.
My understanding is that employer group MA are much different than MA you can get in the wild. Most of the negatives you hear about MA are those bought on your own.
The one I’m being offered has no co- pays (except prescriptions)zero out of pocket for in and out of network.
Provider just needs to accept Medicare and the plan. I don’t see that as being any different than what I have now.
Also no donut hole for prescriptions. Prescription’s have an additional coverage listing, no tier 5-they only go up to 4.
Of course they cover some services not covered by original Medicare.

I’m still doing my research and have a few questions to ask them but I’m leaning towards taking this plan.

I had Kaiser for years through my employer but I don’t live in a Kaiser covered area so I had to give it up. I would totally go for a Kaiser MA plan if I could. It beats the heck out of this ridiculous game these insurance providers play.

My in-laws had a UHC Medicare Advantage plan through his County retirement. They were elderly and used hospital, ambulances, Skilled Nursing Facilities etc., many times in their last few years. I handled their bills and never saw anything more than $20 doctor copays, $50 for hospital stays, $50 for ambulances, and $20 for 90 day prescriptions, although I'm guessing they offer many plans with differences.

 

[Tadpole]

My husband and I were on GEHA High since 1986. When we went on Medicare we stayed with GEHA High. We haven't paid anything for doctor or hospital care but pay the regular copays for drugs under the GEHA plan.

Someone mentioned IRMAA. My husband died recently which means I am RMDing the sum of our deferred accounts. A quick calculation makes it look as though I might be paying a very, very high Medicare B premium, even with the GEHA reimbursement program ($1000 toward Medicare B per year). My GEHA premium for self only High in 2023 is $230/month in 2023. I'm not sure how to calculate the modified adjusted gross income but if both my VA DIC and untaxed SS are added back in, I think I might be paying over $400/mo for Medicare B. Do the new plans get around IRMAA rules?

If someone could explain to me something to me, I would be grateful. I will be filing singly next year. What becomes the basis of my Medicare B premium in 2023 if no tax return is available filing singly? Do they still do the one or two years look-back when I filed jointly? They won't have my first single filer tax return in time for making the determination the first year. So, next year, what determines my Medicare B premium?

 

[zl55lz]

My husband and I were on GEHA High since 1986. When we went on Medicare we stayed with GEHA High. We haven't paid anything for doctor or hospital care but pay the regular copays for drugs under the GEHA plan.

Someone mentioned IRMAA. My husband died recently which means I am RMDing the sum of our deferred accounts. A quick calculation makes it look as though I might be paying a very, very high Medicare B premium, even with the GEHA reimbursement program ($1000 toward Medicare B per year). My GEHA premium for self only High in 2023 is $230/month in 2023. I'm not sure how to calculate the modified adjusted gross income but if both my VA DIC and untaxed SS are added back in, I think I might be paying over $400/mo for Medicare B. Do the new plans get around IRMAA rules?

If someone could explain to me something to me, I would be grateful. I will be filing singly next year. What becomes the basis of my Medicare B premium in 2023 if no tax return is available filing singly? Do they still do the one or two years look-back when I filed jointly? They won't have my first single filer tax return in time for making the determination the first year. So, next year, what determines my Medicare B premium?

I am sorry to hear about your recent loss.

I can't answer your tax question about IRMAA but there are probably some on the group who can.

However, regarding your question about these newer Advantage plans and IRMAA, everything I have seen has mentioned that if IRMAA applies to one, it also applies even if on one of these plans, and maybe to the Part D also? These FEHB Medicare Advantage plans put one technically on a Part C and Part D plan as far as I understand, although they are FEHB plans. The OPM site has links to each plan and how they work, by going to the regular FEHB plan site and then there will be a section for the Advantage Plan option, which oddly is sometimes administered by a different insurance company than the regular plan!

 

[Irishgirlyc58]

My in-laws had a UHC Medicare Advantage plan through his County retirement. They were elderly and used hospital, ambulances, Skilled Nursing Facilities etc., many times in their last few years. I handled their bills and never saw anything more than $20 doctor copays, $50 for hospital stays, $50 for ambulances, and $20 for 90 day prescriptions, although I'm guessing they offer many plans with differences.

This is good to know!
The plan my county offers has zero co-pays for everything except prescriptions which are tier 1 $10 for 1 month $20 for 3, tier 2- 20/40, tier 3&4 $35/70.

I see you are in California- did your in-laws work for a county in California?

 

[zl55lz]

This is good to know!
The plan my county offers has zero co-pays for everything except prescriptions which are tier 1 $10 for 1 month $20 for 3, tier 2- 20/40, tier 3&4 $35/70.

I see you are in California- did your in-laws work for a county in California?

Yes, he worked in CA. I seem to remember that they were restricted to a certain area for providers and I was surprised at how high their premium was; they could have found a much lower priced MA or Medigap plan (initially) but they were happy with the plan and it was their choice.

 

[zl55lz]

Anyone have any comments about the Federal Employee Health Benefits (FEHB) Medicare Advantage plan options? They seem to be adding more of these so maybe they are the direction of the future in FEHB? Aetna Adv, NALC, MHBP, and SAMBA now have these in my state.

I came across one of the FEHB Medicare Advantage plans under nationwide SAMBA. Any FEHB Annuitant can enroll. There is a place to click on the OPM SAMBA site to go to the Advantage option.

It is through UHC and is interesting because I saw that it is offering, besides the $900/yr for an individual and $1800/yr self+one Medicare Reimbursement for the Standard Option ($1200/$2400 for the High Option), it offers some unusual Rx perks such as $0 copays for several major insulin brands, $0 for some asthma meds, some breast cancer meds, some statins, etc.

I have never seen such meds offered at $0 before, except for statins. There are others too. Insulins are usually not on the cheaper side.

Could be a substantial savings per month and the Standard version premium is very nice in my opinion.

 

[Golden sunsets]

Good info to know. The FEHB Aetna Medicare Advantage Plan option now offers a $2400 HRA per year and $275 premium for self+one. However, the Rx plan didn't seem to me as good as Direct. In addition, in my area none of our doctors or our hospital are in-network. Supposedly this doesn't matter if the provider accepts Medicare and is willing to treat, but this sounds too risky for me. How would I ever know in a sudden situation who would? Not something I want to be concerned about. That, and the stories I read about Medicare Advantage plans denying/delaying care make me wonder. Perhaps these FEHB versions are different.

Oh the increase in HRA to $2400 is a big change from what I had recalled. Regarding the Rx, could you comment on the major components on meds reimbursement under the advantage plan? The combination of the higher HRA reimbursement ($600) and lower premium ($275 vs $358) could offset a higher meds cost as long as there is no doughnut hole. Also do you know if all copays and deductibles are waived in the Advantage plan?

 

[zl55lz]

Oh the increase in HRA to $2400 is a big change from what I had recalled. Regarding the Rx, could you comment on the major components on meds reimbursement under the advantage plan? The combination of the higher HRA reimbursement ($600) and lower premium ($275 vs $358) could offset a higher meds cost as long as there is no doughnut hole. Also do you know if all copays and deductibles are waived in the Advantage plan?

If I am reading the info on OPM correctly at the site, it states there is no deductible, zero catastrophic limit, and zero coinsurance. No Rx donut hole.

As for the Rx:
(30 day) preferred generic $2, generic $10, preferred brand $40, non-preferred brand $75, Specialty 25% $350 max.

(90 day) by mail or through local CVS-- preferred generic $4, generic $20, preferred brand $80, non-preferred brand $150.

The Rx formulary is on the site and tells which tier so one can tell the cost for each med.

The biggest reason I have not pursued the plan is because while it states it covers in or out of network providers, our providers are not shown on the site as in-network, and there is a statement that it covers out of network providers if they accept Medicare and the provider is willing to treat. My spouse sees too many providers to always be wondering about this if something happens. I'm hoping they eventually add my area providers in their in-network list. I would be more comfortable with that. My opinion is to go into the site and plug in the appropriate area and providers for anyone interested in the plan. Also, I really like the Aetna Direct medical fund which has Rx copays/coinsurance automatically deducted, so I have zero out of pocket each month. Easy and simple.

 

[Golden sunsets]

If I am reading the info on OPM correctly at the site, it states there is no deductible, zero catastrophic limit, and zero coinsurance. No Rx donut hole.



As for the Rx:

(30 day) preferred generic $2, generic $10, preferred brand $40, non-preferred brand $75, Specialty 25% $350 max.



(90 day) by mail or through local CVS-- preferred generic $4, generic $20, preferred brand $80, non-preferred brand $150.



The Rx formulary is on the site and tells which tier so one can tell the cost for each med.



The biggest reason I have not pursued the plan is because while it states it covers in or out of network providers, our providers are not shown on the site as in-network, and there is a statement that it covers out of network providers if they accept Medicare and the provider is willing to treat. My spouse sees too many providers to always be wondering about this if something happens. I'm hoping they eventually add my area providers in their in-network list. I would be more comfortable with that. My opinion is to go into the site and plug in the appropriate area and providers for anyone interested in the plan. Also, I really like the Aetna Direct medical fund which has Rx copays/coinsurance automatically deducted, so I have zero out of pocket each month. Easy and simple.

I'll have to check this out. Thanks zl55lz.

Sent from my SM-T510 using Early Retirement Forum mobile app

 

[Golden sunsets]

Good info to know. The FEHB Aetna Medicare Advantage Plan option now offers a $2400 HRA per year and $275 premium for self+one. However, the Rx plan didn't seem to me as good as Direct. In addition, in my area none of our doctors or our hospital are in-network. Supposedly this doesn't matter if the provider accepts Medicare and is willing to treat, but this sounds too risky for me. How would I ever know in a sudden situation who would? Not something I want to be concerned about. That, and the stories I read about Medicare Advantage plans denying/delaying care make me wonder. Perhaps these FEHB versions are different.

Zl55lZ; I just checked the OPM website and used the comparison tool and the Aetna Advantage plan has no HRA; zero. The APWU plan has a $2400 HRA. Were you confusing the two? So my conclusion when comparing Aetna Direct and Aetna Advantage continues to be that Direct is lower overall cost. I realize you are looking at other plans. I would compare those you are interested in, to Aetna Direct, N63 and see what makes most sense. And again your providers must accept Medicare for Direct to make sense.